Comparing Care for Older Americans: Skilled Nursing At-Home or in Facilities
As the population of older Americans increases, the need for skilled nursing care and residential care facilities is on the rise. Depending on the care recipient’s ability and medical needs, care options can include home health agencies (HHAs), assisted living facilities (ALFs), or skilled nursing facilities (SNFs).
HHAs are possibly the least invasive care options for older Americans who have minimal mobility or cognitive impairments and need little assistance with activities of daily living (ADLs). There are two types of HHAs: Medicare-certified and private duty home care agencies. Private agencies primarily provide personal care and companionship, with some offering home health aides to assist in ADLs like dressing, bathing, and transportation.
Medicare-certified HHAs focus on providing skilled health care services, including RNs and physical, occupational, and speech therapists. These HHAs can also offer home health aides to assist with ADLs, and social workers who navigate community resources and long-term care assistance. Definitive Healthcare tracks nearly 16,000 active HHAs in the U.S., over 9,000 of which are Medicare-certified.
While visiting nurses and care providers are an option for those who can perform most daily activities independently, ALFs are able to provide care for older Americans who cannot live entirely on their own due to impaired mobility or cognition.
For some older Americans, assisted living facilities are a happy medium between receiving skilled nursing care at home and living in a SNF. The primary purpose of ALFs is to offer support and supervision, allowing residents to maintain relative independence while receiving support and assistance with ADLs.
Where HHAs and SNFs are primarily monitored by federal programs like Medicare, ALFs are most often subject to state licensing, which determines the level of care each facility provides. Individuals living in an ALF have access to some level of personal and medical care at all times, primarily provided by LPNs and RNs. However, ALFs are not designed to support those who need constant medical care and personal support.
For those who may need more assistance than an ALF can provide, SNFs are often the answer.
SNFs are staffed by RNs, LPNs, and CNAs who are available at all times of the day to provide medical care and supervision. Unlike ALFs and HHAs, SNFs are most often used for short-term recoveries and rehabilitation. Longer-term care is only offered at SNFs if it is medically necessary; the patient must have a significant medical condition, and meet state and federal criteria for extended care. Like many HHAs, SNFs are required by the CMS to meet strict guidelines including regular inspections for quality and safety assurance.
Many individual SNFs are part of a larger network of care providers, or are owned by corporations that specialize in skilled nursing care and facilities.
Which care option is the best for an individual depends on physical and cognitive ability, medical needs, desired level of assistance, and more. Additionally, access to medical professionals such as RNs, LPNs, and CNAs can vary between individual facilities of the same classification, particularly between private and government-owned facilities.
Definitive Healthcare has the most up-to-date, comprehensive and integrated data on over 17,000 SNFs in the U.S., nearly 900 SNF corporations, and over 1,400 provider networks. Our facility profiles include detailed current and historical financial information for skilled nursing facilities, home health agencies, hospices, and more.