Nursing Homes: A Comprehensive Guide for 2024

What Is a Nursing Home?

Nursing homes are live-in communities for older adults that require 24/7 care, including both medical and non-medical. This high degree of skilled care is what separates nursing homes from other senior living communities.

Nursing Homes vs. Assisted Living

When it comes to types of care environments, most people have heard of only two: nursing homes and assisted living. Assisted living facilities, however, differ significantly from nursing homes, as they offer predominantly custodial care, that is, help with tasks such as dressing, walking, and cooking. Many assisted living facilities also offer group events like happy hours, restaurant-style dining, group outings, and help with daily living activities like laundry and housekeeping services.

By contrast, nursing homes offer some of the amenities of assisted living like individual suites, but the function is much more geared towards medical care, hence the name: nursing home.

At a nursing home, residents are given the same assistance as assisted living facilities with respect to helping with day-to-day activities like medication management, laundry, housekeeping, and bathing. Still, they may also receive more specialized care like routine rehabilitative therapy, occupational, speech, and physical therapy, palliative, and preventative care, in addition to dental care and other forms of skilled medicine.

When Should You Consider a Nursing Home?

In reality, there is no right answer when it comes to putting a loved one in a nursing home. The decision will largely depend on your finances, your time commitment to being a caregiver, and the overall health of the person in question.

The decision to put a parent in a nursing home is a tough one, and it’s largely met with a mix of guilt and relief. It’s easy to say, “I’ll never put my mom in a nursing home,” but the reality is that in some cases, the care you can offer as a caregiver isn’t sufficient to let your loved one live safely. It’s a trade-off. Older adults may be required to sacrifice a certain level of independence to help ensure their safety and health for years to come.

Some signs of when you should consider a nursing home:

• Your loved one is frequently in and out of the hospital.
• Your loved one has late-stage Alzheimer’s or dementia.
• Your loved one has frequent accidents or injuries at home.
• You’re afraid for the safety of your loved one.
• You find yourself struggling physically with caregiving. (For example, you strain your back helping up a loved one who has fallen.)

If living independently poses a constant risk to an older adult’s health and you’re unable to provide that care yourself, it may be time to consider alternative living arrangements.

While your loved one may disagree with the decision, it’s important to remember that the decision isn’t solely up to them. The decision to place them in a nursing home should be made collectively, with everyone’s needs fully considered. It’s also important to remember that this decision isn’t final. A nursing home resident can potentially recover and return to their home as they regain the ability to care for themselves. Regardless, a nursing home is not the end of your caregiving. Even though your loved one may be relocated, your role as a caregiver is never abdicated entirely, though it may shift.

Making the Transition to a Nursing Home

Transitioning to a nursing home or assisted living facility can be an intense process, one that affects both seniors and caregivers alike. There are steps that can be taken, however, to ease the process for both parties.

Easing the Transition for Older Adults

Think about what it was like going off to college and living in the dorms for the first time or your first day of high school. Entering a new community full of strangers is scary. Now, compound that fear with a confrontation of your own mortality and a change in lifestyle that you may have had for more than half a century. The transition from home to a facility is profound for everyone involved.

As a caregiver, there are several ways to help ease this transition. First, help to facilitate integration into this new community. Accompany your loved one to nursing home events and meals to help ease the transition. Also, let them be heard. An older adult will have opinions and fears about their new situation; be there to empathize with this new arrangement.

It’s amazing how much simply being there is a big deal in helping an older loved one adapt to this new normal. Scheduling time for yourself and other family members to be present, especially early in the transition, can make all the difference. The important thing for an older adult to know is that they’re not in this alone. Until they are more integrated into a senior living community, being that source of comfort is essential.

Finally, helping to make wherever the older adult is staying feel like home — whether it’s an assisted living facility or a nursing home — can be a major step in easing the transition. This can include things like decorating and adorning their room with comforts from home.

Making the Transition as a Caregiver

While the transition to a nursing home or assisted facility is hard on a person, it can also deeply affect caregivers. It’s important that your feelings aren’t lost in this process. Like the senior making the transition, it’s important that you’re heard. Make sure you’re surrounding yourself with people who can empathize with your situation. At a nursing home, there will likely be other caregivers, and forming bonds within that community can help ease the transition for you as well.

How to Choose a Nursing Home

Several factors can help determine which nursing home is right for you. The right facility will largely be based on need and cost (more on that later). Before deciding on a facility, it’s important to have a full understanding of the services the facility offers and what the older adult needs.

For example, if the older adult needs pain management and physical therapy, it’s essential to have a nursing home that is going to provide that care. Beyond that, take an exhaustive look at what competing facilities are providing for what’s being paid. These facilities often offer everything from medical services and housing to meal plans and funding for activities; it can add up fast, and it’s important that you’re getting the best care for your money.

In terms of choosing a facility, word of mouth definitely goes a long way. If an older adult already has friends in a nursing home, this can make the transition much easier and take some of the guesswork out of the selection process. So ask around to friends who may have older parents, and have your loved one ask around as well; they can be a vital voice in deciding on the best place for themselves.

How To Pay for a Nursing Home

We’re not going to sugarcoat it: The cost for nursing homes can be astronomical. The median cost of a private room in an assisted living facility in 2022 was $4,635 per month, and a private room in a nursing home was $9,305 per month. The reality is, there is no universal way to pay for care in a nursing home or assisted living facility. The best option is to consult a financial planner or elder law professional; these experts can help get a full picture of an older adult’s assets to determine what can be leveraged to help pay for a stay in one of these facilities.

Odds are, paying for a stay in a nursing home is going to come down to some mix of the following sources: assets from the older adult (the sale of stock or a home, for example), funds provided by other family members and caregivers, long-term care insurance, and defrayed cost from government programs, specifically Medicaid. 

To learn more, read our guide to Medicare and Medicaid coverage of nursing homes.

Does Medicaid Cover Nursing Homes?

In most cases, Medicaid will pay for nursing home care, provided you meet the financial eligibility requirements laid out by the program. These requirements differ in every state, so you’ll want to stay abreast of your state’s regulations. In my experience, Medicaid generally covers the entirety of nursing home costs, including room, board, and care in the facility. Again, though, you must meet the financial eligibility requirements for this to be the case.

Are Nursing Home Costs Tax Deductible?

In some cases, nursing home costs can be deducted from your taxes as medical expenses. If your loved one is in a nursing home primarily for medical reasons, then all of the nursing home costs (room, board, care, etc.) can be deducted. If, however, your loved one is in a nursing home for non-medical reasons (ex: mobility), then only the itemized costs of care will be deductible, which means room and board will not be.

How to Pay for a Nursing Home with No Money

If you have neither savings nor insurance to cover long-term care, then it is likely that you’ll qualify for Medicaid coverage for a nursing home stay. In 2021, to qualify for Medicaid, you must make less than $2,382 per month.

Alternatives to Nursing Homes

It’s best to think of elder care as a spectrum, with an older adult living at home and a caregiver checking on them periodically to make sure they’re safe on one end, and hospice care on the other. We’ve already drawn a distinction between assisted living and nursing homes, but before an older adult reaches the necessity point for a nursing home, there are other options available, namely in-home care, adult daycare, and continuing care retirement communities (CCRCs).

CCRCs

Think of CCRCs as an all-encompassing senior living environment. Located all on one campus, a CCRC has nursing home facilities and assisted living facilities that seniors can move between as their needs change. Additionally, a CCRC will often have gyms, dining halls, recreation areas, and more. Essentially, they’re designed for seniors to live in for the rest of their lives (which is why they’re sometimes called life plan communities).

In-Home Care

There are many levels to in-home care, with many existing as a stage before assisted living. In-home care is often preferred by older adults because it allows them the freedom to stay in their own homes. In-home senior care is a great option for many older adults, especially in the wake of a medical emergency, because it can provide rehabilitative care from a professional, which helps alleviate the responsibility placed on a caregiver who may not have the knowledge to provide adequate medical treatment. In-home care can be a more affordable option for some, but as needs change, the financial burden of keeping a home health worker on staff full time can rival some assisted living facilities. Unfortunately, Medicare does not cover in-home care.

Adult Daycare

Adult daycare has an admittedly demeaning name, but it is accurate. Think of adult daycare like childcare, though far less condescending once you get past the title. Caregivers are able to take their adult loved one to a facility during the day — which can especially help those who have day jobs—where they receive supervision and care as needed. Adult daycare provides valuable social interaction for older adults and a wide array of care, which can include everything from counseling and educational programs to physical therapy and other specialized services.

Recap

Placing a loved one in a nursing home or assisted living facility is one of the hardest decisions a caregiver will ever have to make and one of the hardest realities an older adult will face. When taken with empathy and understanding, however, it can be a decision that helps ensure the safety and comfort of loved ones for years to come.