Is There Skilled Nursing?

Is There Skilled Nursing Care?

This is a question to raise when you are choosing a place to spend your final years. In fact, the question is fundamental to the issue of a secure future.

Living in a retirement community will not cure your diabetes or your osteoarthritis. It will not even guarantee that you will not fall getting out of the shower.

A stranger wrote an Amazon review of my book, In Borrowed Houses, and spoke about thought-provoking passages that had turned her attention to the international problem of homelessness. Then she said: “On a personal level, I discovered just how borrowed a home is, so this book spoke to me on many levels.”

That little note made me happy, because the story in my book does make the point in many different ways that a house, any house, no matter how we got it, no matter how much we love it or how much we have invested in it, can be lost. In fact, it will be lost, because sooner or later, in one way or another, we must leave it. This includes our house, or an apartment in a retirement community.

It happens regularly in the building in which I live. People move away, unable anymore to deal with the requirements of Independent Living. This is not a tragedy, though, because the system here gives us the right to move over to Assisted Living when we need more help or even to Skilled Nursing if we require medical attention. In fact, the administration will take responsibility for moving us.

I bring it up now because people ask a lot of questions about homes for the elderly. They should. Moving for the last time (you hope) is a big deal. It probably requires you to leave a place you love, so you want the new place to be one you really like. A lot of your questions are probably related to that. You wonder if you can still live the way you want to live. And you want to feel secure.

A part of security is simply knowing that you will stay there. You will neither want to leave nor need to leave. This is why one of the questions you need to ask relates to that part of the home where you will go when you are confined to bed, either by illness or imminent death. You also may be sent there for intense, daily rehab.

But many elder homes lack such a department. When residents get ill, they often go first to a hospital, where they are diagnosed and receive emergency treatment. When they are ready to be dismissed but still need treatment and rehabilitation, or if their case is terminal, they will likely be sent to a nursing home. If the place they have chosen to live includes a nursing department, they will be going “home.”

Though they will not be in their own apartment, they will be in a part of the community they know, another wing of the building they live in, or across the lawn, in a place where they have visited friends. They may know someone who is there in the memory care section.

But the great practical value is that they probably have already paid for it. Some homes work this way. You pay a price, based on the size of your apartment in Independent Living, but when you move, of necessity, to Assisted Living or Skilled Nursing, you may owe nothing more. It is covered by what you pay for rent. This is usually called a Life Plan.

Of course, you must be careful to verify this, but often the apparently expensive place seems so because you have literally paid for whatever accommodations you need. You can move to Assisted Living and then to Skilled Nursing without your rent going up.

Most of the costs you will occur in Skilled Nursing are medical insurance issues. They may be covered by policies you own.

When I was looking for a place to spend the final years of my life, I turned down a place that I basically liked, except for the nursing ward, which was shabby, sad and depressing. Because I hoped aloud never to be there, my daughter said, “Then you never will,” and scratched the establishment off our list.

The presence of an attractive and comfortable skilled nursing wing in a retirement home gives residents the security of knowing where they will go if they need that kind of help, and it also gives them the opportunity to easily visit friends at their time of need.

If my friend Lorrie had been taken some other place to recover from her surgery, I would probably not be able to visit her at all. But she is right here. On her birthday some of her friends took cupcakes and little gifts.

And when Mike’s dementia became serious, so that he was getting lost in the halls and couldn’t even play Bingo with the rest of us, they took him over to the Memory Care department, where the staff understands his needs and he can’t just wander off. We can still visit him there, and he is comforted by familiar faces, though he rarely remembers our names.

Any home you choose is an insecure home if it does not include preparation for your decline. It is in a sense “a borrowed house” because you will lose it. Most of us will not just die without some special need for specific medical care. Something will go wrong, and we will be moved to a skilled nursing ward. If it is already paid for, just part of the “rent,” you and the people who love you will be able to rest easy.