Nursing Home & Senior Care Options

Ken Anderson

Ken Anderson

Greeter
Staff member
We are discussing some of these options in @Marie Mallory's thread (Hospice or Hospital), and should continue to do so, but since that speaks specifically to her situation, I thought we could probably use a more generic thread to discuss these and other options more generally.

Not all of these choices will be available to everyone, since they are quite expensive and not always covered by Medicare or Medicaid.

There is also a lot of overlap among these programs, and many of them are known by other names.

Nursing Homes

Nursing homes are facilities for the residential care of older adults, senior citizens, or people with disabilities.

Skilled Nursing Facilities

Skilled nursing facilities provide 24-hour medical care and supervision for individuals with complex health needs. Services typically include medical monitoring, medication administration, rehabilitation, personal care assistance, nutritional support, and social activities.

Long-Term Care Facilities

Long-term care facilities are primarily designed for older adults who can no longer live safely or comfortably in their own homes. Many people transition to these facilities when they require more assistance than family or friends can provide.

Assisted Living Facilities

Assisted living facilities are designed for seniors who need help with daily activities but do not require constant medical care. Residents usually live in private or semi-private apartments and receive support with meals, medication management, housekeeping, and personal care.

Memory Care Facilities

Memory care units specialize in caring for individuals with Alzheimer's disease or other dementias. These facilities provide structured environments, specialized staff training, and programs designed to enhance cognitive function and safety. Memory care can be part of a larger nursing home or as a standalone facility.

Continuing Care Facilities

CCRCs provide a continuum of care, allowing residents to transition from independent living to assisted living or skilled nursing as their needs change. They offer tiered services: independent living for active seniors, assisted living for those needing daily support, and skilled nursing for complex medical care.

Hospice Facilities

Hospice facilities provide specialized care for individuals with terminal illnesses, focusing on comfort and quality of life. Hospice services can be found in various settings, including private homes, nursing homes, assisted living facilities, and hospitals, while some facilities specialize in hospice care.

Independent Senior Apartments

For seniors who are largely independent but prefer a community setting, independent senior apartments offer housing with minimal support. Residents enjoy social activities and community events while maintaining autonomy, with optional access to services if needed.

Residential/Home-Based Services

Some seniors may benefit from residential care homes or home care services. Residential care homes, also called board-and-care homes, are typically small facilities that provide personal care, meals, and supervision without extensive medical services. Home care services allow seniors to remain in their own homes while receiving visits from nurses or caregivers for health monitoring and assistance with daily tasks.
 
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The last time I was home, an aunt and uncle, as well as two first cousins (brothers), were in the same nursing home. I won't name it because I am going to say both good and bad things about it.

My first impression was that it was kind of a run-down place because it's been there a long time and has that look. However, my aunt and uncle had their own room, although my uncle died a couple of days after I visited with him. The staff seemed caring and kind, and, best of all, it was close enough that relatives could easily visit them without going too far out of the way; in fact, most people probably passed by it regularly. I think if I were a resident of my hometown and found myself in need of nursing care, or a place to die, for that matter, that is what I would probably choose, rather than a more modern, fancier place that would be out of everyone's way that might otherwise want to visit.
 
One of my patients, when I was a paramedic in the Rio Grande Valley of Texas, went into what was the best nursing care facility in the area. Her insurance covered the costs, and she was happy there for a few years until it ran out. We were transferring her from this very nice facility to one of the worst ones around. The first one had taken all of her money and run her insurance up to the maximum coverage, and she was going to have to depend on whatever Medicaid could buy her for the rest of her life. She was devastated.
 
When my Hubby got out of the hospital after a 21 day stay, the doctor sent him to a nursing home for "Therapy". It was a nightmare. He left the hospital in late afternoon. They checked him in and sent him to a room. After a while, he needed to pee. We rung the bell. When somebody finally came, she said she couldn't bring him a pee cup or bedside stool because his papers were not ready. We finally managed to get him to the bathroom in his room.

Then the time came for his medicine. It was crucial that he got his medicine. They said the doctor had not written the order for his meds yet. I happened to have some of his meds from home, so I gave them to him. Hours later, nobody had even been in to even check on him. He begged me to not leave him there by himself all night. One of us stayed all night. They never did bring his meds.

The next morning, we told them he was leaving. The head manager begged us to let him stay. She was all apologetic and tried to placate me. I gave her a not very polite piece of my mind and we left.

That nursing home was closed just after that. My DIL knew somebody that knew somebody. It reopened later and they say it's a lot better now.

Hubby begged me to never let him be sent to another nursing home. I promised him that as long as I was able to look after him, he would not. I kept that promise as long as he lived.
 
My grandmother was in an ACLF for a while before she had to move to a nursing home.

That was an Adult Congregate Living Facility, a 4-bedroom home that had been converted into 4 double-occupancy rooms for 8 ladies.

They had a living room with couches and chairs and a TV. Meals were served to them in the dining room. They were mad for Bingo and card games and played every night. They also had a nice fenced-in (read "secure") patio.

There was a nurse and aide during the day for bathing, medicine, etc. and an aide at night.

The doctor came on visits, as did a lady who did nails and one to do hair.

It was a lot cheaper than a full-service facility and "homier".
 
I worked as a paramedic in the Rio Grande Valley, where there were some pretty horrible nursing homes and at least one very good one. In the bad ones, the RNs and the LVNs employed by the nursing home were nurses who had probably hoped for a more illustrious career, but were perhaps the bottom of the barrel. The nurses would congregate at the nurses' station, rarely interacting with patients, while the real work was done by people with very little training.

In my experience, the best way to ensure that your loved one receives adequate care is to be involved. Patients with family members checking in on them regularly received better care. True, it shouldn't be that way, but it is, or can be. Keep in mind, also, that not all nursing homes are equal, and not everyone employed by a nursing home is lazy, incompetent, or uncaring. Some of them can be relatively pleasant places, and, even in the bad facilities, there are probably some good employees. In any of them, your loved one will be treated better if you visit, ask questions, and get to know the staff.

Too often, the adult children will arrange for their parents to be cared for in a nursing home, visit a few times, and then go on with their lives. Not only do nursing home patients want to retain a connection with their loved ones on the outside, usually, but they will receive better care when people do visit.
 
My mother had dementia. She had long-term care insurance only because a friend mentioned getting such a policy some years earlier, so my mother bought one. It ended up being a fortuitous purchase.

She was in what was supposed to be one of the nicest assisted living facilities in northern Virginia (outside of DC.) One of my sisters worked for the government and had tons of leave, so she stayed with my mother for a period of time. My mother shared a room with another inmate. One day the orderly came in, walked up to my mother's roommate with a tray of pills, and said "Time for your medication, Mrs. Brunner." Had my sister not been there, the roommate would have taken my mother's meds...and one assumes my mother would have been given her roommate's meds. And this was a highly-rated facility.

Before she went into the assisted living facility she was in Fairfax Hospital for a little while (a well-respected facility.) Early on the doctors thought that her anti-depressant (Zypresa) may have been causing her issues, so they were weaning her off. Again, my sister was hanging out with our mother. A nurse came in with my mother's meds and my sister spotted an unfamiliar-looking pill. It was Zypresa, but rather than 0.5mg they were cutting her back to, it was a 5.0mg pill...10x the strength she was prescribed, and the med suspected of being the problem. And this was at northern Virginia's premier hospital.

So things happen at even the best of places, and without someone there all the time, there is no way of knowing if someone is declining or if there's other causes. A nice facade does not tell the entire story, although a dump is always a dump.

To finish the saga: Our mother would not stay put in that assisted living facility and sort of bonded with one of the workers (a woman from the Bahamas.) Our mother offered her enough money plus room & board to live at home with our mother as a dedicated caretaker. The Long Term Care insurance covered a large portion--if not all--of the cost, and the caretaker paid no rent. The caretaker lived there for 2 years until our mother passed. It was kind of an odd situation, because the caretaker did not drive and had no car. She was content to just "be there," getting weekly rides to the grocery store from our family. I guess she saved up a bunch of money, and went back to the Bahamas after our mother passed. It was the best solution we could have hoped for.
 
John Brunner said:
My mother had dementia. She had long-term care insurance only because a friend mentioned getting such a policy some years earlier, so my mother bought one. It ended up being a fortuitous purchase.

She was in what was supposed to be one of the nicest assisted living facilities in northern Virginia (outside of DC.) One of my sisters worked for the government and had tons of leave, so she stayed with my mother for a period of time. My mother shared a room with another inmate. One day the orderly came in, walked up to my mother's roommate with a tray of pills, and said "Time for your medication, Mrs. Brunner." Had my sister not been there, the roommate would have taken my mother's meds...and one assumes my mother would have been given her roommate's meds. And this was a highly-rated facility.

Before she went into the assisted living facility she was in Fairfax Hospital for a little while (a well-respected facility.) Early on the doctors thought that her anti-depressant (Zypresa) may have been causing her issues, so they were weaning her off. Again, my sister was hanging out with our mother. A nurse came in with my mother's meds and my sister spotted an unfamiliar-looking pill. It was Zypresa, but rather than 0.5mg they were cutting her back to, it was a 5.0mg pill...10x the strength she was prescribed, and the med suspected of being the problem. And this was at northern Virginia's premier hospital.

So things happen at even the best of places, and without someone there all the time, there is no way of knowing if someone is declining or if there's other causes. A nice facade does not tell the entire story, although a dump is always a dump.

To finish the saga: Our mother would not stay put in that assisted living facility and sort of bonded with one of the workers (a woman from the Bahamas.) Our mother offered her enough money plus room & board to live at home with our mother as a dedicated caretaker. The Long Term Care insurance covered a large portion--if not all--of the cost, and the caretaker paid no rent. The caretaker lived there for 2 years until our mother passed. It was kind of an odd situation, because the caretaker did not drive and had no car. She was content to just "be there," getting weekly rides to the grocery store from our family. I guess she saved up a bunch of money, and went back to the Bahamas after our mother passed. It was the best solution we could have hoped for.
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I saw a number of cases very similar when I was on the safety committee of acute care hospitals. It happens a lot. Nurses make a LOT of errors, in part due to poor training or lack thereof, and partly because so many demands are made on decreased numbers of employees. Pharmacies make very few errors, but I witnessed a serious one in a pediatric intensive care unit. The pharmacist had made an IV solution with 10x the amount of potassium in it that was intended and nearly killed a child. All healthcare facilities are dangerous places.
 
Don Alaska said:
I saw a number of cases very similar when I was on the safety committee of acute care hospitals. It happens a lot. Nurses make a LOT of errors, in part due to poor training or lack thereof, and partly because so many demands are made on decreased numbers of employees. Pharmacies make very few errors, but I witnessed a serious one in a pediatric intensive care unit. The pharmacist had made an IV solution with 10x the amount of potassium in it that was intended and nearly killed a child. All healthcare facilities are dangerous places.
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I was a little surprised that the Assisted Living/Memory Care facility did not have name tags for the residents, for lots of reasons but especially so staff could identify them without relying on an interaction with folks of diminished capacity.

And I agree regarding the risk of "doing more with less." I see the activity level behind the pharmacy counter at CVS, Walmart, etc and know that perfection is impossible. But given a choice between Quality/Safety and Price, most Americans will choose Price every time. We sort of bring it upon ourselves (the pressures of insurance and profits notwithstanding.)
 
I won't overdo it, but I'll add a couple of bad nursing home experiences I had as a paramedic.

We were sent to one nursing home for what was supposed to be a non-emergency transfer to a hospital for a procedure, I forget which, because that became irrelevant. When we arrived, a cluster of nurses was congregating at the nurses' station, as usual. They told us which room our patient was in. We found him dead, with no one in the room with him.

For another, we returned a patient from a hospital to a nursing home, transferring him to a bed there. As we walked past the nurses' station on the way out, I noticed a patient seated in a wheelchair directly next to it. Noticing something that seemed awry, I checked on him. He was dead.

Okay, I can't help it. One more. We were called to a nursing home to bring a patient to the hospital on a non-emergency trip. When we arrived, we performed our routine assessment of the patient before moving him onto our stretcher and found an infected saline lock, an IV line often used in hospitals when fluids or medications need to be administered. This should have been removed before he left the hospital on his last visit, which was more than a week earlier. Somehow, the hospital staff neglected to remove it; the transferring EMS crew either didn't see it or thought it was supposed to be there; and no one at the nursing home ever noticed or cared that it was still in place, where it became infected over time.

I don't mean to scare anyone off from nursing homes because some people have had good experiences with them. My aunt was in one of the better ones in the Rio Grande Valley, and I was impressed with the facilities and the staff. Every time I visited her, they knew her by name, and they knew just where she was.

At that point in her life, my aunt was having some memory difficulties, and she understandably had trouble placing me when I visited her in uniform, given that she had known me mostly as a child who lived across the road from me in the UP of Michigan, and we were now in the Rio Grande Valley of Texas. When I wasn't in uniform, she usually recognized. When she didn't, she was pretty good at hiding it. One day, I had been talking to her for about forty minutes when I could see the light come on in her face, and she said, "Kenny, is that you?"

She lived in that nursing home for a few years and was pleased with her experience there. Of course, she had two daughters, grandchildren, and me looking in on her often. I would visit when I was off-duty, and every time we transported a patient to or from that nursing home, while on duty, I'd look in on her.
 
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I can say with 100% degree of certainty that no Minnesota Somali assisted living center has ever lost a single patient. (sorry...sort of.)

This subject can be the stuff of nightmares. You hear stories of people in these places who are "not all there," and when they have to stop taking their meds in preparation for surgery, suddenly they "come back" as fully alert as they had been in the past. I guess a thread derail/parallel subject would be how the elderly can just get warehoused, for a lot of reasons (convenience, husband & wife both working, etc.)
 
Ken Anderson said:
We are discussing some of these options in @Marie Mallory's thread (Hospice or Hospital), and should continue to do so, but since that speaks specifically to her situation, I thought we could probably use a more generic thread to discuss these and other options more generally.

Not all of these choices will be available to everyone, since they are quite expensive and not always covered by Medicare or Medicaid.

There is also a lot of overlap among these programs, and many of them are known by other names.

Nursing Homes

Nursing homes are facilities for the residential care of older adults, senior citizens, or people with disabilities.

Skilled Nursing Facilities

Skilled nursing facilities provide 24-hour medical care and supervision for individuals with complex health needs. Services typically include medical monitoring, medication administration, rehabilitation, personal care assistance, nutritional support, and social activities.

Long-Term Care Facilities

Long-term care facilities are primarily designed for older adults who can no longer live safely or comfortably in their own homes. Many people transition to these facilities when they require more assistance than family or friends can provide.

Assisted Living Facilities

Assisted living facilities are designed for seniors who need help with daily activities but do not require constant medical care. Residents usually live in private or semi-private apartments and receive support with meals, medication management, housekeeping, and personal care.

Memory Care Facilities

Memory care units specialize in caring for individuals with Alzheimer's disease or other dementias. These facilities provide structured environments, specialized staff training, and programs designed to enhance cognitive function and safety. Memory care can be part of a larger nursing home or as a standalone facility.

Continuing Care Facilities

CCRCs provide a continuum of care, allowing residents to transition from independent living to assisted living or skilled nursing as their needs change. They offer tiered services: independent living for active seniors, assisted living for those needing daily support, and skilled nursing for complex medical care.

Hospice Facilities

Hospice facilities provide specialized care for individuals with terminal illnesses, focusing on comfort and quality of life. Hospice services can be found in various settings, including private homes, nursing homes, assisted living facilities, and hospitals, while some facilities specialize in hospice care.

Independent Senior Apartments

For seniors who are largely independent but prefer a community setting, independent senior apartments offer housing with minimal support. Residents enjoy social activities and community events while maintaining autonomy, with optional access to services if needed.

Residential/Home-Based Services

Some seniors may benefit from residential care homes or home care services. Residential care homes, also called board-and-care homes, are typically small facilities that provide personal care, meals, and supervision without extensive medical services. Home care services allow seniors to remain in their own homes while receiving visits from nurses or caregivers for health monitoring and assistance with daily tasks.
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Ken this is a very helpful thread, not just for me but for all of us who sooner or later will be makin these type of moves and dicisions.
 
Marie Mallory said:
Ken this is a very helpful thread, not just for me but for all of us who sooner or later will be makin these type of moves and dicisions.
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Yeh, but this stuff always invites the nightmare stories rather than the 99% of perfectly fine stuff. After all, "normal" just ain't all that exciting.

My older brother and I were living with my father when he got cancer (I believe it was pancreatic, may have been bone cancer.) This was in 1975. He stayed at home until the very end when he was taken to the hospital, where he passed a couple of days later. We were given a fridge full of Demerol and a box of syringes. He could have it "on demand." We got replenished by making a phone call. Those were the days...
 
I recall that Lon Tanner had a great experience with Assisted Living. Of course he lived in an upscale facility.

I have a close friend who has Parkinson's who moved into a local Assisted Living facility about 6 years ago as her disease progressed. She is divorced and lived alone in her home, and after having several dangerous falls requiring hospitalization she finally gave in and moved to Assisted Living. She fully expected to hate it, but after getting settled in to her own little "apartment" with her own furniture, two cats, and a private patio she is quite content.

She has assistance when she needs it (bathing, housekeeping, etc.) and has the option of eating in the cafeteria, having food delivered to her room, or making something herself in her tiny kitchen. The facility provides transportation to shopping, doctor appointments, etc. so she sold her car. It has worked out very well for her situation but it is expensive.
 
John Brunner said:
Yeh, but this stuff always invites the nightmare stories rather than the 99% of perfectly fine stuff. After all, "normal" just ain't all that exciting.
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Exactly. People are more apt to complain than to praise. For one thing, when we get what we expect, there doesn't seem to be a reason to talk about it, since that's what we're paying for, after all. Not all nursing homes are bad, and not all nursing home personnel are lazy, incompetent, or uncaring.

We're also inclined to judge a facility by its appearance. That makes sense, and I'm not suggesting that it's irrelevant. If you're touring a facility, that's a big part of what you have to go by, and it's reasonable to infer that if the place is not well-maintained, there is a good chance your care might also be lacking. That's not necessarily true, however. As I said in my second post in this thread, the nursing home closest to my hometown isn't dirty or run-down, but it is clear it's not a modern, shiny facility. Over the years, several of my relatives have lived out the latter part of their lives there, and I haven't heard many bad things about it. It's also true that the care you receive at a shiny new facility won't necessarily be as good as the place's appearance suggests.
 
My Mother-in-Law had Long Term Care Insurance but she never moved to any kind of facility. She remained in her home and had "Visiting Angels" in-home care. They checked on her twice daily for 2-hour visits, making sure she took her medication, helped with her bathing, kept up light housekeeping, laundry, and prepared meals if she wanted. She resisted at first (not wanting "strangers" in her home) but once she got to know her caretakers she didn't seem to mind it.

The Visiting Angels schedule did not include weekends. My husband checked on her several times a week, and spent weekends (during the daytime) at her place. He took care of her finances and maintained her property (mowing, etc.) and we did her grocery shopping.

Personally I'd prefer to go that route if/when I am unable to care for myself. I want to stay in my home.
 
I might have told this story already in another thread, but here goes:

My late sister's mother-in-law had to be placed in assisted living. Because of pain, she was put on some sort of patch, maybe lidocaine. Every 3 days, the old patch came off and the new patch went on. One day, she was found unresponsive in her room and was rushed to the hospital.

At the hospital, it was found that she had twelve patches on her. Twelve. Of course, the old patch still kept putting out doses of lidocaine (?) long after a couple of days. So she had twelve patches, all pumping out varying amounts of whatever substance it was.

She was in the hospital for a couple of days and snapped back just fine. When it was time for her to be released back to the living facility, they said they couldn't accept her unless my brother-in-law paid for 24-hour nursing. Oh, yes, it was THEIR fault, but they wanted HIM to pay.

A strongly-worded letter from an attorney took care of that quite quickly and they welcomed her back with open arms, considering the alternatives. Why would he want her back there, you ask? Well, it was the best one in town and she was as happy there as she would have been anywhere outside her home. AND, now they were on alert to not make any more mistakes.
 
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