An elderly couple talk to their family about important topics such as skilled nursing facilities.

Senior Living and Housing Options: Skilled Nursing Facilities

Living Arrangements for Seniors Who Need a Higher Level of Care

Is your family struggling to provide adequate in-home care for a loved one in declining condition, or does your loved one require a greater level of care than their current community can provide? If so, it may be time to consider a skilled nursing facility or “nursing home.”

Many people have a negative impression of nursing homes, possibly due to past experiences with a grandparent or other family member. Of all senior living arrangements, these offer the highest level of care and supervision and may be the most suitable home. The fact that a skilled facility may also be your loved one’s last home can make the decision to move them feel much more difficult. Family members can experience a range of emotions, including guilt.

Here is the information you need to help make an informed decision about moving a loved one into a skilled nursing facility.

Signs that a Senior May Need Skilled Nursing Care

Whether your loved one is currently living on their own, living with family members or in an Assisted Living Community, there will likely come a time when they need a higher level of care. It may be difficult to acknowledge when the needs of a senior adult exceed your family’s ability to provide adequate care.

Here are common situations that can indicate a need for skilled nursing care:

  • Frequent falls requiring hospitalization and rehabilitation, resulting in little or no improvement in physical function
  • Transfers requiring two or more individuals, or the use of a mechanical lift
  • Need for supervision and hands-on assistance in an emergency
  • Need for daily, hands-on assistance with medication, toileting and behavioral issues
  • Requiring verbal cues and hands-on assistance to eat
  • Limited or no capacity for self-care
  • Increasing unruly or aggressive behavior towards others
  • No understanding of consequences for actions
  • Medical condition that requires a nurse to be present 24 hours per day

Answers to Frequently Asked Questions about Nursing Homes

Most families ask themselves three questions when considering skilled nursing care:

  • “Does my loved one need a higher level of care?”
  • “My loved one does not have the financial means to pay for nursing home care. What are our options?”
  • “How do I find the best facility for my loved one?”

Q1: “Does my loved one need a higher level of care?”

A common sign that can indicate the answer is “yes” is when the ability to care for your loved one’s needs is becoming too difficult. You may not have the necessary medical expertise or the physical and emotional capacity to handle increasing challenges.

The need may be financial, as private in-home care can be quite expensive over a long duration.

You may also be approached by the staff in your loved one’s current community, such as the Nursing Director of an Assisted Living Community. Once the care needs of a resident increase beyond a level of care they are licensed to provide, the only answer is to move into skilled care – with one exception:

If the declining condition is a cognitive one with only limited physical decline, the senior adult may be able to move to Memory Care within an Assisted Living Community.

Q2: “My loved one does not have the financial means to pay for nursing home care. What are our options?”

Skilled care facilities can range from $180 to $300 per day, on average, which translates to a monthly expense of $5,400 to $9,000.

Often, the more expensive facilities are those that only accept private pay arrangements or will only accept Medicaid under certain conditions. These facilities offer a limited number of Medicaid beds and, in almost all cases, require the patient to pay privately for one to three years before a Medicaid bed becomes available.

Facilities on the lower end of the cost spectrum often designate all beds as Medicaid beds, allowing for someone to immediately use Medicaid as the payor. If private pay is required, it is typically for a much shorter period, such as six months to one year.

NOTE: Medicaid eligibility is based on very specific financial guidelines. Individuals or couples who meet the guidelines qualify immediately for Medicaid to pay the costs of long-term care in a nursing facility. Because of its complex guidelines, we strongly encourage families to seek the advice of an elder law attorney who does Medicaid planning before submitting an application.

An elder law attorney can also review other possible pay options, such as Veterans Pension, Masonic scholarships, convertible life insurance policies, long-term care insurance and more.

Q3: “How do I find the best facility for my loved one?”

Proximity of a nursing home to the responsible family member’s home is often the top consideration. Others value word of mouth recommendations from family, friends and other professionals. Veterans may be able to choose a Veterans Home for long-term care and may have some discount options in other settings.

Whether you have narrowed down your choices or are only just beginning to discuss options, will be a helpful resource. The website allows you to search for all skilled facilities in any given geographic area.

This online government guide provides statistics for each facility, such as:

  • An overall quality rating,
  • Inspection results,
  • Staffing and quality measures, and;
  • Whether or not Medicaid is accepted.

Schedule a tour when you have identified your top three to five facilities. Before the tours begin, create a list of questions to ask at each facility. This Guide to Choosing a Nursing Home (see pages 31-39) is very helpful. Be sure to add any questions specific to your loved one’s needs.

Seeking Professional Advice for a Nursing Home Selection

Even with this information and additional resources, you may have difficulty selecting a skilled facility – particularly if you face opposition from family members. There are professionals who can provide an impartial opinion and in-depth knowledge about the skilled facilities in your area.

Discharge planners in hospitals and rehab facilities can be a resource if your loved one is currently in one of those facilities. Life Care Planning Consultants and Care or Case Management companies also provide helpful services. Contact an elder law firm for local recommendations.

It is important to be realistic about the needs and capabilities of your family member. However, there are other living arrangements for independent seniors and those who need less assistance. If you are unsure about the level of care your loved one needs, click these links to read more about Independent and Assisted Living communities.

Discuss Your Long-Term Care Concerns with Beck & Lenox Estate Planning and Elder Law

The attorneys at Beck & Lenox Estate Planning and Elder Law in St. Charles understand how important it is to find a safe, dignified living arrangement for your loved one. We can assess this individual’s assets in order to privately fund long-term care, if possible, and may be able to position them to qualify for Medicaid or other government funding if he or she is eligible.

For more information about skilled nursing, contact our office online or give us a call at (636) 946-7899 to schedule your free consultation.


This article is for informational purposes only and does not provide legal advice, nor does it create an attorney-client relationship with any reader.