Skilled Nursing Facilities (Nursing Homes)

Other options to consider as well include:
Nursing homes are often the choice of last resort. Usually, if a person needs permanent placement in a nursing home, the supervisory care needed exceeds that which can be offered at home or in an assisted living. Many of these patients are exit-seeking or are more difficult to redirect. Some people with dementia may also develop aggressive behaviors which can pose a threat to themselves or those around them. Others simply are no longer able to perform most or all of their activities of daily living and need a higher level of care.

If you are considering placing a loved one with dementia into a skilled nursing facility, there are several factors to consider. Look for and be aware of:
  • A Secured Unit: With exit-seeking behaviors being one of the biggest threats to a patient with dementia, many facilities offer secure units that are kept locked 24/7.These units are generally smaller in nature and are accessed by staff and visitors with authorization. They should be inclusive areas with their living areas, activities and dining all within the secured areas. Some facilities also offer secure courtyards or outside areas in order to give their residents the opportunity to spend time in the fresh air while maintaining their safety.
  • Security Systems: For dementia residents residing on the secure unit and for those on the mainstream floors, additional security measure may be needed to ensure the residents safety. There are several types of security devices that may be used including:
  • Personal Security Alarms: These are devices often placed on wheelchairs and beds of patients whose cognition no longer allows them to understand their safety deficits. For example, if a patient is a fall risk because of poor balance a seat alarm may be placed on their wheel chair to help deter the patient from standing. The sounding alarm will hopefully re-direct the patient back into their sea while alerting staff for assistance. These types of alarms are also vital for patients who are sun downing. The bed alarms alert staff to an out-of-bed patient where they can provide assistance and maintain safety.
  • Door/Elevator Alarms: For some patients whose needs to not warrant a secure unit, alternative security measures may be needed. Some facilities are equipped with systems designed to alert staff members that a dementia patient is close to an exit or elevator. Patients are often outfitted with a bracelet or anklet that is used as sensor for such alarms. Some facilities will place the bracelet on the patient’s wheel chair to keep it hidden for the resident. This is less restrictive than the secured unit but provides the needed security.
  • Day Programing: Many skilled nursing facilities will provide patients with dementia programming throughout the day designed to help keep their minds active, lessening the symptoms of sun downing and hopefully slowing the progression of the disease. If you are considering placement in a skilled nursing facility, be sure to find out if they have structured daily activities for their patients with dementia.
  • Psychiatry/Psychology Services: Many facilities will have visiting specialists who are trained in caring for the psychological needs of those suffering with dementia. Because dementia and Alzheimer’s is such an individualized disease, it is often trial and error before the right medication regimen is established. It is important to have the advice of specialized caregivers available to help develop and maintain such programs.

​Cost: The cost of care in a skilled nursing facility is expensive. Unfortunately, most residents with dementia do not qualify for Medicare or insurance benefits. Medicare guidelines require a 3-midnight hospital stay in order for a benefit period to begin and then patients must meet certain criteria, such as a need for intensive nursing care or rehabilitation in order for the federal program to continue paying. Some dementia patients may initially qualify upon admission, but quickly become what is known as custodial care. If a resident is in a skilled nursing facility under custodial care, private funds or medical assistance will most likely be required to pay for outstanding balances.

Pros and Cons of Skilled Nursing Facilities

  • 24/7 supervision by licensed nurses and clinical staff Cost: The most expensive of the senior housing communities; however has the most options for subsidized funding
  • Intensive medical services available if needed Perceived Loss of Independence
  • Most regulated of the senior living settings which creates a more consistent level of care Stigma associated with nursing homes is still alive and well
  • Certified and trained clinical staff Bed availability in secure units may be hard to find
Skilled Nursing vs. Assisted Living
The question now becomes does my loved one required skilled nursing care or assisted living. There is sometimes only a fine line that separates placing someone in an appropriate assisted living residence from a skilled nursing facility.
Here are some questions to consider when deciding on what level of care your loved one may need:
  • Is 24/7 supervision necessary? Since nursing homes offer 24/7 nursing staff, a resident who requires more supervision may fare better in a nursing home than an assisted living. Remember that residents in an assisted living facility often reside in private apartments where it is more difficult to provide 24-hour supervision.
  • Is the resident easily re-directed? If the resident can be redirected to an appropriate behavior without much effort, an assisted living facility maybe a good choice.
  • Is the resident able to perform most or all of his/her activities of daily living? If the answer is yes, assisted living may be an ideal setting for someone who can perform daily tasks but suffers from memory impairment.
  • Is the resident able to communicate his/her wants and needs? Again, if the answer is no, a skilled nursing facility may be a better option. The inability to communicate may threaten the safety of someone living in a private apartment or suite.
When deciding on the best course of action entering into the setting armed with as much information as possible will help in making choices. This very well may be the hardest decision you will ever make and touring the facilities will help make an informed decision. When touring any facility or program, here are some questions to consider:
  • What security measures are in place to ensure safety?
  • What happens if my loved one declines in health, either physically or cognitively?
  • What will happen when the private funds are depleted? Are there alternative programs to help pay for room and board?
  • What types of activities will my loved one be able to participate in?
  • Is there any type of rehabilitation program available to help with the decline of activities of daily living?
  • What are the visiting hours?
When touring the facility be sure that you take note of several key factors that will help the facility become home:
  • Do other patients have personal belongings in their room to help remind them of their home?
  •  Is it clean and free of odors?
  •  Is the staff respectful to the other residents?
  •  Do the residents appear neatly dressed?
  •  Does it appear as if the residents are having a good time?
The transition from home to either an assisted living facility or a skilled nursing facility is difficult. Do not be surprised if your loved one is agitated, confused and persistent about returning home. This is common and will most likely subside as they become acclimated to their surroundings. Speak with the nurse or administrator about visitation guidelines or suggestions during those first few days. You may find that some facilities will ask that you not visit until the resident has had the opportunity to adjust to his/her new surroundings.

Most facilities will not only focus on the well-being of the resident, but also that of the family. Be sure to ask if there is a support group that is hosted at the facility or one which they can refer you to. These groups will help ease the guilt and hopelessness that may accompany the transition. If you have questions about the resources available in your area, contact the Alzheimer’s Association.

Some of this information was provided by Assisted Living Today, an online resource dedicated to providing valuable information about various aspects of elderly living and elderly care.