Transcript of “Rights
Here, Rights Now –
Episode 39: What is
the Difference Between Assisted Living Facilities and Nursing Homes?
Produced
by the disAbility Law Center of
Virginia.
[INTRO]: The
information provided on this podcast does not, and is not intended to,
constitute legal advice. Instead, all information and materials available, are
for general informational purposes only.
[Enter advocate host, Valerie
Jones.]
[Valerie]: Welcome to Rights Here, Rights Now! the
podcast about disability advocacy, and activism. I'm your Advocate host, Valerie Jones.
[Enter advocate host, Suzanne
Herbst.]
[Suzanne]: And I'm your Advocate host, Suzanne Herbst.
[Valerie]: Every two weeks we dig into to relevant
issues, current events, and avenues for all self-advocacy.
[Suzanne]: ‘Cause
someone has to.
[Valerie]: And it might as well be us!
[Suzanne]:
This
podcast is produced by the disAbility Law Center of
Virginia, the Commonwealth’s protection and advocacy agency for disability
rights. Find out more at dlcv.org
[Enter, again,
hosts Valerie and Suzanne.]
[Suzanne]: And Valerie, we have a very good episode today very
exciting we have one of our delightful colleagues Rhonda thissen
a senior disability rights advocate here and she is talking to us today about
the differences between nursing facilities and assisted living facilities which
I think which is something that people I've heard about but maybe don't really
know the ins-and-outs of so that's what we're going to learn about today.
[Valerie]:
Very
exciting! I’m very excited about that. Before we jump in, let’s check out
Disability in the News!
dLCV will be highlighting on our social media during the month of
May several outstanding individuals, businesses and organizations who over the
course of the 2020 COVID-19 lockdown, exemplified compassion, dedication, and
innovation in continuing to provide services for people
with disabilities throughout Virginia. These stories were the result of
over 45 nominations submitted by members of the public in search of regional
winners for our upcoming disAbility Impact Awards
that we will be virtually hosting on June 17th, 2021 from 5:30 - 7:30.
For more details about this event or to register to participate in the live
awards webinar, please visit our website at www.dlcv.org/events or contact outreach@dlcv.org.
[Suzanne]: Well,
thank you so much for being here with us today, Rhonda! We are so happy to have you.
[Enter,
Senior Advocate Rhonda Thissen]
[Rhonda]: Thank
you!
[Suzanne]: So, a lot of us have heard about
nursing homes and assisted living facilities. But we might not know a whole lot
else about those two settings. So, what are the differences between nursing
homes and assisted living facilities??
[Rhonda]: So there’s a
bunch of differences, actually. And the basic most important difference between
assisted living facilities and nursing facilities which you might hear people
refer to as nursing homes or skilled nursing facilities is the level of care
that they provide nursing facilities provide a higher level of medical and
rehabilitative care then assisted living facilities do so generally so that's for example might be in
need of more intensive “aftercare,” from hospitalization like if it had surgery
or if they've had a heart attack; or, they have a serious medical condition
that you know when they're released from the hospital, that requires, (that)
they have you know, IV medication… […]
Or, (for instance), Artificial Respiration.
You know, like, with a ventilator or something like that. Or, they need you
know a lot of assistance in completing their activities of daily living. Which is,
you know, stuff like bathing, and dressing, and cooking meals, and feeding
themselves, you know. Or, if, they have complex medication needs. So you know, people that are sometimes in nursing facilities
that do provide rehabilitation services.
Which
are people recovering after a stroke, that need
occupational therapy, or things like that. Whereas, assisted living facilities-
are more of a designed to be a more home-like environment, that provides
SOME assistance, with people's activities of daily life. So, you know,
folks in an assisted living facility, the stereotypical view of a nursing
facility (patient), is somebody that's retired, and they're older. So, they no
longer have the physical ability to take care of a house, or like, maintain a
lawn. Or, you know, those kinds of things! Assisted living facilities give them
staff support when they need it, but not at the level that a nursing facility
does.
[Valerie
Jones]: Thank you for that explanation. It
certainly cleared up a lot. So:
Can you tell me, it sounds like nursing homes are more (on) of the medical
settings? What [exactly] are assisted living facilities?
[Rhonda
Thissen]: So, nursing
facilities are considered Medical. In some cases, they’re kind of, more like a hospital
setting but not as not as serious as somebody that needs some hospital care.
Which, is generally like acute care needs, like, you know, somebody that's just
had a heart attack. Or, just had a stroke. Assisted-living facilities are
considered residential settings. So, they can be anything from a small family-like
home, with a handful of residents, like, you know, 8 to 10 residents… To high-rise buildings that have all kinds of [things]: like,
some services, like hair salons, &, you know, (fancy) restaurants on site,
recreational facilities, etc. And there are some larger, facilities, I guess,
settings, that provide in one place, a range of care services.
So,
they might have an assisted living component, [or], they might have a nursing
care component, and, they might have a memory care component. And “Memory
Care,” is generally either assisted living, or nursing care, for people that
have a cognitive impairments like Alzheimer's disease,
for example. And the other thing too is that because nursing facilities are
considered medical they need to have a greater degree of hire skilled medical
staff on hand. So, for example, Virginia Regulations for Licensing Nursing
Facilities has requirements that there have to be a certain number, or, certain
availability of services, provided by registered nurses for a minimum
number of hours a day.
Whereas,
assisted living facilities, because they provide a lower level of that physical
care, they don't always have to have an RN, (for instance), they could have
that a Licensed Practical Nurse, which is a nurse that doesn't have such (high
level) training, lower requirements for education and training.
[Suzanne]: So,
nursing facilities usually have a higher level of medical care. How long are
residents expected to stay at a nursing home? Especially versus an assisted
living facility?
[Rhonda]: Right.
Gotcha. So,
a nursing facility
stays, as compared to assisted facilities stays, they, [the number of
days] tend
to be shorter. Um, like I said before, with skilled nursing care, after a
hospitalization. Or, if a person experiences declining health and they need
regular nursing care…You know, maybe they need, you know, some respite care,
where they can build up their strength or, again, it’s like a recovery
environment. So, it's not supposed to be a long-term stay! Now, that said,
about 80% of people who move into a nursing home, stay, for over a hundred
days.
So,
for a lot of people this is more than just a quick stay you know, for a couple
of weeks ago following a stroke, or whatever-- it might be longer. So, an
assisted living facility on the other hand, because it's residential, it can be
considered a long-term. So- and- it’s even permanent housing for some people so
like I mentioned before that you know Grandma that's retired and she can't take
care of, care of, her home anymore or maybe she needs some support that our
family can't provide because they live so you know in another city, or
whatever. So, you know, assisted living facilities are designed to provide the
person, with quality of life, while having some assistance with those daily
activities that can be a challenge, because of their health or, or because they
have a disabling condition; So in general you don't nursing care is supposed to
be a nursing facilities for a long time, I mean, (you know, it) for people that
are- older adults -that have serious health conditions.
You
know, it's not uncommon for them to stay in nursing homes for an extended period
of time. But it's not really designed for that. Unfortunately, we don't
have a lot of options in our medical care system. So, you know, it's more
difficult sometimes to access home health care services, for example, which
would allow a person to receive the care they need in their home,
instead of going to an institution, like a nursing facility. But yeah, in
general it's, it's, hard to say you know the average time that people
stay but it depends on the person. So, I know that that’s a difficult
question to answer. But.
[Valerie]: It seems
that, you know, that,
assisted living facilities can be more in a relaxed setting, than
nursing facilities. So let's talk about the level of
independence residents have at each of these things?
[Rhonda]: Sure,
sure. So,
because so because
nursing facilities are designed to help people you know rehabilitate or recover
following hospitalization or if they've had a decline in their health those
flowers monitoring picky with needles and do all the other things that they do
in hospital so in nursing facilities is sort of similar because there because
people need a higher level of medical and personal support chair at monitoring
and around the clock stuff that happens and so the residents schedule may be
more limited based on what their medical care or personal care needs are.
On
the other hand, folks that live in Assisted Living you know it's designed to
give them greater freedom so they can come and go as they please; And, and…
decide, you know-- how often and for what degree they will they need or
they would accept the assistance of staff. So, you know good example is, like,
many living communities that offer transportation services. Like, they'll have
a bus that you know takes folks around so that they can go shopping or they can
you do go to medical appointments. Or, take outings in the community, without
having to worry about whether or not they can drive because you know some
people there in Assisted Living because they no longer can do the things that
they used to do when they were younger or maybe healthier so so people choose an independent assisted living rather they
shouldn't be people that need round-the-clock medical attention because assisted
living facilities are not designed to do that again like I said before there
are some facilities that have multiple levels of care.
And
the state- of the Virginia Department of Social Services-- which licenses assisted living
facilities--, licenses, AND, has several levels of care so they
licensed residential only because really people that just kind of need some
support of assistance like there's one level that's not just residential but
it's like residential and significant Personal Care assistants and then there's
another level four people in memory care. So, it really kind of depends on the
facility and what they provide and to what extent they provide. And, I think
also it's important to acknowledge that a an assisted
living facility is going to also vary, and what it offers, based on the cost of the facility.
[Suzanne]: That's an important
consideration, also. And that's a great way to transition, Rhonda, because I'm
sure what a lot of people are wondering here is what about the cost? Because
when we're talking about, especially, some of these assisted living facilities,
that have, you know, hair salons in all these extra amenities in there, you
know what are (you), what are we talkin about
cost-wise for these different kinds of settings?
[Rhonda]: Yeah, great
question. And it’s important for people to understand this! So, because skilled nursing
facilities are nursing homes provide a higher level of care and they have
round-the-clock staffing, there, they're much more expensive. So, Genworth
Financial, which is a nationwide company that provides long-term care
insurance, IN an annual, um, study of the cost of nursing care, and assisted
living care, in the country. And, the most recent numbers that I saw in
Virginia the average cost for an assisted living facility is $404,800—No, I’m
sorry-- $4,800 a month. Now, for a nursing facility, that would be $7,500 a
month for a semi-private room.
Which,
is where you would share room with somebody else. Or, $8,500 a month for a
private room. So again, you know, when you add those costs up, for year, that
comes out to be a significant expense! I mean so if you pay the average cost
per (for) assisted living in Virginia, you know, you’re paying $57,600 right
now per year, just for assisted living. And again, nursing facilities are
a lot more expensive! It can be challenging for people, especially people
with disabilities, I think the poverty rate for people with disabilities is
like, 27.2%, in 2019? And, so… paying these rates is incredibly expensive, so,
it really takes people to plan ahead. IF they can plan (ahead).
Especially when you’re talking about people who are looking at retirement…
To
know what they’re getting themselves into, you know, or what they might need,
if/when they get to that point. You know, as you can imagine…You know,
[certain] people- they don't have the resources. Or, they have you know an
accident for example and they get a traumatic brain injury. And they've had,
you know, no time or ability to plan for that cost, you know and it’s a
challenge for people.
[Valerie]: Okay,
wow! - that
was mind-blowing! Those are some expensive stays! Can you tell me: Does
insurance help with this?
[Rhonda]: So,
nursing facility costs—Well, let me talk about the assisted-living thing first.
So, on the regular Market Insurance, the Marketplace Insurance (is the), only
long-term care insurance that currently helps to pay for assisted living cost
for people who are very low income in Virginia. And they have disabilities.
(And), the Virginia Auxiliary Grant can provide some costs assistance
for people. It is a state-funded program that- (pause) for people who receive
supplemental security income: SSI. Which is the Social Security
Administration’s disability
program for low-income people that don't have significant work history.
The
Virginia, and some, from other states—and, in Virginia offer a monthly
pay supplement to the SSI payment. Because, the state of monthly SSI payment in
Virginia, this year, is (pause)…I think it's $783. That's the national benefit
rate. And so, when you think about the average cost of assisted living…. […]
being only $783 dollars in Virginia that's way out of price range for people
that are living on a $783 monthly income. So, the program provides is
cost-efficient.
It's
a monthly supplement to the person's SSI payment. Which allows them to pay the
cost of assisted living facility placement, OR, a placement in an adult
foster care program which is, I think pretty rare—I don’t think there are too
many of those? In some areas, they (may have) their own apartment placement, in
a Permanent Supportive Housing Program. So, going back to the cost
factor- so, SSI, this $783 a month average cost of assisted living $4,800 a
month. So, what the program does is, it's, the general assembly, approved this
program, to assist people with very low income to get an SSI recipient
(replacement payment).
And
so, the supplement that they provide is about 600 to $800 a month, depending on
where the person lives in Virginia. So…so, what they do is, they wrap up the
person's SSI monthly payment, with the Auxiliary Grant Payment Assistance
Program, and (then) the payment limit. So, the maximum payment for assisted
living, for people in this program, that live in Northern Virginia, is just
over $1,600 a month; I think it’s $1,620 a month this year. And elsewhere in
the state, it is $1,400 a month. So, the way that they apply this program to
the individuals monthly SSI payment— […]. That amount… So, either it's 1,400,
in the non-Northern Virginia areas, and 1604 in Northern Virginia- Those
dollars go to the individual.
And
then, they pay up to that amount for their assisted living. And then, and they
get a small monthly stipend for their personal living expense(s). So, you know,
this program served about 4,000 people during 2020! It's really important for a
lot of people that don't have other resources, and it's for people that need
more (resources). Just recently, in 2015, the General Assembly approved
using those funds. Actually, it might have been a bit later in 2018, maybe? The
General Assembly approved using the auxiliary grant for people in Permanent
Supportive Housing so there is now an alternative to going to an assisted
living facility. They can go to their own apartment and use that Auxiliary
Grant Program to help pay for their monthly rent.
So, let me “flip over,” to
the nursing home(s)/facilities. So, nursing facilities are a little bit
different. But, you can, for Medicare and Medicaid both pay for nursing home
care Medicare is pretty restrictive in the nursing care that it provides. And
there are some certain requirements that have to be met in order for Medicare
to pay for nursing home costs. So, there's like four or five different
requirements in a person has to meet each one of these. So, the first thing is
they have to have Medicaid—(pause)-- I'm sorry, but I'm sorry Medicare, part A,
insurance, which is the Medicare Hospital coverage.
Most
Medicare recipients app and then the next thing is
they have to have a qualifying Hospital stay that means that there had to have
been a medically necessary stay in an inpatient Hospital of at least 3 days or
more, in order to qualify for Medicare to cover Nursing Facility cost. The
doctor- the person's doctor- would have to order a Skilled Nursing Facility
placement because in order for the individual to receive like services from you
do physical therapist, occupational therapist, speech language pathologist,
RN’s? Because again, Home Care, is designed to help people recover or rehabilitate
from illness, or, injury.
And then, you do basically
it Medicare will cover down and I can't remember I
think there might be a limit to the number of days but I have to I'll have to
check on that and people can always contact dLCV if
they have more questions about that! So then, with respect to Medicaid-cover
nursing home care, for people who are extremely low income. Because Medicaid,
by its nature is a health insurance program for low-income people children and
families that live in poverty or children, or, other folks that have extremely
low income.
So
for a person that qualifies for Medicaid assistance for nursing home care I
think the current regulation is that they have to have an income I think the
last I heard was $1,700 a month and then also meet the requirements and terms
of physical and Medical Care needs for nursing facility care hope that makes
sense but the difference really is that your Medicare part A Nursing Facility
cost can be covered for anyone under Medicare assuming that they meet the
required criteria but for Medicaid covers the person would have to be extremely
low income, AND, have a life is a resource limit is $2,000 in liquid resources
like cash and bank accounts or whatever the cost Medicaid long-term care. It's
kind of complicated and if people have questions about those things they with
respect and Medicaid they would want to contact their local Department of
Social Services.
And
for Medicare they would want to contact Medicare program and there's an 800
number that has to answer Medicare and Medicaid are both insurances but with
the auxiliary Grant good questions and the person would need to apply to
their local Department of Social Services for the auxiliary grant program and
they would need to be recipients already recipients of SSI so if they if the
person receives SSI and they do want to move into an assisted living facility
or potentially two into their own home in a permanent Supportive Housing
setting and let me explain for folks with that mean, so:
[Suzanne]: So:
Medicare and Medicaid are
both insurances. But with the Auxiliary Grant [Program], is that something you
have to apply for personally? How does that work, getting that support?
[Rhonda]: Yes,
good question! The
person would need to apply through (to) their local Department of Social
Services for the Auxiliary Grant Program. And they would need to be recipients-
already
recipients-
of SSI. So, if they-…
if the person receives SSI, and they do want to move into an Assisted Living
Facility, or potentially, into their own home in a Permanent Supportive Housing
setting… [..] And, let me explain for folks with that means, so:
Permanent
Supportive Housing is a
service that is designed to provide people with access to housing by allowing them
to find and develop the lease for their own apartment, or house, or whatever it
is that they decide to rent. And the program pays-- generally in Permanent
Supportive Housing- the program pays for two-thirds of the monthly rent. And,
then, the resident pays a third of their monthly income to the rent.
Essentially, the resident pays its third, and then, the program picks up the
balance of the cost. And so, these programs are/were designed to provide people
that may need some support with independent living. Like, they may need— (you
know)- Do you have some support understanding or training?
And.
(also), how to manage their money, or, how to maintain an apartment, or do some
of these other things. But it is designed to be permanent housing for the
person. It is the Supportive Housing Model that pretty much everybody follows
now, & is that it has a housing first model. Which means they don't have to
agree to participate in any kind of services. Because, the goal is for them to
be housed. That’s the important thing for everybody, is that they have a
safe and secure place to live! I mean, housing is healthcare, -from that perspective!
- (Esp.), for people with disabilities. And disabling conditions! So, this
program, the auxiliary grant program, covers two-thirds of the monthly rent for
people who are in a Permanent Supportive Housing setting. So, to apply, they
would need to go to their local Department of Social Services to apply. And
they would not be eligible unless they are unless they’re (they are) SSI recipients.
[Suzanne]: Thank you so much, Rhonda.
This is really interesting! And a lot of information that I think people
probably didn't know before. [So,] if they want more information on nursing
facilities or assisted living facilities or anything that we talked about
today, where can they find it?
[Rhonda]: So, there are many places online where people
can get information about individual facilities, &, about assisted living
facilities, about the differences between assisted living facilities (and nursing
facilities). They can always contact dLCV, if they've
got questions Or, if they have concerns about the care that they're receiving.
Or, you know, they feel like something isn't quite right, you know, they should
definitely contact dLCV. Because we might be able to
provide them with some assistance- in figuring out, you know, what their rights
are. We CAN’T recommend specific
facilities here at dLCV. Like, we’re… [...] we can't
really do that. But, there are, if people have access to the internet, they can
Google: “Assisted- Living Facility reviews, Virginia. Or, Nursing Facility
reviews, Virginia.” Because there are lots of websites out there that do
provide this information. You know.
If you think you need to,
OR, you want to, go into an assisted-living setting or you need to go
into a nursing facility setting? You know that- you have- there are lots of
choices, and, in finding out more about the facility, the specific
facility, that the person might be looking at, will be really good
(information) to have. I mean, and, what I want to mention, too, is
that nursing facilities in Virginia are licensed by the Virginia
Department of Health. Just like hospitals and home healthcare agencies,
here, do, they have specific requirements. Because of all these Nursing
Facilities receive federal funds.
So
they have, you know,- there are certain rights that
people have in nursing facilities, as residents. Same thing with Assisted
Living facilities. However, like I said earlier, for Assisted Living Facilities
in Virginia are licensed by the Virginia Department of Social Services. So it's a different licensing agency. But again, if
people have concerns or questions other than needing recommendations, for a
specific facility. they can contact dLCV. And we
might be able to help.
[Suzanne]:
Well, fabulous! Thank you so much, Rhonda; we so appreciate you being here!
[Rhonda]: Well,
thank you for having me! I’m glad we got to do this!
[Suzanne]: Me
too. It’s always a pleasure chatting with you.
[Valerie]: And now, a dLCV
highlight!
Starting in May 2021
the Transportation Security Administration (TSA) will be implementing new staff
training and screening procedures to better serve individuals with disabilities
as they travel. Several states have recently updated laws to allow people with
disabilities to add “communication impediment designation” on identification
cards, like drivers’ licenses. These new additions will help law enforcement
officers and TSA, as well as others in the community, be aware of potential
communication needs for these individuals. All TSA officers will be trained
starting in May to be aware of the designation on cards and how to work with
those individuals. “We are committed to
helping individuals with disabilities navigate the travel screening process and
to ensuring that all passengers, regardless of their personal situations and
needs, are treated with dignity, respect and courtesy,” TSA’s Darby LaJoye wrote.
[Suzanne]: Thank you so much, again, to Rhonda Thissen,
for being on the podcast today. I think we learned a WHOLE LOT, about
the differences between assisted
living facilities and nursing homes. Especially when it comes to insurance,
which is complicated, as always, but I hope Rhonda was able to shed some light
on everything for our listeners, as much as she was able to shed some light on
it for us, here.
[Valerie]: Yes, mind-blowing
information, and greatly appreciated! Very informative and educational!
Thank you so much, Rhonda.
[Suzanne]: Thank you, Rhonda.
[Valerie]: Thank you all for
listening to this episode of Rights
Here, Rights now, brought to you by the disability Law Center of Virginia.
We’re available on Apple Podcasts, Spotify, or, wherever you get your podcasts.
Don't forget to subscribe and leave a review!
[Suzanne]: If you need
assistance, or want more information about dLCV, and
what we do, you can visit us online at: www.dLCV.org.
[Valerie]: Follow us on Twitter, at: disAbilitylawVA. All one word. And share us with your
friends. J
[Suzanne]: Until
next time: I’m Suzanne Herbst!
[Valerie]: And I’m Valerie Jones!
And this has been: Rights Here,
[Suzanne]:
Rights Now!
**[End
of Transcriptions]**