Options for Extra Care: Nursing Homes and Hospice Facilities

Options for Extra Care: Nursing Homes and Hospice Facilities
The services offered by nursing homes, assisted living facilities, or hospice are all very different. Find out more about each one and the costs associated with them.

Most people hope to live out their last years at home, but health circumstances may necessitate moves to nursing homes or assisted living facilities. When a loved one’s illness is terminal, hospice facilities or hospice care at home may be the most caring solution.
According to admissions director Janice Harris of Pickersgill Retirement Community in Towson, Md., each facility serves a different purpose and entails different costs.

Assisted Living Facilities

If your loved one is not incapacitated to the point that you need to consider the skilled care offered by a nursing home, assisted living can be a viable solution. Many are in pleasant, planned communities and can be a terrific option for people who are unable to maintain their own homes any longer or take care of daily needs such as cooking or driving; they may be experiencing decreased sensory perceptions and delayed reaction times or confusion, but don’t need round-the-clock nursing care.

The down side is the high cost. “Assisted living facilities can run from $1,000 to $5,000 per month or more,” says Bill Guerra, RN, BSN, with the Seven Hills Surgery Center in Henderson, Nev. Some assisted living facilities also charge extra for services like administering medications, providing trips to the physician, bathing, and so forth.

Medicaid will pay for assisted living for certain patients, depending on their income and personal resources.

Nursing Homes

Nursing homes provide care when patients can’t take attend to their basic needs, are incapacitated by illness, or have dementia, says Guerra. Some, like “memory centers,” cater to patients with dementia who are prone to wandering — leaving home and getting lost — or hurting themselves unintentionally, though they can usually walk and talk.

Nursing homes can be private-pay facilities or state-run homes covered through the Medicaid system for people who can’t afford the costs on their own. Qualifying for Medicaid is a complicated procedure, and it might be a good idea to consult with an elder law attorney. If you have time to plan ahead, you can take out a long-term care insurance policy to cover some or all costs, should a nursing home be necessary later in life. Medicare pays only for very limited stays under certain circumstances and not continual, long-term residence.

Hospice Facilities

Hospice facilities offer end-of-life care — care that is often administered in the patient’s home, though there are physical hospice facilities, too. Some hospice programs are independent, others might be within hospital settings. Tina Daniel, RN, a nurse manager with Gilchrist Hospice Care in Towson, Md., says that anyone can request an evaluation for hospice care: the patient, the doctor, friends, or family members. “At some facilities, a representative from the hospice or a nurse can determine if hospice is appropriate by visiting your loved one in their home, assisted living facility, or nursing home,” says Daniel.

“It does not matter whether you have personal insurance, Medicare, or Medicaid. If your loved one is terminally ill, you do not ever have to pay for hospice care services as there are non-profit hospice facilities that offer services for free,” says Guerra.

Gilchrist Hospice Care, where Daniel works, is an example of a non-profit facility and admits patients for hospice services regardless of their ability to pay. “Medicare covers 100 percent of services relating to terminal illness at home and at a long-term-care facility,” says Daniel. However, Medicare does not pay for room and board. The services covered are clinical support, equipment, and medication relating to the terminal illness. Insurance may assist with a portion of the cost of room and board. Daniel says, “We work with all insurances and discuss the benefits and co-pay with you.”

Your loved one’s medical team, the support staff at the hospital where treatment was given, and non-profit organizations are ways to get suggestions for local hospice facilities.

Finding Solutions

Your first step is deciding which facility is right for your loved one’s needs at this stage of his or her life. Then you’ll need to research costs, figure out what resources are available to pay for it, and whether your loved one qualifies for financial assistance or has any insurance. Investigate what your loved one may be entitled to from Medicare and Medicaid. Depending on the person's age and health status, there may be time to get long-term insurance for the future.
Once you know your budget, you can begin interviewing facilities about the level of care they offered and find the best one to meet your loved one’s needs.