By Molly Wigand
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| Getty Creative |
The journey from living independently to requiring increasing levels of care can be emotionally and financially overwhelming for an individual and their loved ones. When a person can no longer live safely on their own or begins to need specialized care, their family may seek the assistance of a nursing home, which can also be called a skilled nursing facility or skilled nursing community, to help provide care for their loved one.
Learning about the costs and financial expectations of nursing home care can help provide focus, clarity and direction as families navigate this life-changing transition together. Here’s what you need to know.
What Is a Nursing Home?
According to the National Institute on Aging, nursing homes typically offer residents a range of services, including:
- Nursing care
- 24-hour supervision
- Three meals a day
- Assistance with activities of daily living (ADLs), such as bathing, dressing, walking, using the toilet and eating
- Rehabilitation services, such as physical, occupational and speech therapy
Skilled nursing communities are able to accommodate “higher acuity situations,” meaning residents with feeding tubes, tracheostomy tubes and/or respirators, says Don Minter, a certified senior advisor, certified dementia practitioner and area owner of Senior Care Authority in the Kansas City area. He cites these three medical necessities as primary reasons a resident may require skilled nursing care instead of independent or assisted living.
Experts like Minter often prefer the term “skilled nursing community” to “nursing home” due to the negative connotations of the latter phrase. Meanwhile, the Centers for Medicare and Medicaid Services (CMS) uses the term “skilled nursing facility,” which is often abbreviated as “SNF.”
Types of Nursing Homes and Senior Living Facilities
Once a person is either unable to live on their own safely or elects to relocate to an environment that provides access to more daily assistance, they can choose from a variety of community options that cover the full continuum of care.
Board and care homes (sometimes called residential care facilities or group homes) are small, private facilities in which residents receive meals, assistance with ADLs and 24/7 access to on-call staff 24/7. These facilities typically do not offer medical services.
Assisted living communities vary in size and are designed for people who are somewhat independent but may require assistance with medication management, housekeeping or laundry. Assisted living communities typically offer various levels of care, and the price of residency varies based on the amount of care provided.
In assisted living communities, people may live in private or shared apartments, rooms or studios and socialize with other residents in community areas. Assisted living accommodations may include up to three meals a day, as well as recreational and educational activities, shopping trips and transportation services.
Both board and care homes and assisted living facilities are regulated by states, according to Joseph Shega, M.D., executive vice president and chief medical officer of VITAS Healthcare and a Forbes Health Advisory Board member. As a result, the services rendered by these facilities and their ability to handle acuity and complexity will vary depending upon state rules and regulations, he adds.
Skilled nursing facilities offer acute medical care, three meals a day and 24/7 medical staff support. Short-term skilled nursing facility stays are sometimes recommended following an injury or hospital stay, with residents returning home following recovery. Many nursing home residents, however, have health or cognitive issues requiring ongoing care, most likely living permanently in these facilities.
Continuing care retirement communities (CCRCs), sometimes known as life care communities, incorporate various levels of care in a single campus location. Independent living, assisted living and skilled nursing care are all available in these communities, and people can move from one level of care to another as their circumstances change.
“If a resident is living on the independent living side of the community and falls and breaks a hip, they can stay in the same community and rehab back to home in independent living,” says Minter. However, the costs associated with CCRCs can be prohibitive, with initial buy-ins averaging from $60,000 up to $750,000, according to Minter.
Nursing Home Costs and Expenses
Average Costs and Considerations
Because of the level of care provided in these communities, nursing homes are expensive. The average cost of a private room in a nursing home ranges from $280 to $550 per day—approximately $9,000 to $15,000 per month—depending on the person’s location and level of care required, according to Minter.
The American Council on Aging publishes a list of average prices of nursing homes by state and region annually through its Medicaid Planning Assistance organization. Review this breakdown for a more accurate estimate for you or your loved one, as cost can vary dramatically based on geography.
Medicare and Skilled Nursing Care
Medicare can cover a nursing home stay if the person meets all three of the following criteria:
- They are enrolled in Medicare Part A.
- They had a qualifying hospital stay of at least three consecutive days.
- Their doctor ordered services in a skilled nursing facility.
Most daily services in a nursing home are included in a community’s daily rate. Depending on the resident’s care plan, Medicare can cover physical, occupational and speech therapies, as well as basic daily skilled nursing care. Check with your facility’s director to avoid unexpected charges.
Medicare’s skilled nursing benefits vary according to the length of a person’s stay in each benefit period.
- Days 1-20: Medicare pays 100% of the costs.
- Days 21-100: The resident pays coinsurance in the amount of $194.50 per day (in 2022), and Medicare covers the remainder of the cost.
- Day 101 and beyond: The resident is responsible for 100% of the costs.
Medicare Advantage plan benefits may also vary.
Ways to Pay for Nursing Home Care
While Medicare covers short-term skilled nursing stays, longer-term or permanent residence in a nursing home requires other financing options.
Minter says residents and their families typically have the following options when paying for long-term skilled nursing facility care:
- Private pay. Either a resident’s assets or their family’s assets can pay for skilled nursing care.
- Veterans’ benefits. VA Aid and Attendance benefits can contribute up to $1,800 a month to skilled nursing care.
- Long-term care insurance. Accrued benefits can help defray costs.
- Life insurance, depending on the policy. Some policies can help cover costs associated with skilled nursing care, but check with your insurance company to ensure this benefit is provided by your or your loved one’s policy.
- Medicaid. A common method of paying for skilled nursing care, Medicaid benefits are determined at the state level, so check your specific benefits before signing any contracts.
What to Consider When Searching for a Nursing Home
Medicare’s nursing home comparison chart can help you compare facilities within a specified radius of your preferred location. The tool aggregates consumer ratings (one to five stars) for facilities overall, as well as their health inspections and quality measures. Individual states provide these ratings as well.
Working with a certified senior advisor (CSA) can also help narrow your search for appropriate accommodations for yourself or a loved one. Many CSAs have extensive knowledge of the local market and are trained to help older adults and their families find the community that most appropriately suits their specific needs.
It’s a good idea to visit a nursing home in person, too, as ratings and impressions of a community “on paper” may not give a complete picture. “When we go into a community, we’re always looking at the care the residents are receiving,” says Minter. “How do the residents look? Are their faces shaved, is their hair combed, do they look clean and are they smiling? Resident and staff interactions are paramount,” he adds. “It’s everyone’s goal to have their loved one age in a place where they don’t have to move again.”
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