Benjamin Franklin said it best: “Nothing in life is certain except death and taxes,” but with daily advances in science, technology, and health care, Americans are living longer than ever*. However, this blessing has created a unique dilemma for modern American families: how to plan and prepare for the retirement years.

Have you been on a road trip lately? Nearly every road is adorned with large billboards providing the locations of new planned communities where couples can spend their retirement years engaged in recreational pursuits. I doubt you’ll find a local newspaper that doesn’t have at least one ad promoting the amenities found in a local assisted living facility. Try searching for “nursing homes in Virginia” on the internet and thousands of web pages will come up. New facilities offering different programs are being built and marketed every day throughout the state.

Is this facility right for you and your family? If so, what installation? We often hear the terms “retirement community,” “nursing home,” and “assisted living facility,” but we rarely consider what these terms actually mean. However, the differences are striking and it is imperative to understand these differences when making decisions for yourself or your loved ones.

NURSING HOMES

In Virginia, a nursing home means any facility whose primary function is to provide long-term nursing care, nursing services, and health-related services on a continuing basis for the treatment and inpatient care of two or more non-patients. related**. Simply put, a nursing home is a facility designed for someone who needs less care than a hospital, but requires daily medical assistance.

The Virginia Department of Health licenses these facilities and has established guidelines governing various aspects of their operations, programs and staffing needs, etc.***. For example, a nursing home must: (a) have written policies and procedures on resident treatment and resident care management that are available to residents and their families (12VAC5-360-20); (b) provide emergency medical services within 15 minutes, under normal conditions (12VAC5-360-50); (c) be subject to unannounced on-site inspections of the nursing facility by state employees (12VAC5-371-60); (d) have a written agreement with one or more physicians licensed by the Virginia Board of Medicine to serve as medical director (12VAC5-371-230); and (e) each resident will be under the care of a physician licensed by the Virginia Board of Medicine (12VAC5-371-240).

In addition, nursing home residents are also afforded certain rights as defined by Virginia Code §32.1-138. See http://leg1.state.va.us/cgi-bin/legp504.exe?000+cod+32.1-138. Nursing homes are the most regulated and structured residential options for our seniors who require some level of daily medical care. If the facility provides care through the Medicare and Medicaid programs, it is considered a “certified nursing facility” (Va. Code §32.1-123; Va. Code §32.1-127) and must comply with federal and state laws .

Of course, the more rules and regulations define and control the daily operations of a nursing home, the greater the responsibility of the staff. These are the people who will handle the day-to-day job of caring for your loved one and making sure they comply with state and federal laws. No matter how nice or attractive the facility is, the staff will make the difference between caring and nurturing your loved one or not.

A nursing home is best suited for someone:

• Who requires daily medical care, such as assistance getting in and out of bed; taking medications; or using the restaurant.
• May have dementia or Alzheimer’s and, as a result, be unable to eat or bathe daily without prompting or assistance;
• Who is recovering from a fall or accident and therefore cannot walk, dress or eat without assistance.

ASSISTED LIVING FACILITY

“Assisted Living Facility” means an adult care residence that has been licensed by the Virginia Department of Social Services to provide a level of service to adults who may have physical or mental impairments and require at least moderate assistance with activities of daily life. Within assisted living, there are two types: regular assisted living for those seniors (typically) who need help with one or more daily activities; and intensive assisted living for someone who may be unable to perform activities due to severe physical or mental impairment (12VAC30-120-450).

The Virginia Department of Social Services licenses assisted living facilities, but does not regulate in the same way that the Department of Health regulates nursing homes. While there are Virginia guidelines regulating aspects of assisted living facilities, they are limited: An assisted living facility must: (a) provide or coordinate personal and medical care services; and (b) provide 24-hour supervision.

As reflected in the table below, assisted living facilities are not required to provide medical care and/or have healthcare personnel available to assist your loved one. Additionally, without an obligation to provide such services, there is the question of whether or not they have a duty to warn or treat residents with illnesses or diseases that may be transmitted from other residents.

While a nursing home will have many nurses on staff and physicians hired to monitor residents, assisted living is more analogous to an apartment building or college dormitory where laundry and food services are provided and residents are alone for the day. rest of the day.

An assisted living facility is best suited for someone:

• That you are basically independent but cannot or will not prepare your own food or drive to medical appointments;
• Someone who wants to scale down and anticipates needing help with laundry, cooking, etc. in the near future.
• A couple in which one spouse is independent but may need help feeding or meeting the other spouse’s needs.

Continuing Care Retirement Community

In Virginia, you may also see ads for a retirement community. They’re popping up in all of our favorite college towns and tourist destinations.

A continuing care retirement community provides care based on your current needs. Like an insurance policy, the resident pays an entry fee and adjustable periodic payments, which in turn provide the resident with a package of residential and healthcare services that the CCRC is required to provide at the time these services are residential and health care are required. For example, if when entering all you want is help with your meals, that is the only service that will be provided. Whether you need intensive physical therapy or God forbid daily assistance for a dementia patient, CCRC has assisted living or nursing home services available under your contract. Continuing care contracts are regulated by the Virginia Insurance Office of the Virginia State Corporations Commission.

Many CCRCs may have nursing home services available on-site or at licensed off-site facilities (12VAC5-360-10). While you may enter the retirement community as a very healthy, independent and capable resident, as your needs change, so will your contract with the community and, in turn, the facility’s obligations to you.

A continuing care community retirement center is best suited for someone:

• Who is basically independent but anticipates the need for daily medical care for himself or his spouse in the near future;
• Someone who has a physical disability and would not be able to care for themselves or their spouse if the disability worsened.

With at least three very different options, it is very important to do your research:

To search for assisted living facilities in Virginia, visit the Department of Social Services website: http://www.dss.state.va.us/facility/search/alf.cgi.

To search for nursing homes, visit the Medicare website: http://www.medicare.gov

AND LAST BUT NOT LESS IMPORTANT

It’s always best to speak with a family member of a current resident and spend time getting to know the staff, no matter what type of facility you’re looking for. If looking and researching isn’t enough, then consider the chart below: a comparison of the legal duties of a nursing home to the legal duties of an assisted living facility in Virginia.

DUTY or REQUIREMENT

NURSING HOME

ASSISTED LIVING

Duty to provide nursing care and/or monitor the health of residents?

YES

NO

Is a doctor required to supervise the residents?

YES

NO

Will each resident be under the care of a physician licensed by the Virginia Board of Medicine?

YES

NO

Should you have nurses on staff?

YES

NO

Should you offer rehabilitation services?

YES

NO

Do you need to have ongoing consultation from a registered dietitian or dietitian on staff?

YES

NO

Is 24 hour supervision required?

YES

YES

Do you have to develop a written plan at the time of the resident’s admission?

YES

YES

Do staff have to undergo a criminal background check?

YES

YES

Overseen by the Virginia Center for Quality Health Care Services and Consumer Protection

YES

NO

Overseen by the Department of Social Services

NO

YES

*Life expectancy has increased dramatically over the past century, from 47 years for Americans born in 1900 to 77 years for those born in 2001. These same factors (better health care and prevention efforts) that are partly responsible for increases Dramatic changes in life expectancy have also produced a major shift in the leading causes of death in the United States in the past century, from infectious diseases and acute diseases to chronic diseases and degenerative diseases. The State of Aging and Health in America 2004, published by the Centers for Disease Control, available at http://www.cdc.gov/aging/pdf/State_of_Aging_and_Health_in_America_2004.pdf.

**See generally, Virginia Code §32.1-123, as amended and Virginia Administrative Code § 12VAC5-360-10.

***It is a felony under Virginia law to operate a nursing facility without a license. See generally, 12VAC5-371-30.