Friday, June 1, 2012

Differences in the middle of Nursing Homes, Assisted Living & persisting Care withdrawal Communities

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Benjamin Franklin said it best - “nothing in life is definite except death and taxes” but with daily advancements in science, technology and health care, Americans are living longer than ever before*. This blessing however, has created a unique dilemma for contemporary American families: How to plan for and put in order for one's retirement years.

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Have you taken a road-trip lately? almost every highway is graced with large bill-boards providing the locations of new planned communities where couples can spend their retirement years dedicated to recreational pursuits. I doubt you will find a local newspaper that doesn’t have at least one ad promoting the amenities found at a local assisted living facility. Try to crusade for “nursing homes in Virginia” on the Internet and thousands of web pages will appear. Each and every day new facilities offering distinct programs are being built and marketed across the state.

Is such a installation right for you and your family? If so, which facility? We often hear the terms “retirement community,” “nursing home,” and “assisted living facility” but rarely think what these terms unquestionably mean. The differences however, are stunning and it is imperative to understand these differences when making choices for yourself or your loved ones.

Nursing Homes

In Virginia, a nursing home means any installation with the original function of providing long-term nursing care, nursing services and health-related services on a chronic basis, for the rehabilitation and patient care of two or more non-related individuals**. Put simply, a nursing home is a installation designed for someone who needs less care than a hospital, but requires daily health care assistance.

The Virginia branch of health licenses such facilities and has established guidelines regulating various aspects of their operations, programs, and staffing needs, etc***. For example, a nursing home must: (a) have written policies and procedures regarding the rehabilitation of residents and the management of resident care which are ready to residents and their families (12Vac5-360-20); (b) contribute crisis curative services within 15 minutes, under normal conditions (12Vac5-360-50); (c) be subject to unannounced on-site inspections of the nursing installation by State employees (12Vac5-371-60); (d) have a written agreement with one or more physicians licensed by the Virginia Board of rehabilitation to serve as curative director (12Vac5-371-230); and (e) each resident shall be under the care of a physician licensed by the Virginia Board of rehabilitation (12Vac5-371-240).

In addition, residents of nursing homes are also given definite rights as defined by Virginia Code §32.1-138. See http://leg1.state.va.us/cgi-bin/legp504.exe?000+cod+32.1-138. Nursing homes are the most regulated and structured residential options for our Seniors requiring some level of daily health care. If the installation provides care through Medicare and Medicaid programs, it is deemed a "Certified nursing facility" (Virginia Code §32.1-123; Virginia Code §32.1-127) and must be in compliance with both federal and state laws.

Of course, the more rules and regulations that define and control the daily operations of a nursing home, the greater the responsibility of the staff. These are the citizen who will be expensed with the daily task of caring for your loved one, and making sure they are in compliance with state and federal laws. No matter how nice and or bright the installation might be, the staff will make the contrast in the middle of your loved one being cared for and encouraged, or not.

A nursing home is best distinguished for someone:

Who requires daily health care – such as aid getting in and out of bed; taking medicine; or using the restroom. Who may have dementia or Alzheimer’s and as a result, is unable to eat and or bathe daily without reminder or assistance; Who is recovering from a fall or crisis and is therefore unable to walk, dress and or eat without aid
Assisted Living Facility

“Assisted living facility” means an adult care house which has been licensed by the Virginia branch of public Services to contribute a level of assistance for adults who may have bodily or thinking impairments and want at least moderate aid with the activities of daily living. Within assisted living, there are two types: quarterly assisted living for those seniors (typically) who need aid with one or more daily activity; and oppressive assisted living for someone who may be incapable of performing activities due to thinking and/or severe bodily impairment (12Vac30-120-450).

The Virginia branch of public Services licenses assisted living facilities but does not regulate in the way the branch of health regulates nursing homes. While there are Virginia guidelines regulating aspects of assisted living facilities, they are limited: An assisted living installation must: (a) contribute or coordinate personal and health care services; and (b) contribute 24-hour supervision.

As reflected in the table below, assisted living facilities have no compulsion to contribute health care and/or have health care staff ready to sustain your loved one. In addition, with no compulsion to contribute such services, there is the demand as to either or not they owe a duty to warn or treat residents with illnesses or diseases that could be transmitted from other residents.

While a nursing home will have many nurses on staff and doctors hired to monitor the residents, assisted living is more analogous to an apartment building or college dorm where laundry and food services are provided and residents are on their own for the rest of the day.

An assisted living installation is best distinguished for someone:

Who is basically independent but may not be able or willing to put in order their own food or drive to doctors’ appointments; Someone who wants to scale back and anticipates needing aid with laundry, cooking, etc. In the near future. A consolidate where one spouse is independent but may need aid in feeding and or providing for needs of other spouse.
Continuing Care retirement Community

In Virginia you may also see advertisements for a retirement community. They are popping up all around our popular College Towns and tourist destinations.

A chronic Care retirement community provides care depending on your current needs. Like an assurance policy, the resident pays an entry fee and periodic adjustable payments, which in turn gives the resident a box of residential and healthcare services that the Ccrc is obligated to contribute at the time these residential and health care services are required. For example, if upon entering, all you want is help with your meals, that is the only assistance which will be provided. If you want oppressive bodily therapy or God forbid, daily aid for a Dementia patient, the Ccrc has assisted living services or nursing home services ready under your contract. chronic care contracts are regulated by the Virginia Bureau of assurance of the Virginia State Corporation Commission.

Many Ccrcs can have nursing home services ready either on-site, or at licensed facilities off-site (12Vac5-360-10). While you may be entering the retirement community as a very wholesome independent and capable resident, as your needs change, so will your covenant with the community and in turn, the facility’s obligations to you.

A chronic Care retirement community installation is best distinguished for someone:

Who is basically independent but anticipates the need for daily health care for themselves or a spouse in the near future; Someone who is physically disabled and would be unable to care for themselves or a spouse if the disability grew worse. With at least three very distinct choices, it is very foremost to do your research:

To investigate assisted living facilities in Virginia, go to branch of public Services website: http://www.dss.state.va.us/facility/search/alf.cgi.

To investigate nursing homes, go to Medicare’s website: http://www.medicare.gov

And Last But Not Least

It is all the time best to speak to a house member of a current resident and spend time getting to know the staff, no matter what type of installation you are looking into. If looking and researching is not enough, then think the chart below – a comparison of the legal duties of a nursing home compared to the legal duties of an assisted living installation in Virginia.

Duty or Requirement

Nursing Home

Assisted Living

Duty to contribute nursing care and or monitor resident’s health?

Yes

No

Doctor required to supervise residents?

Yes

No

Each resident shall be under the care of a physician licensed by the Virginia Board of Medicine?

Yes

No

Must have nurses on staff?

Yes

No

Must offer rehabilitative services?

Yes

No

Must have ongoing consultation from a registered dietitian or dietitian on staff?

Yes

No

24 Hour management required?

Yes

Yes

Must build a written plan upon admission of resident?

Yes

Yes

Staff must endure criminal background check?

Yes

Yes

Monitored by Virginia town for quality health Care Services and consumer Protection

Yes

No

Monitored by branch of public Services

No

Yes

*Life expectancy increased dramatically during the past century, from 47 years for Americans born in 1900 to 77 years for those born in 2001. These same factors—improved curative care and prevention efforts— that are partly responsible for the dramatic increases in life expectancy have also produced a major shift in the foremost causes of death in the United States in the past century, from infectious diseases and acute illnesses to chronic diseases and degenerative illnesses.” The State of Aging and health in America 2004, published by the town for Disease Control, ready at http://www.cdc.gov/aging/pdf/State_of_Aging_and_Health_in_America_2004.pdf.

**See generally, Virginia Code §32.1-123, as amended and Virginia menagerial Code § 12Vac5-360-10.

***It is a Felony under Virginia law to control a nursing installation without a license. See generally, 12Vac5-371-30.

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