Assisted Living Vs. Long-Term Nursing

Ask any number of adult children of elderly parents if they know the difference between assisted living and a skilled nursing facility and you will likely receive a variety of answers, many of which are only somewhat accurate. Except for those who have recently gone through the process of placing a loved one in either facility, many people have misconceptions about what each has to offer.

Skilled nursing facilities — also known as SNFs, nursing homes or rehabilitation centers — usually provide both short- and long-term care. The short-term option is for those who will usually stay for only a few weeks following illness, injury or surgery with the goal of returning home. The long-term option is for those who may have medically complex situations, which can’t be handled at home or be accommodated by an assisted living facility in order for the patient to become a permanent resident. Although some SNFs may offer a group dining experience and activities for those able to participate, it is usually considered to be a more clinical-type setting.

Assisted living facilities provide a home-like environment. Support with all activities of daily living is provided as well as more robust options for socialization, activities and entertainment for those who are able and wish to participate. Most assisted living facilities offer the opportunity for onsite visits by certain health care providers. Transportation to appointments is also usually available.

Many families I work with are surprised when I assure them that their loved one is a potential candidate for assisted living rather than SNF. Having limited mobility, being bed bound or receiving end-of-life care does not rule out the option of assisted living if a more home-like option is preferred.

Short-term SNF stays are usually covered under Medicare or private health insurance. For these stays to be covered, certain criteria must be met, primarily a three-night stay in the hospital as an admitted patient. Some situations can cause confusion as certain patients have been in the hospital for three nights under observation, but they aren’t considered on admitted status.

Long-term SNF stays, as well as assisted living, are privately paid, although both have the potential to be covered by Medicaid if the resident qualifies. These Medicaid-covered opportunities are few and far between. Most every SNF has at least a few beds designated for Medicaid, but availability can be limited. The only assisted living facilities that usually take Medicaid are small homes that house five to eight residents, also with limited availability.

Unfortunately, many families I speak with are surprised to learn that Medicare does not cover assisted living or long-term SNFs at all. Long-term care insurance and Veterans Affairs benefits, for those eligible, may cover the cost to some extent. Investing in long-term care insurance early is one of the suggestions I have for those interested in planning ahead for the future. Veterans and spouses should start the process of investigating what benefits they are eligible for before they are needed. Frequently, the process to determine those benefits and implement them can take quite a while.

Having open and honest conversations with family members, or those who have been designated as power of attorney, are highly recommended well before the need to move to assisted living or skilled nursing facilities are even on the horizon. Documentation using such forms as the Maryland Order for Life Sustaining Treatment are important in ensuring that a loved one's wishes are followed in dire medical situations. Planning with the understanding of what the options are and how they are paid for is critical to have a realistic expectation of what the future may hold.