Nursing Home Facts
When it comes time for families to consider placing a loved one in a nursing home or assisted living facility, there are a lot of factors to consider. Where is it? How is it run? What sorts of activities does a particular nursing home offer? You'll need to investigate these and many other questions to find the right fit for your loved one.
And there are a lot of options out there. According to data from the National Center for Health Statistics, as of 2016, in the U.S. there were an estimated:
4,600 adult day services centers.
12,200 home health agencies.
15.600 nursing homes.
28,900 residential care communities.
That’s a lot of potential sources of care for your loved one, and digging a little deeper into the facts and statistics surrounding nursing home care could help you make a more informed decision.
How Many and Who?
The Centers for Disease Control and Prevention reports that as of 2016, there were 1.7 million beds in licensed nursing homes in the United States. Many people who reside in nursing homes need assistance with one or more activities of daily living such as:
Eating or preparing meals.
Bathing and dressing.
Going to the toilet.
Moving around in the residence or getting to other locations.
As we age, these activities tend to become more challenging, especially if chronic health issues such as diabetes, arthritis, eye diseases, or cognitive impairment are also present. Many of these problems occur simultaneously.
The National Center for Health Statistics reports that in 2015-2016, the most recent year for which data is available, the majority of long-term care service users were aged 65 or older, with 83.5% of nursing home residents being in that older age bracket. That means 16.5% of residents were younger than age 65 – a sizable minority.
Gender and Ethnicity
More women reside in nursing homes than men – 60.3% of short-stay residents and 67.9% of long-stay residents were women. Additionally, non-Hispanic white people accounted for 75.1% of nursing home residents, the National Center for Health Statistics reports.
Residents in nursing homes typically have at least one chronic condition for which they need some ongoing medical care, and some have experienced falls or other injuries that have necessitated more intensive care. However, the Centers for Medicare and Medicaid Services reports that just 5.3% of nursing home residents in 2014 (the most recent year for which data are available) had recently experienced an "injurious" fall. Another 11% had fallen recently but weren't injured.
While some people may assume that nursing home residents all have cognitive difficulties such as Alzheimer's disease or other forms of dementia, that's not the case. Nearly 20% of residents have no impairment to their activities of daily living and "more than one-third (38.7%) had no more than mild cognitive impairment; a further 11.1% had no ADL (activity of daily living) impairment and little or no cognitive impairment," the CMS reports.
Those with significant cognitive impairment, meaning they had difficulty with five or more activities of daily living, represented just shy of 15% of the nursing home population.
Costs and Paying for a Nursing Home
Another popular misconception is that Medicare pays for a person's residency in a long-term care facility. Andrew Shea, senior vice president for eHealth, Inc., a private, online health insurance exchange based in Santa Clara, California, says that "many seniors are unpleasantly surprised to discover that Medicare doesn’t pay for long-term care."
While Medicare does cover the cost of skilled nursing home care in the shorter term, it only does so immediately following a hospitalization that lasts for at least three days, Shea says. “In those circumstances, Medicare may pay for up to 100 days."
When you get to day 101, other forms of payment need to be in place. (The coverage rules for Medicare Advantage plans are different, so check your specific coverage plan for details.)
Finding a way to pay for long-term care can be a big problem for many people. "Depending on where you live, nursing homes can cost as much as $80,000 per year," Shea notes, or more in some cases.
In fact, Genworth Financial, a financial advisory firm, reports in its 2019 Cost of Care Survey, the most recent data available, that the median monthly cost of skilled nursing in a private room at a nursing home will set you back $102,200 per year. Prices can vary a lot depending on where in the country the community is located and which services a senior is using.
For example, Genworth reports that Alaska, Connecticut, and Hawaii have the highest daily costs for private nursing homes at $994, $458, and $440 per day, respectively, adding up to a whopping $362,628 per year in Alaska and $160,418 in Hawaii. At the other end of the spectrum, Oklahoma, Louisiana, and Missouri are the least expensive areas, with per day costs of $185, $187, and $187, respectively, which brings the annual total to around $68,000 per year in those states.
With fierce competition, how do nursing homes separate themselves?
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