Benjamin Franklin said it best: “nothing in life is certain except death and taxes,” but with daily advances in science, technology, and health care, 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 taken a road trip lately? Nearly every highway is adorned with large billboards providing the locations of new planned communities where couples can spend their retirement years engaged in recreational pursuits. 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 for “Virginia nursing homes” on the Internet and thousands of web pages will come up. New facilities offering different programs are being built and marketed every day throughout the state.
Is this facility right for you and your family? If so, what facility? We often hear the terms “retirement community,” “nursing home,” and “assisted living facility,” but rarely consider what these terms really mean. However, the differences are striking, and understanding these differences is imperative when making decisions for yourself or your loved ones.
NURSING HOMES
In Virginia, a nursing home means any facility whose primary function is to provide continuous long-term nursing care, nursing services, and health-related services for the treatment and inpatient care of two or more uninsured persons. related**. 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 governing various aspects of their operations, programs and staffing needs, etc.***. For example, a nursing home must: (a) have written policies and procedures on 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 licensed 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).
In addition, nursing home residents are also afforded 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 older adults 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” (Virginia Code §32.1-123; Virginia Code §32.1-127) and must comply with federal and state laws .
Of course, the more rules and regulations that define and control the day-to-day operations of a nursing home, the greater the responsibility of the staff. These are the people who will handle the day-to-day business of caring for your loved one and making sure they comply with state and federal laws. No matter how nice 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 care, such as assistance getting in and out of bed; taking medications; or using the restaurant.
- May have dementia or Alzheimer’s and, as a result, may not be able to eat or bathe daily without reminder or assistance;
- Who is recovering from a fall or accident and therefore unable to walk, dress or eat without assistance.
ASSISTED LIVING FACILITY
“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 to 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 severe physical or mental impairment (12VAC30-120-450).
The Virginia Department of Social Services licenses assisted living facilities, but does not regulate them in the same way that 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 health and personal care services; and (b) provide 24-hour supervision.
As reflected in the table below, assisted living facilities are not required to provide health care and/or have health care staff available to assist your loved one. Also, without an obligation to provide such services, there is the question of whether or not they have a duty to warn or treat residents with illnesses or diseases that may be transmitted from other residents.
While a nursing home will have many nurses on staff and doctors hired to monitor the residents, assisted living is more analogous to an apartment building or college dorm where laundry and food services are provided and the residents are alone for a while. the rest of the day.
An assisted living facility is more suitable 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 scale down and anticipates needing 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 needs of the other spouse.
CONTINUING CARE RETIREMENT COMMUNITY
In Virginia, you may also see ads for a retirement community. They’re popping up in all of 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 pays an entrance fee and adjustable periodic payments, which in turn provides the resident with a package of residential and health care services that the CCRC is obligated to provide at the time these services are rendered available. residential and medical care are required. For example, if when you check in all you want is help with your meals, that is the only service that will be provided. If you need intensive physical therapy or heaven 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 Bureau 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 retirement community as a very healthy, independent, and capable resident, as your needs change, so will your contract with the community, and in turn, the facility’s obligations to you.
A continuing care community retirement center is best suited for someone:
- That you are basically independent but anticipate needing daily medical care for yourself or your 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 to investigate:
To search for assisted living facilities in Virginia, visit the Department of Social Services website: http://www.dss.state.va.us/facility/search/alf.cgi.
To search for nursing homes, visit the Medicare website: http://www.medicare.gov
AND LAST BUT NOT LEAST
It’s always best to talk to a family member of a current resident and spend time getting to know the staff, no matter what type of facility you’re looking for. If looking and researching isn’t enough, then consider the chart below: A Comparison of the Legal Duties of a Nursing Home to the Legal Duties of an Assisted Living Facility in Virginia.
DUTY or REQUIREMENT
NURSING HOME
ASSISTED LIVING
Duty to provide nursing care and/or monitor the health of residents?
YES
NO
Is a doctor required to supervise residents?
YES
NO
Will each resident be under the care of a physician licensed by the Virginia Board of Medicine?
YES
NO
Should you have nurses on staff?
YES
NO
Should you offer rehabilitation services?
YES
NO
Do you need to have ongoing consultation from a registered dietitian or an on-staff dietitian?
YES
NO
Is 24 hour supervision required?
YES
YES
Must you develop a written plan at the time of the resident’s admission?
YES
YES
Are staff required to undergo a criminal background check?
YES
YES
Overseen by Virginia Center for Quality Health Care Services and Consumer Protection
YES
NO
Overseen by the Department of Social Services
NO
YES
*Life expectancy increased dramatically over the past century, from 47 years for Americans born in 1900 to 77 years for those born in 2001. These same factors (improved health care and prevention efforts) that are partly responsible for the increases Dramatic changes in life expectancy have also produced a major shift in the leading causes of death in the United States in the past 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.
