Benjamin Franklin said it well – “Nothing is certain in life except death and taxes”, but with increasing advances in science, technology and healthcare, Americans are living longer than ever*. Yet this blessing has created a unique dilemma for the modern American family: how to plan and prepare for their own retirement.
Have you taken a road trip recently? Nearly every highway is lined with large billboards offering locations for newly planned communities where couples can spend their retirement years devoted to recreational activities. I doubt you’ll find a local newspaper without at least one ad advertising the amenities of a local assisted living facility. Try an Internet search for “nursing homes in Virginia” and thousands of web pages will come up. New facilities offering different programs are being built and sold across the state every day.
Is a facility like this right for you and your family? If yes, which facility? We often hear terms like “retirement community,” “nursing home,” and “assisted living facility,” but rarely consider what these terms actually mean. However, the differences are staggering and must be understood when making choices for yourself or your loved ones.
In Virginia, a nursing home is any facility whose primary function is the continuing provision of long-term care, nursing services, and health-related services for the treatment and residential care of two or more unrelated individuals**. Simply put, a nursing home is a facility designed for people who require less care than a hospital but need help with their day-to-day health care.
The Virginia Department of Health issues licenses for such facilities and has guidelines governing all aspects of their operations, programs, and staffing needs***. For example, a nursing home must: (a) have written policies and procedures regarding the treatment of residents and management of resident care for use by residents and their families (12VAC5-360-20); (b) under normal circumstances (12VAC5-360-50) , to provide emergency medical services within 15 minutes; (c) undergo an unannounced on-site inspection of a nursing facility by a state employee (12VAC5-371-60); (d) communicate with one or more physicians licensed by the Medical Board of Virginia A written agreement (12VAC5-371-230); (e) Each resident shall receive the care of a physician licensed by the Medical Board of Virginia (12VAC5-371-240).
In addition, residents of nursing homes have certain rights as defined in §32.1-138 of the Code of Virginia.Look http://leg1.state.va.us/cgi-bin/legp504.exe?000+cod+32.1-138A nursing home is the most regulated and structured residential option for older adults who require some level of day-to-day health care. If a facility provides care through the Medicare and Medicaid programs, it is considered a “Certified Nursing Facility” (Virginia Code §32.1-123; Virginia Code §32.1-127) and must comply with federal and state law.
Of course, the more rules and regulations that define and control the day-to-day operations of a nursing home, the greater the staff’s responsibility. These people will be responsible for the day-to-day work of caring for your loved one and making sure they comply with state and federal laws. No matter how good or attractive the facility is, the staff will determine whether your loved one is cared for and supported.
Nursing homes are best suited for people who:
- Who needs daily care—such as assistance getting in and out of bed; taking medication; or using the restroom.
- who may have dementia or dementia and therefore be unable to eat and/or bathe daily without reminder or assistance;
- who are recovering from a fall or accident and therefore unable to walk, dress and eat without assistance
Assisted Living Facility
“Assisted Living Facility” means an adult nursing residence licensed by the Virginia Department of Social Services to provide a certain level of services for adults who may have a physical or mental disability and who require at least moderate assistance with activities of daily living. In assisted living, there are two types: routine assisted living for older adults who (usually) need assistance with one or more daily activities; and for people who are unable to perform activities due to mental and/or serious physical impairments Provides Intensive Assisted Living (12VAC30-120-450).
The Virginia Department of Social Services issues licenses for assisted living facilities but does not regulate them the way the Department of Health regulates nursing homes. Although there are Virginia Codes that regulate various aspects of assisted living facilities, they are limited: an assisted living facility must: (a) provide or coordinate personal and health care services; (b) provide 24-hour supervision.
As shown in the table below, assisted living facilities are not obligated to provide health care and/or provide health care personnel to assist your loved one. Furthermore, since there is no obligation to provide such services, there is the question of whether they are obliged to warn or treat residents who have a disease or a disease that may be transmitted from other residents.
While nursing homes will have many nurses and doctors supervising residents, assisted living is more akin to an apartment building or college dorm, where laundry and food services are provided and residents are to themselves for the rest of the day.
Assisted living facilities are best suited for people who:
- who are largely independent but may not be able or willing to prepare their own food or drive to the doctor;
- People who want to downsize and anticipate needing help with laundry, cooking, etc. in the near future.
- Couples where one spouse is independent but may need help feeding and/or meeting the needs of the other spouse.
Continuing Care Retirement Communities
In Virginia, you may also see advertisements for retirement communities. They’re popping up around some of our favorite college towns and travel destinations.
Continuing care retirement communities provide care based on your current needs. Like an insurance policy, residents pay an initiation fee and periodic adjustable payments, which in turn provide residents with a package of accommodation and health care services that the CCRC is obliged to provide when they are needed. For example, if upon entering, all you want is help cooking your meal, that will be the only service offered. If you need intensive physical therapy or, God forbid, day-to-day help for people with dementia, CCRC can provide assisted living services or nursing home services under your contract. Continuing care contracts are regulated by the Virginia Bureau of Insurance of the Virginia Corporations Commission.
Many CCRCs can provide nursing home services on-site or in a licensed off-site facility (12VAC5-360-10). While you may enter a retirement community as a perfectly healthy, independent and capable resident, as your needs change, so do your contracts with the community and the facility’s obligations to you.
Continuing care retirement community facilities are best suited for those who:
- who are largely independent but anticipate needing daily health care for themselves or their spouse in the near future;
- A person who is physically disabled and will not be able to care for themselves or their spouse if the disability worsens.
It’s important to do your research for at least three distinct options:
To research assisted living facilities in Virginia, visit the Department of Social Services website: http://www.dss.state.va.us/facility/search/alf.cgi.
To research nursing homes, visit Medicare’s website: http://www.medicare.gov
last but not last
No matter what type of facility you’re looking for, it’s best to talk to the family of a current resident and take the time to get to know the staff. If viewing and research isn’t enough, consider the table below – How Nursing Home Legal Liability Compares to Virginia Assisted Living Facility Legal Liability.
Responsibilities or Requirements
Responsibility for providing care and monitoring residents’ health?
Doctors need to supervise residents?
Should every resident be under the care of a physician licensed by the Medical Board of Virginia?
Must there be a nurse on staff?
Must rehabilitation services be provided?
Must receive ongoing consultation with a registered or practicing dietitian?
Need 24 hour supervision?
Must a written plan be in place when a resident moves in?
Employees must undergo criminal background checks?
Monitored by the Virginia Center for Quality Healthcare Services and Consumer Protection
Overseen by the Department of Social Services
*Over the last century, life expectancy has increased dramatically, from 47 years for Americans born in 1900 to 77 years for Americans born in 2001. These same factors—improvement in health care and prevention efforts—are partly responsible for the dramatic increase in life expectancy. It has also caused a major shift in the leading causes of death in the United States over the past century, from infectious and acute to chronic and degenerative. disease. ” Aging and Health in America 2004, published by the Centers for Disease Control, available at http://www.cdc.gov/aging/pdf/State_of_Aging_and_Health_in_America_2004.pdf.
**See generally §32.1-123 of the Code of Virginia, as amended, and §12VAC5-360-10 of the Administrative Code of Virginia.
*** Operating a nursing facility without a license is a felony under Virginia law. See 12VAC5-371-30 generally.