Inside Assisted Living Facilities: What They Are and How They’re Different
Director Series 1: Home Care with Marco Aguiluz
January 18, 2022
Director Series 2: Residential Care with Arda Kardjian
February 9, 2022Inside Assisted Living Facilities: What They Are and How They’re Different
Finding the right assisted living facility for a loved one can feel overwhelming. Moreover, this is especially true for those who require ongoing, long-term care. Some options include skilled nursing centers or residential care facilities for the elderly. In conclusion, knowing what facilities are available and what kinds of care they offer, can be challenging.
To help clear up the confusion, we’ve created this overview to help you understand:
- The different types of care facilities and what assisted living facilities are
- What kinds of care they provide
- How to find the best fit for your loved ones
The different types of long-term care facilities
Individuals who need long-term care stay at different kinds of facilities for different lengths of time. Consequently, It depends upon their short-term and long-term needs. Some facilities are designed for short-term care. However, others–commonly known as “assisted living facilities”—can provide care for longer periods of time.
“Assisted living facilities” can mean multiple things. It includes small, independently-owned Residential Care Facilities for the Elderly (RCFE) homes. It also includes large complexes owned by national chains. On first glance, it may seem that assisted living facilities provide skilled and custodial care. However, this is not the case. In assisted living facilities, skilled care is provided through third-party or outside home health or hospice teams.
Skilled care vs. custodial care
Under the Centers for Medicare & Medicaid Services (CMS), assisted living facilities provide “long-term care” (LTC) for those who need help with physical or emotional needs over an extended period of time1.
There are two kinds of LTC facilities, per CMS guidelines:
- Skilled care is medically necessary care that can only be provided or supervised by skilled or licensed medical personnel, including nurses and physical therapists.
- Custodial care is non-medical care that involves help with daily living activities. This includes bathing, dressing and any other routine activity that can be safely and reasonably provided by non-medical caregivers2
Skilled care facilities
Patients can receive post-hospitalization, skilled care and supervision can be offered at their home or in a specialized type of facility. Specialized facilities offering short-term, post-acute care are skilled nursing facilities (SNFs) or rehabilitation centers. Specialized facilities offering long-term care are called nursing homes.
- Skilled nursing facilities and rehabilitation centers essentially offer the same kind of nursing care patients receive in hospitals.
- Nursing homes offer custodial care under the supervision of registered nurses (RNs).
Skilled nursing facilities
SNFs specialize in post-acute care, care provided after a hospital stay3. As a result, they offer short-term care that’s focused on rehabilitating patients. The goal is to stabilize patients for transfer to home, assisted living facilities, or RCFEs4.
SNFs feature RNs, LVNs, as well as non-skilled specialized staff. This staff can include physical therapists, speech language pathologists and occupational therapists. SNFs also provide necessary non-medical care alongside skilled nursing, such as meal preparation and non-medical assistance.
In addition, once patients no longer require post-acute care, they may return to their pre-hospitalization environment. This can be home, an assisted living center or a residential care facility for the elderly.
Nursing homes
The primary difference between SNFs and nursing homes is the length of care and the provision of custodial care for qualified patients5. Nursing homes feature several different types of nurses. Keep in mind, these include RNs, Licensed Practical Nurses (LPNs), Certified Nursing Assistants (CNAs), Nurse Practitioners (NPs) and occasionally gerontological nurses.
Within the nursing home setting, each nurse plays a different role:
- RNs are often in supervisory roles. Their title is sometimes referred to as “Head Nurse”. They work directly with patients’ doctors to oversee LPNs and CNAs. They create work schedules and designating assignments. RNs also initiate patient care plans. In addition, they administer medications, prepare IDs, draw blood, and check vital signs.
- Gerontological nurses are sometimes known as geriatric nurses. They are RNs with specialized certifications that assist other RNs with chronic conditions. In addition, they help with patient and family education and outreach. Plus, they monitor signs of abuse and neglect6.
- LPNs work under the direct supervision of RNs. They focus on routine and bedside patient care. This includes assisting RNs with checking vital signs or applying dressings and bandages. Finally, they monitor IVs to helping patients get in and out of bed.
- CNAs work alongside LPNs. They assist with everyday care. Firstly, this includes bathing/grooming, feeding, and transportation. They also provide assistance that LPNs cannot provide. In addition to administering medication, they supply and start IV medications7.
- Different states have different regulations about CNAs administering medication and IVs.
Custodial care facilities
In addition, custodial care is non-medical. It can be provided in residential care facilities for the elderly, assisted living centers, adult day service centers, and continuing care retirement communities, as well as in home settings9.
More importantly, Some seniors need more care than can be provided in a home setting. But not necessarily 24/7 medical care. There are multiple options ranging from small, intimate settings to large retirement communities.
In general, there are more opportunities for personalized, long-term care at a small, intimate residential care facility for the elderly. The large assisted living facilities typically do not offer this level of care.
Residential care facilities for the elderly
RCFEs are non-medical facilities that provide housing, meals, supervision, personal care assistance, medication storage and distribution and housekeeping for people aged 60 and older10
Moreover, RCFEs are smaller and more personal than retirement communities, assisted living facilities and nursing homes. RCFEs–sometimes known as board and care facilities–are licensed, home-like environments, for up to six residents.
For instance, Verona Court, a Parentis Health residential care facility, offers its residents more opportunities for customized care services than larger assisted living facilities can. The small 3:1 caregiver-to-resident ratio helps ensure that every resident receives personalized care whenever needed.
In contrast, while RCFEs are classified as non-medical and don’t require RNs, CNAs or LVNs on staff11, Verona Court was founded by an RN who personally oversees each facility. In addition, an LVN administrator and care manager are on-site, ensuring seamless communication with medical teams for every resident.
Verona Court’s executive team’s has decades of knowledge and relationships with area hospitals, doctors and nurses. This makes it much easier for residents to receive medical care quickly and comprehensively. This is one of several key differentiators between Verona Court and other LTC providers.
Assisted living centers
In contrast, assisted living centers (ALCs) are generally larger than RCFEs, housing anywhere from 100 to over 300 residents. ALC residents typically live in private apartments or rooms and share common areas.
ALCs frequently provide “tiered” care, offering different levels of care. Progressive care tiers require residents to pay more with each successive care level12, which can make the cost of care substantial. By contrast, as an RCFE, Verona Court is able to offer residents flat rates that never change. As a result, even if their care needs do change, their rates will not.
Adult day service centers
Adult Day Service (ADS) centers—sometimes known as adult day care programs—offer care and companionship during the day to older adults who need supervision.
The National Adult Day Services Association (NADSA) is a professional membership association that is the national voice of the Adult Day Service industry. The NADSA creates guidelines and sets forth a Code of Ethics for all member organizations. They also help standardize the kind of care patients can get.
Per NASDA, ADS facilities offer recreation, meals and some health-related services, including medication management and transportation.13
ADS providers can be standalone centers or can be located inside dedicated senior centers and houses of worship14. It is worth noting that while licensing and regulation of ADS providers varies from state to state, the NADSA’s Code of Ethics binds member providers.
In addition, ADS facilities typically charge a daily fee that ranges depending upon what services are needed. Care costs average from $25/day to over $100/day15.
Continuing care retirement communities
Continuing Care Retirement Communities (CCRCs)—sometimes known as life care or multi-level care communities—combine multiple levels of service, including independent, assisted and skilled16 care.
CCRCs are much larger, campus-style facilities, and what kind of care residents require determines where they live. In contrast, ALCs also offer similar hybrid care options. Most offer a wealth of personal services. similar to those found in large, independent living and retirement communities. These services include hair salons, libraries, cafeteria-style restaurants, exercise program. Some even have organized social and recreational activities. Plus, some have bank branch offices17.
It is worth noting, the plethora of activities and apartment-style living typically makes CCRCs significantly more costly than RCFEs and ALCs. As a result, their entrance fees and monthly charges are significantly higher; CCRCs also frequently have wait lists that can delay entry for months or years18.
The large environment of CCRCs also limits the amount of dedicated care residents can receive. However, RCFEs like Verona Court have limits of up to six residents. Consequently, this ensures a 3:1 resident-to caregiver ratio at all times.
Finding the right fit
Understandably, with so many different kinds of care levels and facilities, finding the right long-term care for loved ones can be challenging.
Moreover, seniors who can no longer live independently at home or large assisted living centers due to medical or memory decline are best served in small, home-like environments. As a result, more independent seniors who just need supervision may be better served in larger environments like ALCs, CCRCs or retirement communities.
Therefore, for those who don’t want to live in a large, campus-like setting, RCFEs are ideal, particularly if nurses are directly involved in the supervision of care. For instance, Verona Court is one of the few facilities that can offer this exact care mix to its residents.
Superior residential care
Verona Court was founded by an RN with decades of bedside experience who oversees every aspect of each facility, alongside an LVN administrator and care manager. Consequently, our residents receive care and companionship around the clock while maintaining their independence in a warm, intimate setting with all the comforts of home. Most importantly, with a six resident maximum, Verona Court preserves an ideal 3:1 caregiver-to-resident ratio, ensuring residents always get the care they need, when they need it.
In contrast, unlike other RCFEs, Verona Court can also offer residents coordinated care services. As part of Parentis Health’s unique continuum of care model, Verona Court residents can get access to services like transportation, home health, and hospice quickly and easily.
To learn more about Verona Court, please visit www.veronacourt.com. And to learn more about any of our services, please contact us any time!
The Parentis Health Learning Center is a trusted source for information, developed by our team of healthcare experts and created to inform and help guide patients and families on their healthcare journey.
1https://www.cms.gov/Medicare-Medicaid-Coordination/Fraud-Prevention/Medicaid-Integrity-Education/Downloads/infograph-CustodialCarevsSkilledCare-%5BMarch-2016%5D.pdf, accessed 1/11/22.
2IBID
3https://www.familyassets.com/nursing-homes/resources/skilled-nursing-vs-nursing-home#:~:text=Nursing%20home%20care%20provides%20permanent,allow%20recovery%20outside%20a%20hospital, accessed 1/12/22.
4http://www.caregiverslibrary.org/Caregivers-Resources/GRP-Care-Facilities/Types-of-Care-Facilities-Article, accessed 1/11/22.
5IBID
6https://www.payingforseniorcare.com/types, accessed 1/12/22.
7https://nursejournal.org/careers/geriatric-nurse/, accessed 1/12/22.
8https://www.nursingworld.org/~4af4e6/globalassets/docs/ana/ethics/state-chart-medication-aide-status-09-15.pdf, accessed 1/27/22.
9https://www.assistedliving.org/the-role-of-nurses-in-a-nursing-home/, accessed 1/12/22.
10https://www.nursingworld.org/~4af4e6/globalassets/docs/ana/ethics/state-chart-medication-aide-status-09-15.pdf, accessed 1/27/22.
11https://www.nia.nih.gov/health/residential-facilities-assisted-living-and-nursing-homes, accessed 12/29/21.
12http://www.canhr.org/RCFE/rcfe_what.htm, accessed 1/10/22.
13https://www.nadsa.org/learn-more/about-adult-day-services/, accessed 1/17/22.
14https://eldercare.acl.gov/public/resources/factsheets/adult_day_care.aspx, accessed 1/17/22.
15https://www.nadsa.org/code-of-ethics/, accessed 1/17/22.
16https://eldercare.acl.gov/public/resources/factsheets/adult_day_care.aspx, accessed 1/17/22.
17https://www.nia.nih.gov/health/residential-facilities-assisted-living-and-nursing-homes, accessed 12/29/22.
18http://www.caregiverslibrary.org/Caregivers-Resources/GRP-Care-Facilities/Types-of-Care-Facilities-Article, accessed 1/15/22.