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Skilled Nursing Home Care: Everything You Need To Know

When your senior loved one is dealing with a health condition which requires proper medical support, in-home care, or assisted living communities may not suffice. In this case, you can consider moving them to a fully-staffed and monitored skilled nursing facility. 

As providers of long-term medical care, nursing home care provides the required level of medical support to residents, while improving their health and quality of life.

However, there are many homes to choose from, especially in metropolitan areas. Thus, finding the best one for your elderly parent or grandparent can be challenging. It is recommended that you learn as much as possible about the nursing home care before deciding on a skilled nursing home for your senior.  

Important factors in finding the right nursing home care are the location of the nursing home, cost, type of care they specialize in, services and amenities provide, and much more. It is recommended that you include an in-depth site visit when selecting a nursing home for a family member. Choose a nursing home that best fits your budget and needs of seniors.

What is Skilled Nursing Home Care?

Skilled nursing homes are also known as skilled nursing facilities or convalescent homes. These serve seniors with severe or debilitating physical or mental disease and require preventive, therapeutic, and/or rehabilitative nursing home care. These elderly persons are unable to care for themselves.

Nursing homes provide residential care to seniors who don’t require hospitalization. Instead, they require 24-hour care that cannot be provided at home. Some nursing homes are designed like hospitals with trained nurses and medical professionals. Residents may also receive help with activities of daily life such as bathing, dressing, walking, eating, etc. 

Difference between A Nursing Home and Assisted Living

Most people often feel confused about whether they should send their aging parent to an assisted living or a nursing home. 

If the senior cannot live independently at home and doesn’t need full-time medical care, but seeks help with activities of daily life, you may consider assisted living. Assisted living facilities provide custodial care for seniors who need limited daily living assistance, such as cooking and housekeeping and little medical care.

These facilities provide a high-level of enjoyment, independence, and privacy to residents. Some assisted living communities also provide added medical assistance as needed. 

If your senior loved one is suffering from a health condition, which requires full-time medical support, assisted living is not for them. In this case, you are encouraged to choose nursing homes that provide high levels of medical care, which assisted living facilities don’t provide.

Living arrangements for assisted living and nursing homes are quite different. Assisted senior housing facilitates a private or semi-private apartment with personal bathroom and kitchen. Some of these communities offer added freedom, such as pet ownership, tobacco use, overnight guests, etc.   

Assisted living communities are often cheaper than nursing homes, but most don’t accept Medicaid or Medicare.

Home Health Care vs. Nursing Homes

Home health care is for those who want to age in place. Home health care is different from home care that is non-medical assistance. On the other hand, home health care includes medical and non-medical assistance. Both are facilitated at the client’s own home as per their needs and schedule. But don’t confuse home health care with hospice care, which is considered end-of-life care to those expected to live about six months or less. 

Home care workers are called caregivers. They are professionally trained to provide a safe environment and companionship to clients. On the other hand, home health care workers provide the same services, plus medical support. These caregivers are often registered nurses, which makes it much pricier than non-medical home care and nursing homes. 

Demographics in the US and Canada

On any given day, more than 15,000 nursing homes in the U.S. care for approximately 1.4 million people, and most of them are elderly. One of every ten individuals age 85+ is a nursing-home resident. About one-third of senior Americans spend time in a nursing home in their final months of life.[1]

Almost half of all people who live in nursing homes are 85 years or older. Relatively few residents are younger than 65 years of age. Most are women (82%), many of whom do not have a spouse (almost 70% are widowed, divorced, or were never married). Many also have only a small group of family members and friends for support.[2]

More than 50% of these residents suffer from the inability to control bowel or bladder, and over one-third have difficulty with seeing or hearing.[3]

In addition to physical illness, dementia is one of the primary reasons for nursing home admission globally.[4] Dementia affects around 50-70% of residents. More than three-fourths of these have problems making decisions, while two-thirds have memory issues. Almost one-third (30.2 percent) of nursing home residents exhibit at least one form of behavioral issue— verbally or physically abusive, socially inappropriate behavior, wandering, or resistance to care.[5]

Skilled Nursing Home Care Types

The level of care provided in nursing homes can be divided into two categories: short-term care and long-term care.

Short-term nursing home care

Short-term nursing home care is provided to patients after surgery or an acute injury or illness. They stay temporarily while recovering from convalesce or an injury after hospitalization. They move back to their own house, after recuperating and meeting their health goals. Seniors rarely need a short-term nursing facility.

Long-term residential care

Long-term nursing home care is designed for elders dealing with chronic or terminal diseases, or cognitive disorders, such as dementia. Residents typically stay for the rest of their lives and need constant intensive care.

Skilled nursing home care is often synonymously used for long-term residential care. For these residents, a nursing facility is their home. That’s why most nursing homes provide a homelike comfortable environment and facilities to residents.

Services Offered in Skilled Nursing Home Care Facilities

The basic services offered in nursing homes are:

  • Comfortable private, or semi-private, rooms
  • Daily cooked meals
  • Laundry and housekeeping service
  • Speech therapy, pain/medication management, and hospice care
  • Physical therapy programs
  • Social programs and activities
  • 24-hour personal and medical assistance

Most of these facilities have medical equipment, such as oxygen machines, pharmacies, and electronic beds, to cater to their patients' needs. Some facilities provide Alzheimer's care, with special facilities and layouts ideal for dementia patients.

Live your retirement can provide you with a list of services offered at nursing homes. We can also provide a list of attractions and other facilities near their listings like hospitals, malls, and parks.

Skilled Nursing Home Care Costs

The cost of nursing home care depends on a number of factors, such as location, how long you plan to stay, type of special service you need, etc.  Many facilities have all inclusive rates, while some charge extra for additional services, including physical therapy,  speech therapy, memory care, etc. Medicare or insurance may pay some nursing home expenses, although how much is covered varies depending on the care needs and insurance plans.

Use the following tool to figure out skilled nursing home care cost details by state and region. The tool displays average costs for different types of senior nursing home.

Type of care Average Cost in Region
Skilled Nursing Facilities Private Room Annual Rate: $91,279.20
Skilled Nursing Facilities Semi-Private Room Annual: $77,573.45
Assisted Living Facility Monthly Rate (2 bedroom): $5,699.17
Assisted Living Facility Monthly Rate (1 bedroom): $5,048.10
Assisted Living Facility Monthly Rate (Studio): $4,361.03
Registered Nurse Per Visit Rate: $134.31
Licensed Practical Nurse Per Visit Rate: $121.60
Home Health Aide Hourly Rate: $22.63

In 2018, a private room in nursing homes cost an average of $8,370 per month, or over $100,000 yearly. A semi-private room may cost around $7,440 per month, or $89,290 annually. The average nursing home stay is 850 days, or over two years.[6]

In the USA, the daily of nursing home averages around $240 per day for a shared room. The difference in the cost between different states is significant. For instance, in Alaska, the most expensive state, the daily cost of nursing home is about $800. In Oklahoma, the least expensive cost is about $150 per day.[7]

The average cost of nursing home care by room type:

Room Type Daily Monthly Annually
Private $270 $8,360 $100,350
Semi-private $240 $7,400 $89,290

The cost of nursing home care by state:

State Semi-private Private
Alaska $27,570 $29,290
Connecticut $12,620 $13,730
Hawaii $12,170 $13,660
Massachusetts $12,020 $12,780
New York $11,760 $12,190
North Dakota $11,030 $11,690
New Jersey $10,650 $11,860
Delaware $10,490 $10,950
New Hampshire $10,340 $11,100
West Virginia $10,280 $11,070
Pennsylvania $9,600 $10,110
Vermont $9,480 $9,900
Maine $9,430 $10,100
Oregon $9,280 $9,980
Maryland $9,230 $9,670
District of Columbia $9,130 $9,730
Minnesota $9,130 $10,190
Rhode Island $8,820 $9,730
Washington $8,670 $9,720
Michigan $8,560 $9,130
California $8,370 $9,820
Wisconsin $8,330 $9,350
Nevada $8,230 $9,260
Florida $8,150 $9,060
Colorado $7,890 $9,000
Idaho $7,570 $8,050
Virginia $7,450 $8,520
New Mexico $7,290 $7,620
Wyoming $7,180 $7,540
Ohio $7,120 $7,910
Montana $7,000 $7,300
North Carolina $6,950 $7,710
Nebraska $6,900 $7,270
Indiana $6,860 $8,240
Kentucky $6,840 $7,600
Mississippi $6,700 $7,090
South Dakota $6,600 $7,070
Arizona $6,500 $8,000
South Carolina $6,400 $7,210
Tennessee $6,390 $6,840
Georgia $6,340 $6,770
Alabama $6,280 $6,660
Iowa $6,080 $6,480
Utah $6,080 $7,600
Illinois $5,900 $6,750
Kansas $5,400 $5,870
Arkansas $5,350 $5,990
Louisiana $5,230 $5,540
Missouri $5,000 $5,540
Texas $4,800 $6,540
Oklahoma $4,640 $5,290

The monthly costs of a nursing care home in Canada on average are:

Room Type Monthly Average Cost
Basic 1 675$
Semi-private 2 275$
Private 1 085$

The cost of government-run nursing home in Canada ranges between $25K-40K annually.[8] The cost significantly varies according to the location of the facility you are considering. For instance, in Prince Edward Island, the cost of living in a nursing home is around $700 or more per month.[9]

In Manitoba, the minimum rate of nursing home care is 38$ per day, and the maximum rate is around 90$ per day.

Choosing a Skilled Nursing Home Care

Location

If you are looking for a nursing home facility for your loved one, you may visit him or her frequently. It is recommended to consider driving after a long day at work. If the nursing home is far from your location, you may choose the one that is closer to another trusted family member or friend.

Size

The size of the nursing home is also important. Are the elderly introvert or outgoing? Would s/he feel comfortable in a place with lots of other people?

Are there arrangements for walking around? Are outdoor places easily accessible and safe?

Does the facility have quiet areas and activity spaces so that residents spend their time the way they want?

Services

Though the majority of nursing home care provides long-term care, services, and level of care often vary among facilities. Thus, it is recommended that you find out one that provides services needed by your elderly.

While some services are quintessential for the residents, others are optional for improving their quality of life. For example, the dining experience makes a huge difference in overall quality of life and satisfaction of nursing home residents. You may always visit the home during mealtime before making the final decision. A visit will give you the opportunity to check if the residents can choose their preferred meal options.

Many other activities help improve the seniors’ quality of life. The best nursing care homes provide residents the flexibility to plan and select these activities as per their interest.

It is important that special health care services are also available for different patient needs. For example, if the individual needing care has dementia, it is recommended to choose a place with a specialized unit to care for dementia patients. If they need rehabilitation, it would be helpful to have a rehabilitation unit on-site.

Nursing homes often provide special health care services as per the resident’s need. For instance, someone with dementia can choose a specialized unit in the facility. If they require rehabilitation, it would be helpful for them to choose a nursing home care rehabilitation unit on-site.

Staffing

The staff members of nursing home care are responsible for ensuring your loved one’s safety and happiness. Thus, their attitude, professionalism, and expertise are important. You may ask plenty of questions and spend some time observing the staff.

It is recommended to look for staff who possesses skilled nursing and personal care but also is warm, polite, and respectful with other staff members and residents.

Independence

While it is true that elderly moving to a nursing home care cannot do many things at their own, they can still independently handle some aspects of their lives independently.

It includes choices like desserts they want to eat, activities they want to participate in, their sleeping hours, etc. A good nursing home provides independence under supervision with personal choices to individuals.

Questions to Ask A Nursing Home Care Facility

Asking questions to staff and other residents at the nursing home helps you determine if the facility is the right fit for your loved one. 

It is important that you take time, ask many questions, and try to bring a trusted family member or friend with you during a visit. 

Care type, services, and payment

  • Is the nursing home Medicare or Medicaid certified?
  • What kind of care does the home provide, and how much does it cost?
  • Do they have a special unit for short-term rehabilitation, memory care, and/or ventilator care?
  • What are their billing process and payment options?
  • Has the facility been cited for any abuse or neglect? If yes, ask the administrators about it.
  • How will the resident and family members be informed in case a different care level is needed?
  • Are there physicians or do residents keep their own doctors?
  • How are prescriptions filled and refilled?
  • Do residents get to choose their own schedule?
  • What types of meals are served? Does the kitchen accommodate dietary meals? If needed, does the staff help individuals eat?
  • Does the nursing home arrange transportation?
  • What activities are available?
  • What is their visiting policy?
  • What are the admission and discharge policies?

Facility layout and ambiance

  • Is the facility well-maintained and clean? Does it appear pleasant, warm, and attractive to you?
  • What are the noise levels?
  • What is the layout of the various floors? Is it easy to get from your room to a common area?
  • Are there handrails in rooms, hallways, bathrooms, and other areas?
  • Is the furnishing comfortable?
  • How do the residents appear? Are they well-dressed and groomed?
  • How many residents live in one room?
  • Is there locked and/or unlocked storage space available?
  • Do the residents have access to a television and telephone and television?
  • Are there secure outdoor areas?
  • Does your senior like the demographics?

Staff

  • Is the staff trained and certified?
  • Is the staff available on a 24-hour-basis?
  • How many registered nurses are there on each shift?
  • How the staff interacts with the residents? Are they friendly, respectful, and kind?
  • How does the staff enter a resident’s room? 

Other questions

  • Does the facility has a bed available now, or is there a waitlist?
  • Is the nursing home considering any future improvements?
  • Is the location convenient for visits from family and friends?
  • Are there arrangements for weather-related or electrical emergencies?
  • What is their procedure to handle the event when the state or local government declares a mandatory evacuation?
  • Does the nursing home provide cultural or religious programs?

Nursing Home Care Facilities by State or Province

The Most Affordable Cities For Nursing Home Care

Rank City State Cost
1 Wilmington NC $3,692
2 Tucson AZ $3,774
3 Tampa FL $3,812
4 Mesa AZ $3,856
5 Orlando FL $4,132
6 Baltimore MD $3,950
7 Fayetteville NC $4,045

References:

  1. U.S. News Information. October 30, 2018. U.S. News Names Best Nursing Homes for 2018-19. usnews.com
  2. Ari Houser AARP Public Policy Institute. October 2007. Nursing Homes: Fact Sheet, aarp.org
  3. Felix W. Leung and John F. Schnelle. September 1, 2009. Urinary and Fecal Incontinence in Nursing Home Residents, ncbi.nlm.nih.gov
  4. Bredholt Jørgensen, Berit Marie Thorleifsson, Geir Selbæk. Jūratė Šaltytė Benth and Anne-Sofie Helvik. October 22, 2018. Physical diagnoses in nursing home residents - is dementia or severity of dementia of importance?, http://ncbi.nlm.nih.gov
  5. Nancy A. Krauss, and Barbara M. Altman. December 2004. Characteristics of Nursing Home Residents, 1996, meps.ahrq.gov
  6. David Levine, July 10, 2019. How to Pay for Nursing Home Costs, health.usnews.com
  7. Bill Fay, Assisted Living and Nursing Home Costs, debt.org
  8. HOOPP: Healthcare Of Ontario Pension Plan. February 2018. The Cost Of Long-Term Care: Canada’s Retirement Savings Blind Spot, hoopp.com
  9. January 28, 2019. Province hikes nursing home rates by $700 a month, cbc.ca