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How do you envision life in your later years? Most of us imagine ourselves aging happily and healthy in our own homes. The reality is the experience of aging falls along a spectrum.

Seven out of 10 of us who turn 65 will at some point need long-term care services. While most of us will get that care at home – most often from family caregivers – some will require a level of medical care that makes moving into a nursing home the right option.

A nursing home is a communal living facility providing 24-hour on-site services such as nursing care, physical therapy, and assistance with everyday activities like bathing, eating, or walking. Importantly, nursing homes are not all alike.

Many nursing homes are beautiful, safe environments that help people thrive, no matter their physical and mental condition. Others desperately need radical changes, which my organization and many others are calling for right now.

Not everyone who moves into a nursing home does so for the same reason. Here are five common questions and answers that will help you and your family better understand nursing home care:

  1. When is a nursing home stay needed and for how long?

You may need a nursing home after a hospital stay for something like a joint replacement or recovering from a stroke. The most common reason for living in a nursing home, however, is dementia, which affects more than 50%-70% of all nursing home residents.

The length of time you’ll stay depends on how much care you need and for how long. For example:

  • Short-term stay (up to 100 days): This is usually for physical, occupational, or speech therapy following an in-patient hospital stay (like for a hip replacement or small stroke) or after an outpatient procedure
  • Long-term stay (100 days and beyond): For disabled, chronically ill, and older individuals who do not require hospital-level care but need more support than is possible in their own homes

What may start as a short-term stay can unexpectedly turn into a long-term stay in a nursing home, especially if your condition is not improving.

  1. Who cares for me in a nursing home?

A variety of professionals care for nursing home residents: registered and licensed practical nurses; physical, speech and occupational therapists, and social workers. Certified nursing assistants (CNAs) handle much of the day-to-day patient care such as helping with bathing, getting in and out of bed, and delivering medications. Often, CNAs do not receive livable wages, full-time benefits, or adequate training for their incredibly difficult and highly skilled work. These issues have been exacerbated by COVID-19, and you should ask any nursing home you are considering about their staffing policies.

  1. What will it cost?

A short-term rehabilitation stay in a nursing home can be covered for up to 100 days by Medicare following a hospital stay. But be aware: if Medicare classifies you as being on "observation status" (meaning the hospital has not admitted you as an in-patient but just as "observational"), that could disqualify you from Medicare coverage for that post-hospital nursing home stay. The Center for Medicare Advocacy has a helpful resource on nursing home coverage.

Intermediate- to long-term stays are typically paid for by private insurance or out-of-pocket by the patient or family members. Nursing home stays can cost on average $255 per day for a shared room or $290 per day for a private room.

  1. How have nursing homes changed?

Many of today's nursing homes were designed 50 years ago to meet the needs of a past era. They often reflect how care was delivered. But nursing homes are beginning to adapt to the contemporary needs of patients and deliver high-quality care with a supportive and fair workplace for staff.

Green House senior living is one example of innovative nursing home care where the number of residents in each of its small homes is restricted to a maximum of 12 and dedicated staff are assigned exclusively to each home. This proved incredibly important during the pandemic.

  1. How do I choose a nursing home?

Choosing a nursing home can seem daunting at first, but there are several checklists that can help you make your decision, including ones from the National Institute on Aging and Medicare.

You may want to consider reviewing nursing home safety ratings before you make your decision as well. Medicare's Nursing Home Compare online tool features a database of nursing home ratings based on health inspections, staffing levels, and certain measures of the quality of resident care. The tool has limitations, and not all nursing homes accurately report their data. Another tool, Nursing Home Inspect, allows you to compare nursing homes based on citations and penalties related to safety deficiencies.

As you consider your options, it's important to ask how nursing homes have adapted during COVID-19 and what new policies they have in place to safeguard and ensure the highest quality of life for staff and residents.

For more resources on age-friendly care, visit johnahartford.org/agefriendly.

(A version of this article, by Terry Fulmer, PhD, RN, FAAN, president of The John A. Hartford Foundation, originally appeared on Next Avenue.)

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