This is the sixth in a series of articles intended to demystify the experience of living in a retirement community.
The federal government makes a distinction between "skilled nursing facilities" whose residents require extensive medical care, and "nursing facilities," which provide care that is more custodial in nature. The second of these is what most people think of as nursing homes.
Of the four retirement communities in the Prescott, Arizona area visited for this series, Good Samaritan and Las Fuentes offer nursing/skilled nursing. Granite Gate and Alta Vista do not.
The facilities at Good Samaritan and Las Fuentes carry dual certification, which means that they are licensed as both "skilled nursing" and "nursing" facilities.
Two types of units offered by both organizations are short-term rehabilitation centers and long-term care facilities.
Short-term rehab centers typically house individuals for just a few weeks, often as they recover from surgery such as a knee or hip replacement. Rehab centers also offer outpatient services.
Long-term care facilities are home to people who - because of physical or cognitive impairment -- are unable to take care of themselves, require a high level of care 24/7, and typically are expected to stay in that setting as long as they live.
Good Samaritan and Las Fuentes both separate short-term rehab and long-term care populations, housing them in different corridors. The people in rehab tend to be about 15 years younger than those in long-term care. They typically spend hours each day in physical and occupational therapy. The units house one or two people per room.
The facilities are licensed under a combination of federal and state regulations. Many core requirements for sites that want to be eligible for any federal funding from Medicare are spelled out in federal rules. They have many elements similar to state rules for a lower level of care, assisted living.
For example, the facilities must arrange "an ongoing program of activities designed to meet. . .the interests and the physical, mental, and psychosocial well-being of each resident."
Such programs variously need to "provide stimulation or solace; promote physical, cognitive, and/or emotional health; enhance, to the extent practicable, each resident's physical and mental status; and promote each resident's self-respect by providing, for example, activities that support self-expression and choice."
Guidelines for inspectors ask, "Are residents who are confined or choose to remain in their rooms provided with in-room activities in keeping with life-long interests (e.g., music, reading, visits with individuals who share their interests or reasonable attempts to connect the resident with such individuals) and in-room projects they can work on independently? Do any facility staff members assist the resident with activities he or she can pursue independently?"
The facilities are also required to arrange for medically related social services. These include, for example, "making referrals and obtaining services from outside entities (e.g., talking books, absentee ballots)" and "assisting residents with financial and legal matters (e.g., applying for pensions, referrals to lawyers.)"
Facilities are also advised that they must address needs for a "home-like environment, control, dignity, and privacy." For example, the facility is expected to encourage residents to bring as many personal possessions as they want, including furniture, that can safely be accommodated in their rooms (or their half of a room.)
The Arizona Department of Health Services offers information about choosing a nursing home here: http://www.azdhs.gov/als/ltc/nhconsgde.pdf.
Medicare offers a comprehensive checklist to use when comparing nursing homes here: http://www.medicare.gov/files/nursing-home-checklist.pdf.
States are charged with inspecting nursing/skilled nursing facilities and deciding whether they meet Medicare's requirements. You can see the results of Arizona state inspections on the Arizona Department of Health Services website by using the search tool provided at http://hsapps.azdhs.gov/ls/sod/SearchProv.aspx?type=LTC.
One piece of good news that you will be able to see is that neither Las Fuentes nor Good Samaritan has been the subject of any enforcement actions.
Medicare also offers an online system at http://www.medicare.gov/NursingHomeCompare that allows you to look up information about any nursing home, and to compare nursing homes on a wide variety of measures --- for example, what percentage of long-term care residents have had falls that result in serious injuries. Online comparisons, though, do not do away with the need to visit in person to get a feel for the place.