When To Move From Assisted Living To A Nursing Home
Transitioning from an assisted living facility (ALF) to a skilled nursing facility (SNF)/ nursing home is a significant decision that many families face as their loved ones age and require higher levels of care. Recognizing the time to make this transition is crucial for ensuring quality of life with the appropriate care and assistance. This article delves into the signs indicating when it might be suitable to make this shift, the distinctions in levels of care, and the effects on both family members and older adults.
Understanding the Levels of Care
As individuals age their requirements for physical and functional support often evolve, i.e. levels of care change over time. Assisted living facilities offer a sense of community where older adults can maintain a great deal of independence while receiving support with activities like bathing, dressing and managing medications. However, more extensive care may become necessary due to increased safety needs and progressive medical conditions.
Assisted Living Communities
Assisted living facilities cater to older adults who require some assistance but don’t need the extensive medical care and support provided by nursing homes. They are residences with supplemental medical supports. Typically, older adults living in ALFs have a private apartment with an ensuite bathroom and small kitchenette. These settings provide services such as daily housekeeping, restaurant-like dining, and an extensive calendar of events to foster an environment that encourages independence and builds community.
Assisted living facilities are ideal for older adults with minimal care needs (such as medication management or meal preparation), who can benefit from the activities and social events offered, and have substantial financial resources to pay the monthly rate without the need for Medicaid assistance.
Skilled Nursing Facilities
A skilled nursing facility, commonly known as a nursing home, is a medical facility that delivers a higher level of medical attention, care coordination, and hands-on support than provided at assisted living communities.
Nursing homes are run by state licensed healthcare professionals. They provide round the clock care for individuals with chronic, progressive conditions (ex: Alzheimers Dementia, Parkinson’s Disease) and/or post-acute care needs (ex.recovering from surgeries or acute illnesses). An interdisciplinary medical team that includes physicians, APRNs, nurses (RN and LPN), social workers (LCSW/ MSW), dieticians (RD), and therapists (PT/OT/ SLP) manages the care needs of residents at a nursing home.
It’s important to understand the difference between these levels of care to choose the best living arrangement for your loved one. This article, and upcoming blogs, will help you to ask the right questions, read “between the lines,” and manage expectations if the time comes to move from one setting to the next.
Signs It’s Time to Move from Assisted Living
Determining the time to transition from assisted living to nursing home involves assessing your loved ones physical and mental well-being, safety and overall quality of life. Consulting with current caregivers, your loved one’s primary physician, and even a certified geriatric care manager are all good places to start.
Increasing Medical Needs
A sign that it may be time for a change in living arrangements is when an older adult’s medical requirements surpass what an assisted living facility can provide. Conditions such as advanced dementia or Parkinson’s disease, that cause an individual’s mobility to be severely impaired, will be better addressed in a nursing home environment that is appropriately staffed and properly managed.*
In such cases, specialized equipment and multiple caregivers are needed to provide hands-on assistance. Currently, most states do not require assisted living facilities to adhere to needs-based staffing ratios.
*An upcoming article will address the important question of how to find the best nursing homes in your area: what to look for and what to avoid.
Declining Ability to Perform ADLs
If an older adult finds it challenging to perform activities of daily living (ADLs) and requires more frequent and extensive assistance, it could be a good time to begin researching nursing home options in your area. ADLS include personal care & hygiene, eating, dressing, using the toilet and continence, and mobility.
(Example of a significant change in ADL status: An older adult was able to eat meals independently when certain foods were chopped in advance but now needs pureed meals due to swallowing difficulties and requires the assistance of a caregiver to be fed.)
Frequent Hospital Visits
A skilled nursing facility can manage many medical needs effectively onsite and reduce unnecessary hospital visits. If your loved one is living in an ALF and there has been an increase in visits to the hospital emergency room, then their medical conditions may require a higher level of clinical management and oversight. Nursing homes provide 24 hr/day care supervision by a registered nurse (RN) and specific medical interventions that help minimize the need for hospital visits.
Running Out of Money?
You may have been told that you should only move your loved one to a nursing home when they run out of money. This is poor advice.
Assisted living facilities only accept private funds as payment for room and board charges. In some instances, state funded “waiver” programs will pay for a portion of the care related charges. Nursing homes charge an all-inclusive rate and accept private funds, Medicaid & Medicare, and commercial insurances as payment. (Much more to come on how to pay for nursing home care in an upcoming blog!)
Waiting to run out of private funds while at an ALF does NOT mean that a subsequent stay in a nursing home will be paid for by other insurances. If your loved one’s care needs increase, and all evidence points to them needing a higher level of medical attention, then that’s the time to do your research, make visits to nursing homes, and reassess your loved one’s financial status.
Family Members’ Role in the Decision
Family members play an important role in deciding if and when it’s time to transition their loved one from an assisted living facility to a nursing home. This decision can be emotionally challenging, requiring thorough consideration of your loved ones quality of life and care needs, the quality and availability of nursing homes in your local area, and financial status.
Evaluating the Type of Care Needed
It’s essential for families to evaluate whether the current assisted living facility can meet their loved ones’ escalating needs. If the facility is unable to provide the required care, it may be necessary to explore nursing homes that offer higher staffing ratios and specialized, clinical services.
Ensuring Quality of Life
Proper medical management of chronic conditions improves a person’s quality of life but it’s not the only factor that impacts well-being. All transitions are challenging. In supporting your loved one’s need for a higher level of clinical care, give consideration to the new routines and personal connections made at the assisted living facility. If it is clear that the necessary care cannot be provided at the ALF, be sure to do thorough research on what the nursing home options are in your area so the next transition is the right one.
Balancing Care and Support
Caring for an aging family member involves a great deal of time and energy. Family members should truthfully evaluate their capacity to continue caring for their loved one either at home or at an assisted living facility. When these responsibilities become overwhelming, the right nursing home can provide the necessary assistance and peace of mind.
The Transition Process
Moving from an assisted living to a nursing home can be a smooth process with proper planning and communication.
Preparing for the Move
Begin by researching and visiting local nursing homes to get a sense of the atmosphere, staffing, and services provided. Seek out facilities with positive feedback, ample staffing ratios on all shifts, and a proven history of quality care.
Communicating with the Older Adult
It’s crucial to involve the older adult in the decision making process as much as possible. Have conversations about their preferences, concerns and expectations to ensure they feel valued and respected. Being transparent about why the move is necessary can help ease any worries.
Coordinating the Transition
Collaboration between the assisted living facility and nursing home is key to facilitate a smooth transition. The admissions coordinator and social worker at the nursing home will ensure that all required medical documentation and physician orders are in place before the move. Assisted living staff will prepare necessary paperwork and help pack up personal belongings. A well-coordinated transition plan is crucial for managing emotions and expectations.
Benefits of a Nursing Home
Nursing homes offer advantages that can enhance the quality of life for older adults requiring higher levels of care.
Comprehensive Healthcare Services
Nursing home residents have access to baseline services such as 24hr nursing care, in-house primary care physician visits, an onsite social worker, dining services, daily housekeeping and laundry services, and therapeutic recreation. If needed, residents also have access to onsite lab and radiology services, physical therapy, occupational and speech therapies, palliative care, and specialized treatments for chronic conditions.
Improved Safety Measures
Nursing homes provide an environment with round the clock nursing care and supervision for older adults facing cognitive or physical challenges. This helps reduce the likelihood of accidents and ensures medical assistance is readily available onsite.
Social & Recreational Activities
Nursing homes organize daily activities and social gatherings to keep residents engaged and enhance their well-being. From chair yoga to arts and crafts workshops these activities promote social interaction and mental stimulation.
In Conclusion
Transitioning from an assisted living facility to a nursing home is a significant decision that requires careful consideration of the older adult’s needs, the type of care required, and the impact on their quality of life. By understanding the levels of care and the signs that indicate a need for more intensive support, families can make informed decisions that ensure their loved ones receive the best possible care and support.
Frequently Asked Questions
Assisted living facilities are residences with amenities such as dining services, daily housekeeping, and recreational programs. Care assistance like medication administration, support with bathing and dressing are typically add-on services with additional charges. Nursing homes are medical facilities with several residential amenities. Typically, there are no add-on services charged to residents in addition to the daily room and board rate. As the older adult’s care needs evolve, the nursing home is regulated to meet those needs through higher staffing levels, care coordination, and clinical interventions.
Factors to consider include: increasing medical needs, declining ability to perform activities of daily living (ADLs) and frequent visits to the hospital. Seeking advice from healthcare providers and working with a certified geriatric care manager can be beneficial.
Family members can help by researching and visiting nursing homes, consulting with current healthcare providers, and discussing the potential relocation with the older adult in a manner that is supportive and well-informed.
YES- nursing homes are required to employ certified therapeutic recreation staff to organize and facilitate activities that keep residents engaged and enhance their quality of life.
It’s important to do your research. Often a “word of mouth” referral by a friend, family member, or co-worker is more beneficial than online searches. Well managed nursing homes, with stable staff and a history of providing quality care, will be known in your community. Be sure to look beyond facility websites and advertisements to real-life testimonials of people who have received care at the nursing home or have had loved ones there.
*An upcoming article will focus entirely on this important question
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