Benjamin Franklin said it best: “Nothing in life is certain except death and taxes,” but with daily advances in science, technology, and healthcare, Americans are living longer than ever *. However, this blessing has created a unique dilemma for modern American families: how to plan and prepare for the retirement years.
Have you been on a road trip lately? Almost every road is adorned with large billboards providing the locations of new planned communities where couples can spend their retirement years engaged in recreational activities. I doubt you’ll find a local newspaper that doesn’t have at least one ad promoting the amenities found at a local assisted living facility. Try searching the internet for “nursing homes in Virginia” and thousands of web pages will appear. New facilities are being built and sold every day offering different programs across the state.
Is this facility suitable for you and your family? If so, what installation? We often hear the terms “retirement community,” “nursing home,” and “assisted living facility,” but rarely do we consider what these terms really mean. However, the differences are striking and it is imperative to understand these differences when making decisions for yourself or your loved ones.
ELDERLY HOUSEHOLDS
In Virginia, a nursing home means any facility with the primary function of providing long-term nursing care, nursing services, and health-related services on an ongoing basis, for the treatment and hospital care of two or more unrelated persons. **. Simply put, a nursing home is a facility designed for someone who needs less care than a hospital, but requires daily medical assistance.
The Virginia Department of Health licenses such facilities and has established guidelines regulating various aspects of its operations, programs, and staffing needs, etc. ***. For example, a nursing home must: (a) have written policies and procedures regarding the treatment of residents and the management of resident care that are available to residents and their families (12VAC5-360-20); (b) provide emergency medical services within 15 minutes, under normal conditions (12VAC5-360-50); (c) be subject to unannounced on-site inspections of the nursing facility by state employees (12VAC5-371-60); (d) have a written agreement with one or more physicians authorized by the Virginia Board of Medicine to serve as medical director (12VAC5-371-230); and (e) each resident will be under the care of a physician licensed by the Virginia Board of Medicine (12VAC5-371-240).
Additionally, nursing home residents also have certain rights as defined by Virginia Code §32.1-138. See http://leg1.state.va.us/cgi-bin/legp504.exe?000+cod+32.1-138. Nursing homes are the most regulated and structured residential options for our seniors who require some level of daily medical care. If the facility provides care through the Medicare and Medicaid programs, it is considered a “certified nursing facility” (Code of Virginia §32.1-123; Code of Virginia §32.1-127) and must comply with federal and state laws .
Of course, the more rules and regulations that define and control the daily operations of a nursing home, the greater the responsibility of the staff. These are the people who will be in charge of the daily chore of caring for your loved one and making sure they comply with state and federal laws. No matter how pleasant or inviting the facility is, the staff will make the difference between caring for and encouraging your loved one, or not.
A nursing home is best suited for someone:
- Who requires daily medical attention, such as help getting into and out of bed; taking medications; or use the bathroom.
- Who may have dementia or Alzheimer’s and, as a result, cannot eat or bathe daily without reminder or help;
- That you are recovering from a fall or accident and therefore cannot walk, dress, or eat without assistance.
ASSISTED LIVING EASE
“Assisted living facility” means an adult care residence that has been licensed by the Virginia Department of Social Services to provide a level of service for adults who may have physical or mental impairments and require at least moderate assistance with activities of daily life. Within assisted living, there are two types: regular assisted living for those older people (typically) who need help with one or more daily activities; and intensive assisted living for someone who may be unable to perform activities due to a severe mental or physical impairment (12VAC30-120-450).
The Virginia Department of Social Services licenses assisted living facilities, but does not regulate how the Department of Health regulates nursing homes. While there are Virginia guidelines governing aspects of assisted living facilities, they are limited: An assisted living facility must: (a) provide or coordinate personal and medical care services; and (b) provide 24-hour supervision.
As reflected in the table below, assisted living facilities are not required to provide medical care and / or have health care personnel available to assist your loved one. In addition, without the obligation to provide such services, the question arises as to whether or not they have a duty to warn or treat residents with illnesses or diseases that could be transmitted from other residents.
While a nursing home will have many nurses on staff and doctors hired to monitor residents, assisted living is more analogous to an apartment building or college dorm where laundry and food services are provided and residents are alone on their own. rest of the day.
An assisted living facility is best suited for someone:
- Who is basically independent but is unable or unwilling to prepare their own food or drive to medical appointments;
- Someone who wants to reduce their activity and anticipates that they will need help with laundry, cooking, etc. in the near future.
- A couple in which one spouse is independent but may need help feeding or meeting the other spouse’s needs.
CONTINUING CARE RETIREMENT COMMUNITY
In Virginia, you may also see advertisements for a retirement community. They are popping up around our favorite college towns and tourist destinations.
A continuing care retirement community provides care based on your current needs. Like an insurance policy, the resident country pays an adjustable entry fee and periodic payments, which in turn provides the resident with a package of residential and healthcare services that the CCRC is required to provide at the time of that these residential and health care services are required. For example, if when you enter all you want is help with your meals, that is the only service that will be provided. If you need intensive physical therapy or, God forbid, daily assistance for a dementia patient, the CCRC has assisted living services or nursing home services available under your contract. Continuing care contracts are regulated by the Virginia Office of Insurance of the Virginia State Corporation Commission.
Many CCRCs may have nursing home services available on-site or at licensed off-site facilities (12VAC5-360-10). While you may enter the Retiree Community as a very healthy and capable independent resident, as your needs change, so will your contract with the Community and, in turn, the facility’s obligations to you.
A Community Continuing Care Retirement Center is best suited for someone:
- Those who are basically independent but anticipate the need for daily medical care for themselves or their spouse in the near future;
- Someone who has a physical disability and would not be able to care for themselves or their spouse if the disability worsened.
With at least three very different options, it is very important that you do your research:
To research assisted living facilities in Virginia, visit the Department of Social Services website: http://www.dss.state.va.us/facility/search/alf.cgi.
To research nursing homes, visit the Medicare website: http://www.medicare.gov
AND LAST BUT NOT LESS IMPORTANT
It is always best to speak with a family member of a current resident and spend time getting to know the staff, no matter what type of facility you are looking for. If searching and research isn’t enough, consider the chart below: A Comparison of the Legal Duties of a Nursing Home vs. the Legal Duties of an Assisted Living Facility in Virginia.
DUTY or REQUIREMENT
NURSING HOME
ASSISTED LIVING
Duty to provide nursing care or monitor the health of the resident?
YES
DO NOT
Is a doctor required to supervise the residents?
YES
DO NOT
Will each resident be under the care of a physician licensed by the Virginia Board of Medicine?
YES
DO NOT
Should you have nurses on staff?
YES
DO NOT
Should you offer rehabilitation services?
YES
DO NOT
Should you have ongoing consultation from a registered dietitian or dietitian on staff?
YES
DO NOT
Is 24 hour supervision required?
YES
YES
Should you develop a written plan upon admission of the resident?
YES
YES
Do staff have to undergo a criminal background check?
YES
YES
Overseen by Virginia Center for Quality Health Care Services and Consumer Protection
YES
DO NOT
Supervised by the Department of Social Services
DO NOT
YES
* Life expectancy has dramatically increased over the past century, from 47 years for Americans born in 1900 to 77 years for those born in 2001. These same factors – improving health care and prevention efforts – are partly responsible for the dramatic increases in life expectancy. it also produced a major shift in the leading causes of death in the United States in the last century, from infectious diseases and acute diseases to chronic diseases and degenerative diseases ”. The State of Aging and Health in America 2004, published by the Center for Disease Control, available at http://www.cdc.gov/aging/pdf/State_of_Aging_and_Health_in_America_2004.pdf.
** See generally, Virginia Code §32.1-123, as amended and Virginia Administrative Code § 12VAC5-360-10.
*** It is a felony under Virginia law to operate a nursing facility without a license. See generally 12VAC5-371-30.