What is the difference between an Assisted Living Facility and a Skilled Nursing Facility ("Nursing Home")?
Assisted living provides a bridge between independent living and nursing home care. It enables a person (or a couple) to maintain a unit/apartment within the facility while receiving help with dressing and other activities of daily living. The facility provides meals, transportation to medical appointments, etc. For instance, an 86 year old widow may sell her house and move into an assisted living facility to receive help with daily dressing, bathing, bathroom needs, housekeeping, meals, etc. The facility provides transportation to doctor’s appointments and also provides activities, but does not provide on site medical care (or if it does, only limited). There is 24 hour security. In Pennsylvania, Assisted Living facilities require private pay and do not accept medical insurance.
Conversely, nursing homes provide medical and/or custodial care (meaning, a person can not maintain themselves in independent living). Each person’s needs for care or assistance are different. Some individuals may have a short-term need, perhaps caused by a fall and a broken hip, which necessitates a brief hospitalization followed by rehabilitation. After a one- or two-month Nursing Home stay, the senior may be able to return home and continue receiving some services such as physical therapy from a home health care agency, if necessary.
Other people have more long-term needs, possibly due to Alzheimer's, extreme frailty, or a stroke. In this case, care is necessary on an ongoing basis.
A Skilled Nursing Facility is for an individual who meets one or more of the following criteria:
- Cannot take care of themselves because of physical, emotional, or mental problems;
- Can no longer care for their own personal needs, such as eating, bathing, using the toilet, moving around, or taking medications (custodial care);
- Requires more care than can be provided by their caregiver, and cannot live alone;
- Might wander away if unsupervised;
- Has extensive medical needs requiring daily attention or monitoring by an RN supervised by an MD;
- Is going to be discharged from the hospital and requires temporary Skilled Nursing care or rehabilitation before returning home or to a residential facility;
- Has been recommended for a Nursing Home by a physician.
Most medical insurance coverage follows Medicare guidelines. Private insurance and Medicare pay for nursing home care only for limited time periods following a hospitalization:
- You must have been hospitalized for at least 3 days.
- You must enter the nursing home within 30 days of the hospitalization.
- Only the first 20 days are 100% covered; then there is a daily deductible. The deductible is generally covered by co-insurance (such as Medicare Part B).
- There’s a 100-day maximum related to any one hospitalization and diagnosis.
- You must be making regular progress as documented by medical professionals. If progress toward independence is no longer occurring, insurance coverage ends.
If the person will need to remain in a nursing home (“SNF”), then they may have to private pay. This is where Medicaid Planning enters the picture. After Medicare runs out, either the patient pays privately (depending on the amount of resources) or the person must “spend down” in order to qualify for Medical Assistance (call “MA” or “Medicaid”).
This is where a knowledgeable elder lawyer can assist!
DISCLAIMER: This information is not intended as legal advice and should not be construed as such.Contact Us
Law Offices of Rise P. Newman, LLC
1515 Market Street
Suite 1520
Philadelphia, PA 19102
Tel: (215) 670-0055
Fax: (215) 557-0322
Rise P. Newman, Esq. E-Mail: rise@risenewmanlaw.com
Lisa A. Holland, Esq. E-Mail: lisa@risenewmanlaw.com
