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Nursing Homes

Nursing homes are facility-based care that provides various services including personal care and medical services.

They vary in cost, appearance and services offered. Some nursing homes are state-funded and others are privately operated.

Increasingly, nursing homes are also providing skilled nursing care and therapy services for short-term care following a hospitalization or injury.

Many nursing homes also have memory care facilities for individuals with Alzheimer’s and other Dementia. Although these units generally house the elderly, memory care facilities are open to individuals of all ages.

Short-term care is offered for patients who recently underwent surgery, are recovering from illness, injury, or need rehabilitation services before they can return home.

Long-term care is offered for those with chronic illnesses, terminal conditions or cognitive disorders.

Rooms in nursing homes are normally shared.

Nursing Home Services

Residents in nursing homes generally require 24-hour monitoring.

All nursing homes provide assistance with Activities of Daily Living (ADLs), also known as personal care.

Nursing homes are staffed with certified nursing aids and medical care providers.

Nursing homes and skilled nursing centers are not the same. Nursing homes generally provide more basic personal care services, while skilled nursing centers offer more extensive rehabilitation and specialized medical services.

Many nursing homes offer additional services such as restorative care, pain management, and palliative care.

Other general services include:

Medication Management: Medication errors are a leading cause for senior admission to the emergency room.

Life Enrichment: Isolation and loneliness put older adults at greater risk of health problems, such as depression, diabetes and high blood pressure. Nursing homes offer a variety of life enrichment activities designed to meet residents’ physical, emotional and spiritual needs.

Secure Environment: Nursing homes are designed to house elders with handrails, grab bars, emergency call systems, etc.

Meals: Nursing home residents are provided with three meals daily.

Many nursing homes may offer more specialized services including:

Physical Therapy: For residents who underwent surgery or are recovering from a physical ailment.

Respiratory Therapy: For residents with pneumonia, asthma, lung trauma, emphysema, and other lung diagnoses.

Speech Therapy: Speech therapists in nursing homes concentrate on articulation. However, speech therapists can shift their focus to swallowing if the resident requires those specialized services.

Rehabilitation: Rehabilitation services for residents who need short-term recovery services.

Dietitians: To create personalized meal plans aimed to minimize any nutritional complications a resident may have.

Dental Services: By Federal law residents in all nursing homes should have access to emergency and standard dental care.

Laboratory Services: Some nursing homes have in-house lab services to conduct blood and other tests.

Nursing Home Costs

Nursing homes in Greater Boston average about $10,380 a month and range between $7,050 and $13,200 per month.

Annually, the costs are $84,600 to $158,400 with the mean cost of around $126,290 in Greater Boston, which is higher than the national mean average of $77,380 a year.

Nursing Homes Versus Skilled Nursing Care Center

In a skilled nursing care center, around-the-clock care is provided by licensed and trained nursing professionals. Residents generally have higher care needs and more complex medical conditions than in nursing homes.

Licensed nurses are onsite 24-hours and a doctor is on call at all times.

The definition of a nursing home versus a skilled nursing care center is getting blurred as many nursing homes are adding specialized medical services.

Nursing Homes Versus In-Home Care

An AARP study found that 90% seniors wish to stay at home and Age In Place versus being moved into another senior care option.

With in-home care, there are no shared rooms with roommates or the divided attention of nursing home staff.

The in-home caregiver focuses on only one person, your loved one.

By remaining at home there is none of the confusion, stress, and anxiety your loved one feels when relocated to the new settings of a nursing home.

Live-in home care costs are comparable to the cost of nursing homes at around $384 a day for the care needs of one person or $504 per day for two people to receive care in the same home.

24 Hour in-home care is about $576 a day for the care needs of one person or $624 a day for two people to receive care in the same home.

In-home care is very flexible and hours of care and services can be add or reduced as needed. The flexibility of in-home care reduces costs as you only pay for the care and services needed.

With in-home care your loved one also has less exposure to infection:

The Centers for Disease Control (CDC), states that over 4 million Americans are admitted to or reside in nursing homes and skilled nursing facilities each year and nearly 1 million persons reside in assisted living facilities. Data on infections in long-term care facilities (LTCFs) is limited, but it is estimated that 1 to 3 million serious infections occur every year in these facilities.

These infections include urinary tract infections, diarrheal diseases, antibiotic-resistant staph infections and many others.

Infections are a major cause of hospitalization and death with as many as 380,000 people dying of these infections in LTCFs every year.

Over 50% of family members are now more likely to choose in-home care for their loved ones than they were prior to the COVID-19 pandemic, according to a recent survey by Transcend Strategy Group.

Nursing Homes Versus Assisted Living

Assisted living communities do not provide 24-hour supervision, and medical care, or the more extensive specialized medical care that nursing homes with skilled nurse center services do.

They provide some assistance with the Activities of Daily Living (ADLs) such as bathing, grooming, etc.

Similar to nursing homes, assisted living communities offer planned activities, laundry and housekeeping services, meals, transportation, exercise, and wellness programs.

Nursing homes and assisted living communities differ in appearance. Nursing homes generally look institutional and hospital like because of the type of care provided and assisted living usually resembles an apartment community.

Nursing Home Versus Residential Care

Residential care homes cater to individuals who live in a residential facility.

They usually offer more personalized services than assisted living communities.

Similar to assisted living communities, residential care homes focus on helping residents with personal care rather than medical care or rehabilitation services.

Choosing A Nursing Home

Start is asking your doctor for recommendations.

Checked the nursing home’s star ratings on Medicare.gov.

Once you have a list of nursing homes of interest, consider what is most important to you or your loved one:

• Physical Therapy

• Nursing Care

• Meals

• Religious Connection

• Special Care Units for Dementia Patients

• Hospice Care

Identifying your most important needs will help you narrow your list.

Call each nursing home and asks questions about the number of residents, cost, waitlists, etc.

Plan a visit to each facility and meet with the director and nursing director.

Look for indicators of quality of care such as handicap access, Medicare and Medicaid certification, warm interaction between staff and residents, and residents who look well-cared for.

Questions To Ask During Your Nursing Home Visit

General Questions:

• Is the nursing home Medicare and Medicaid certified?

• Has their license ever been revoked?

• Is the nursing home currently accepting new patients and is a bed available?

• What is the patient to staff ratio?

• Does the nursing home offer skilled nursing and specialized services, such as a special care unit for a resident with dementia or ventilator care?

• Are there resident policies that must be followed and will you get a written copy of these policies?

• Are transportation services available?

• Are there extra charges for other services such as beauty shop services?

• Will you get in writing their services, charges, and fees before the move in?

• Is the nursing home located close enough for friends and family to visit?

• Are there quiet areas where residents can visit with friends and family?

• Is there a person on staff assigned for social service needs and can you meet with them?

Safety Questions and Observations:

• What safety and security measures does the facility have?

• Does the nursing home do background checks to make sure they do not hire staff with a finding or history of abuse, neglect or mistreatment of residents in the state nurse aid registry?

• Does the nursing home have policies and procedures on prohibiting and reporting abuse and neglect?

• Is the nursing home taking action to keep residents safe from abuse, neglect, mistreatment, or exploitation?

• Does the staff knock before entering rooms?

• Are the doors shut while staff members help with dressing and bathing residents?

• Is there information about how to report concerns about the care and the safety of residents?

• Is there information about how the facility responds to concerns that are reported?

• Has the nursing home been cited for issues related to abuse in the past year or two?

• Is there a backup generator or alternate source of power in the event of a blackout?

• Is the facility well-lit and are the exits clearly marked?

• Does the nursing home have smoke detectors and sprinklers?

• Are there handrails and grab bars in the bathrooms and hallways?

• Are all common areas, resident rooms, and doorways designed for wheelchairs?

• Does the floor plan make sense?

• Can residents still see their personal doctors? If needed, does the facility help arrange transportation for this purpose?

• Does the nursing home have an arrangement with a nearby hospital?

• Does the nursing home’s inspection report show quality of care problems or other citations? (The nursing home should have the report of the most recent state or federal survey of the facility available for you to look at. These reports tell you how well the nursing home meets Federal health and safety regulations. Reports can also be found on most State Survey Agency websites and Medicare.gov.)

• Has the nursing home corrected all citations on the last State Inspection Report?

Quality of Care Questions and Observations:

• Does the nursing home have an arrangement with a nearby hospital?

• Are care plan meetings held with residents and family members at times that are convenient
and flexible whenever possible?

• Is the nursing home free from overwhelming unpleasant odors?

• Does the nursing home appear clean and well kept?

• Is the temperature in the nursing home comfortable for residents?

• Are the noise levels in the dining room and other common areas comfortable?

• Is the furniture sturdy, yet comfortable and attractive?

• Do the residents look clean, well-groomed, and appropriately dressed for the season and time of day? Are their nails cut and the men shaved?

• Does the relationship between staff and residents appear to be warm, polite, and respectful?

• Does the staff refer to residents by name?

• Do residents seem to participate in group activities?

• Do the residents get the same caregivers daily?

Quality of Life Observations:

• Do residents have a choice of food items at each meal? Do they serve foods you like?

• Can the nursing home provide for special dietary needs, such as low-salt or no-sugar-added diets?

• Are nutritious snacks available?

• Does the staff help residents eat and drink at mealtimes if needed?

• Does the facility meet your cultural, religious and language needs?

• Does the nursing home have outdoor areas for resident use?

• Is staff available to help residents go outside?

• Do residents have daily routine choices?

• Can residents, including those who are unable to leave their rooms, choose to take part in any activities?

• Do residents help plan or choose the activities that are available to them?

• Are personal items allowed?

• Does each resident have storage space such as a closet and drawers in their room?

• Are there policies and procedures to protect residents’ possessions, including lockable cabinets and closets?

• Is there a window in the bedroom?

• Do residents have access to the internet, a computer, a personal phone, and television?

• Do residents have a choice of roommates?

• Does the staff look nice and happy? Do they smile or look miserable like they do not want to be there?

Attend a Resident or Family Group Meeting

While visiting a nursing home ask if you can attend a resident or family group meeting.

These groups are usually organized and managed by the residents or their families to address concerns and improve the quality of care and life for the residents.

If you are able to attend a meeting, ask a group member these questions:

• What improvements were made to the quality of life for residents in the past year?

• What are the plans for future improvements?

• How has the nursing home responded to recommendations for improvements?

• Who does the group report to?

• How does membership in the group work?

• Who sets the agendas for group meetings?

• How are group decisions made, for example, by voting, consensus, or does one person make them?

Visit a second time

It is good to visit the nursing home a second time on a different day of the week, and at a different time than your first visit. As staffing can be very different at another time of the day or on weekends.

About Unique HomeCare Services

Our headquarters in Norwood, Massachusetts serves the Greater Boston communities in Suffolk, Middlesex, Norfolk, Bristol and Plymouth counties.

We provide private in-home care for elders, those with Alzheimer’s or Dementia, and people who are recuperating from illness, injury, or surgery.

We provide both short-term and long-term in-home care needs from as little as one 4 hour day a week to 24 Hour Care and Live-In Care.

We offer a full range of in-home personal care services including Bathing Assistance, Personal Hygiene and Grooming, Dressing Assistance, Toileting and Incontinence Assistance, Feeding Assistance, and Medication Reminders.

We also provide support services such as Case Management, Accompaniment to Appointments, Nutrition and Meal Management, Light Housekeeping and Laundry Services, Bed and Wheel Chair Transfers, and Shopping and Running Errands.

It is our pleasure to assist our veteran clients with VA Aid and Attendance Benefit approval at no cost.

To schedule a no cost and no obligation In-Home Assessment to determine the home care needs and get a quote, please call us to speak to a Case Manager at (800) 296-9962 or fill out our Free Quote Contact Form.