If you or a loved one needs nursing home care, either on a temporary or long-term basis, it’s helpful to know what nursing homes offer, whether Medicare covers nursing homes, and how to choose the right one.
What are nursing homes?
Nursing homes are facilities for people who are ill or frail and need 24-hour care. They are required to have a registered nurse on staff around the clock to provide skilled nursing services, as well as aides to assist with day-to-day care.
Some people move to a nursing home temporarily if they are recovering from an illness, injury, or surgery. Others move there permanently because they require ongoing medical care, need memory care for dementia, or can no longer take care of their daily personal needs such as bathing, dressing, or eating.
Some nursing homes resemble hospital settings, with a central nurses’ station. Others offer a more homelike environment, with furniture that residents can bring from home. Some will let couples live together.
Nursing homes, also called long-term care facilities, are one of several options for senior living. There are more than 15,000 licensed nursing homes in the U.S., and all must meet certain health and safety standards in order to maintain their license to operate.
What is the difference between a nursing home and a skilled nursing facility?
Nursing homes are sometimes called skilled nursing facilities. But usually, a skilled nursing facility refers to one that treats people for the short term, so they can receive nursing care while they recover.
People move to a skilled nursing facility when they no longer need to be in a hospital but can’t return home right away for various reasons, such as being unable to get out of bed safely, having surgical wounds that require ongoing treatment in order to heal, or needing physical therapy.
Medical and personal care services provided by nursing homes
Nursing homes provide medical services for anyone who requires 24-hour care, not just older people. These services include administering medication or breathing treatments, caring for joint or bone problems, checking vital signs, managing chronic health conditions such as diabetes or heart failure, and more.
They also provide personal care for help with activities of daily living, such as bathing, toileting, getting dressed, and eating. Physical, occupational, and speech therapists, as well as nutritionists, will come to nursing homes to offer on-site care.
Nursing homes focus on safety issues, such as preventing falls and keeping people with memory issues from wandering away. Many offer a separate memory care unit for people with dementia. Some nursing homes also provide respite care for a day or longer to give family caregivers short breaks, and offer end-of-life care such as hospice.
In addition to doctors and nurses, other licensed professionals working at nursing homes may include physician assistants, nurse practitioners, social workers, and therapists.
Recreational and social activities in nursing homes
Recreational and social activities vary from one nursing home to another. They may include singing and music, arts and crafts, gardening, movies, and exercise sessions. Many also offer social hours for residents to gather with one another, and outside walking paths that are wheelchair accessible.
How much do nursing homes cost?
The cost of nursing home care varies, depending on the state where it’s located and the facility you choose. According to the National Council on Aging, in the U.S. the average cost per month is $7,908 for a shared room and $9,034 for a private room.
Does Medicare cover nursing homes?
Medicare may cover short-term nursing home stays, such as if you are recovering from pneumonia or a joint replacement and need care while you rehabilitate. But generally, Medicare does not cover long-term nursing home stays. Most families pay out of pocket.
However, Medicare Part A, which is hospital insurance, covers up to 100 days in a Medicare-certified nursing home after hospitalization. Medicare Part B covers doctor visits and physical, occupational, or speech therapy while in a nursing home.
If you qualify, your state’s Medicaid program may cover long-term nursing stays. You can find contact information for your state on the Medicaid.gov website.
In order to be reimbursed for certain services by Medicare or Medicaid, nursing homes are regulated by both the federal government and the government of the state in which they operate. They must follow certain laws, regulations, and compliance requirements.
Finding the right nursing home
The search for the right nursing home starts with considering the person’s wants and needs. Do they need short-term rehabilitation care? Memory care? Help with everyday activities?
Also consider which features are most important, such as being located close to family members, having recreational activities, and the availability of high-quality meals. For many families, the cost plays a large role in the decision.
Touring various nursing homes is helpful in planning. Some questions to ask include:
- Is the nursing home clean and well maintained?
- Is the facility licensed by the state and certified by Medicare and/or Medicaid?
- What is the ratio of staff members to residents?
- What recreational and social activities are available?
- Do the administrators and medical professionals have special training in geriatrics?
- What services are covered as part of the basic cost?
- Will the nursing home continue to care for people who run out of money and need to rely on Medicaid for coverage?
The U.S. government, through Medicare, provides a website where you can find Medicare-certified nursing homes based on your location, and can compare the quality of care they provide. The site rates nursing homes on a scale of one to five stars, based on the facility’s combined ratings for health inspections, staffing, and quality of care.
