What are the usual medical needs that are deciding factors when determining if a person needs skilled nursing vs assisted living?
What does a SNF facility do that an AL facility cannot/will not? What is the “crossover” point between the two levels of care where AL is no longer appropriate?
You need to talk to the specific Assisted Living facility. My dad's AL has some specific things they can't/won't deal with but I know that in some situations long-term residents have been able to hire private help so that they can continue living there. Assisted Living facilities are pretty unregulated so there is probably not a lot of consistency. In some places it seems like there is a lot of overlap long-term nursing homes and in others, it seems that it's more independent living with meds disbursement, meals and a bit of help.
In general people in assisted living have to be able to perform all the ADL's with minimal assistance
"Walking, or otherwise getting around the home or outside. The technical term for this is “ambulating.”
Feeding, as in being able to get food from a plate into one’s mouth.
Dressing and grooming, as in selecting clothes, putting them on, and adequately managing one’s personal appearance.
Toileting, which means getting to and from the toilet, using it appropriately, and cleaning oneself.
Bathing, which means washing one’s face and body in the bath or shower.
Transferring, which means being able to move from one body position to another. This includes being able to move from a bed to a chair, or into a wheelchair. This can also include the ability to stand up from a bed or chair in order to grasp a walker or other assistive device." https://betterhealthwhileaging.net/what-are-adls-and-iadls/
Minimal assistance may mean the difference between -helping someone dress vs dressing them -reminders to wash up, comb hair, shave etc vs doing those things for them -helping use the toilet vs needing to actually schedule toileting and then wiping (while urinary incontinence can usually be managed I think anyone with fecal incontinence is going to be encouraged to move on) -helping someone get to the dining room and perhaps providing a modified diet but not helping them to eat -helping to get into the shower/tub and supervising bathing vs actually bathing them
All ALs have a sliding fee scale for every extra service, some ALs will promise the moon and not deliver, and some will only agree to a accommodating a higher level of care if extra aids are paid for.
Assisted living is just as the name says, the person needs assistance in some way. There is usually an RN and maybe an LPN. The rest of the staff are aides. The resident should not have Dementia. Thats were Memory Cares come in. They are a step up from ALs. The units are lockdown. More aides. But neither of theses are able to care for someone with serious health problems. Thats were SN and Long-term care come in.
Then there is the money thing. When it runs out for AL or MC, the only other option is LTC with medicaid paying.
Everyone at the assisted living where my mom was for several years had some sort of dementia. What they wouldn't do: take care of incontinence (residents had to know how to do that by themselves), handle serious physical illness, lock doors for wanderers, or put up with any violence. They helped them get dressed and into pajamas at night for bed (with a hug), reminded them to brush their teeth, helped with bathing, brought in entertainment, had church service, baked way too many sweets, took them for short walks in the neighborhood, and let them watch TV non stop. Many were able to live to the end of their lives right there at the facility with very kind attention to their needs. However, when dementia got too hard to deal with, as with my mom trying to go outside in the middle of the night, they would have to move to memory care.
Unlike ALF and MC, SNF facility has nursing staff present in some numbers.
It really is difficult to tell you all the conditions that can/do require SNF, but basically you are looking at any condition that requires medical care/assessment ongoing. This could be a pressure sore. This could be airway issues due to indwelling trach. This could be any serious healing condition such as amputation, et al that requires dressing changes. This could be a patient who requires medication titration due to say a severe and unstable diabetes. There could be indwelling, surgically implanted devices needing nursing assessment for other patients.
Some SNF facilities have long term care areas where rehab and nursing care can come easily in on a daily basis.
What LTC specialty might be required is generally decided with the physician in charge of and familiar with the patient.
"Skilled Nursing Facilities provide more complex medical care and rehabilitation while Long Term Care Facilities offer more permanent support for day-to-day needs. In some instances, both types of institutions are combined to provide the most comprehensive level of care."
AL facililties provides "assistance" with ADLs but no real on-going medical care (like if someone has a progressive physical illness or has lost all their mobility).
In my experience a doctor assesses someone as needing LTC or SNF.
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"Walking, or otherwise getting around the home or outside. The technical term for this is “ambulating.”
Feeding, as in being able to get food from a plate into one’s mouth.
Dressing and grooming, as in selecting clothes, putting them on, and adequately managing one’s personal appearance.
Toileting, which means getting to and from the toilet, using it appropriately, and cleaning oneself.
Bathing, which means washing one’s face and body in the bath or shower.
Transferring, which means being able to move from one body position to another.
This includes being able to move from a bed to a chair, or into a wheelchair. This can also include the ability to stand up from a bed or chair in order to grasp a walker or other assistive device."
https://betterhealthwhileaging.net/what-are-adls-and-iadls/
Minimal assistance may mean the difference between
-helping someone dress vs dressing them
-reminders to wash up, comb hair, shave etc vs doing those things for them
-helping use the toilet vs needing to actually schedule toileting and then wiping (while urinary incontinence can usually be managed I think anyone with fecal incontinence is going to be encouraged to move on)
-helping someone get to the dining room and perhaps providing a modified diet but not helping them to eat
-helping to get into the shower/tub and supervising bathing vs actually bathing them
All ALs have a sliding fee scale for every extra service, some ALs will promise the moon and not deliver, and some will only agree to a accommodating a higher level of care if extra aids are paid for.
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Then there is the money thing. When it runs out for AL or MC, the only other option is LTC with medicaid paying.
It really is difficult to tell you all the conditions that can/do require SNF, but basically you are looking at any condition that requires medical care/assessment ongoing.
This could be a pressure sore. This could be airway issues due to indwelling trach. This could be any serious healing condition such as amputation, et al that requires dressing changes. This could be a patient who requires medication titration due to say a severe and unstable diabetes. There could be indwelling, surgically implanted devices needing nursing assessment for other patients.
Some SNF facilities have long term care areas where rehab and nursing care can come easily in on a daily basis.
What LTC specialty might be required is generally decided with the physician in charge of and familiar with the patient.
Source: https://www.sierracare.com/long-term-care-facility-vs-skilled-nursing-facility
AL facililties provides "assistance" with ADLs but no real on-going medical care (like if someone has a progressive physical illness or has lost all their mobility).
In my experience a doctor assesses someone as needing LTC or SNF.