Are there different levels of nursing homes?

According to the American Association for Long-Term Care Insurance, nearly 30% of nursing home residents stay less than 100 days. Understanding the care variations is crucial for finding the right fit for a short-term rehabilitation stay or a long-term residence. This comprehensive guide answers, "Are there different levels of nursing homes?"

Quick Summary

Yes, nursing homes offer distinct levels of care, typically including skilled nursing for complex medical needs and intermediate or custodial care for long-term assistance with daily activities. The appropriate level depends on a resident's specific health condition and needs, requiring professional assessment for proper placement.

Key Points

• Skilled Nursing (SNF): Offers the highest level of medical care with 24/7 access to licensed nurses and intensive rehabilitation therapies for complex health needs.

• Intermediate Care (ICF): Provides a moderate level of care with intermittent nursing and consistent supervision for stable, chronic conditions that require assistance with daily tasks.

• Custodial Care (Long-Term Care): Focuses on non-medical assistance with daily activities (ADLs) and general supervision for individuals who can no longer live independently.

• Assessment Determines Placement: A physician-certified assessment of a person's medical needs and ability to perform daily activities is crucial for determining the correct level of care.

• Multiple Senior Living Options: Beyond nursing homes, options like assisted living, memory care, and CCRCs offer different care levels, sometimes on a single campus.

• Informed Choice: Families should understand the differences in care levels to make the best decision for a loved one's specific needs, whether for short-term recovery or permanent residence.

Understanding the Care Continuum in Nursing Facilities

Navigating the world of senior care can be complex, and one of the most important decisions involves selecting the right type of facility. Many assume all nursing homes offer the same services, but the reality is that they provide a spectrum of care designed to meet various health needs, from temporary post-hospital recovery to permanent, ongoing assistance. These varying levels are often determined by the intensity of the medical and personal support a resident requires.

Skilled Nursing Care: The Highest Level of Medical Support

Skilled nursing facilities (SNFs) provide the most intensive care, suitable for individuals needing complex medical attention from licensed professionals 24/7. This level is often for rehabilitation after illness or injury, or long-term care for severe chronic conditions.

Services Provided in Skilled Nursing

• 24-hour nursing care: Continuous medical attention by licensed nurses.
• Rehabilitation services: Physical, occupational, and speech therapy.
• Medical treatments: Wound care, IV therapy, respiratory support, and pain management.
• Medication management: Professional administration of complex medication.
• Chronic disease management: Specialized care for conditions like diabetes or post-stroke recovery.
• Complex health needs: Medically intensive care requiring a doctor's certification.

Intermediate Care: Consistent Supervision for Ongoing Needs

Intermediate care offers regular but less intensive nursing and rehabilitative services than skilled nursing. It's for residents with ongoing health issues requiring consistent supervision but not 24-hour skilled nursing. Intermediate care facilities (ICFs) help with daily activities and provide some medical oversight.

Services Provided in Intermediate Care

• Intermittent nursing care: Oversight from a registered nurse, not around-the-clock.
• Assistance with ADLs: Help with bathing, dressing, eating, and mobility.
• Medication assistance: Ensuring correct medication intake.
• Supportive services: Therapies, dietary, and social services.
• Less intensive medical needs: For those with stable, chronic conditions.

Custodial Care: Long-Term Personal Assistance

Custodial care, or long-term care, focuses on non-medical assistance with daily living activities (ADLs). It's provided in licensed nursing facilities under physician supervision but doesn't require continuous skilled medical attention.

Services Provided in Custodial Care

• Help with ADLs: Assistance with daily living activities.
• Supervision: Monitoring resident well-being and safety.
• Supportive environment: Providing a secure living space.
• Personalized care: Provided by non-medical staff under physician oversight.

A Comparison of Nursing Home Care Levels

Feature	Skilled Nursing Care	Intermediate Care	Custodial Care
Medical Intensity	High, 24/7 skilled care	Moderate, intermittent nursing care	Low, primarily non-medical
Staffing	Registered Nurses (RNs), Licensed Practical Nurses (LPNs), Therapists	LPNs, Aides, under RN/MD supervision	Aides, under MD supervision
Resident Profile	Complex medical issues, post-op, severe chronic illness	Chronic conditions requiring consistent supervision	Physical or cognitive limitations with ADLs
Therapies	Intensive physical, occupational, and speech therapy	Access to intermittent therapy services	Occasional access to therapy services
Duration	Short-term rehabilitation or long-term for severe cases	Ongoing for stable, chronic conditions	Long-term residential support
Primary Goal	Medical recovery and rehabilitation	Maintaining health and functional ability	Assistance with daily living

The Assessment Process: Matching Needs to the Right Level

A thorough assessment is crucial before placing a resident. This evaluates health, abilities, and ADL needs. A physician's certification is needed to confirm the required care level. A post-surgery patient might need skilled nursing for rehab, while someone with early dementia might need intermediate or memory care for supervision and support.

Other Related Senior Care Options

Understanding other senior care options is also helpful:

• Assisted Living: For those needing some ADL help but remaining relatively independent.
• Memory Care: Specialized care for dementia, often in a dedicated unit.
• Continuing Care Retirement Communities (CCRCs): Offer multiple care levels on one campus, allowing residents to transition as needed. For more information, read this comprehensive guide from the National Institute on Aging: [https://www.nia.nih.gov/health/long-term-care/residential-facilities-nursing-homes].
• Hospice Care: Palliative care for terminally ill patients, which can be provided in a nursing home.

Conclusion: Making an Informed Decision

Understanding the differences between skilled, intermediate, and custodial care is vital for choosing the right nursing home level. The assessment process ensures appropriate support for a senior's health, safety, and quality of life. Consulting healthcare providers and visiting facilities is recommended.

Frequently Asked Questions

What is the primary difference between skilled nursing and intermediate care?

The main difference lies in the intensity of the medical care. Skilled nursing provides continuous, 24-hour medical care from licensed nurses for complex or severe health conditions. Intermediate care provides consistent supervision and intermittent nursing care for stable, chronic conditions that require less intensive medical intervention.

Is assisted living a type of nursing home?

No, assisted living is a separate category of senior living. While it provides help with daily activities like a nursing home, it is for relatively independent individuals who do not need the continuous, intensive medical supervision found in skilled or intermediate nursing care facilities.

How is the level of care determined for a resident?

A medical professional, such as a physician or nurse, performs an assessment to determine the appropriate level of care. This evaluation considers the person's overall health, physical and cognitive abilities, and their need for assistance with activities of daily living (ADLs).

Can a resident transition between different levels of care?

Yes. A resident's needs can change over time. Many nursing facilities, especially those within a Continuing Care Retirement Community (CCRC), can facilitate a transition to a different level of care within the same facility or network as their health condition evolves.

Does long-term care insurance cover all levels of nursing home care?

Not all policies are the same. It is crucial to review the specific terms of a long-term care insurance policy, as some may only cover certain levels of care, such as skilled, intermediate, or custodial care. Understanding the accepted terminology is important for coverage.

What is custodial care in a nursing home?

Custodial care is the lowest level of care in a licensed nursing facility. It focuses on providing non-medical assistance with daily living activities, such as bathing, dressing, and eating, for individuals who cannot perform these tasks independently.

Are memory care units considered a different level of nursing home care?

Memory care is a specialized type of care for individuals with dementia. It is often a distinct unit within an assisted living or skilled nursing facility, but it is not typically classified as a separate 'level' in the traditional sense of skilled vs. intermediate. It provides a structured and secure environment tailored to the cognitive and safety needs of memory-impaired residents.