Assisited Living or Skilled Nursing – Is It Only One or the Other? Do Doctors Know the Difference?

I’m here with Margie Veis, the Executive Director of Summerhill Villa, an assisted living facility in Santa Clarita, California.

KH: How can families keep their parents in assisted living and out of skilled nursing?

MV: Sometimes you have to be in a skilled nursing. If somebody requires medical care, they need to be in a skilled nursing.

Is it the same environment? No. Can they be yucky? Yes.

Sometimes you need that and not that it has to be permanent, but there might be a time when your parent gets sick and they need a week or two or three in a skilled nursing before they come back to an assisted living or back to home.

I went through that with my parent. My mom had pneumonia. She was sick. She needed IVs. She needed a lot of care. There was no way she could go home even with a care giver. She had to stay in a skilled nursing but you present it: “This is not long term but this is where you need to be for now. When you’re well you’ll come back. You’ll go back home,” whether it’s assisted living or whether it’s their own home.

KH: Do people have the misconception that it’s all or nothing?

MV: Yes. I think that’s a huge misconception not only with lay people but with physicians. If you have someone that’s elderly and needs custodial care, the doctor might say: “They can’t live at home. They need to go to a nursing facility.” Maybe they don’t. You only need to be in a nursing facility if you require medical care. Are you on IVs? Do you need constant nursing attention? Do you need injections? Can you not feed yourself?

If it’s custodial care you need – meaning you’re not safe or you need someone to help you take a shower or you’re incontinent or you’re in a wheelchair – that doesn’t always mean you need to go to a skilled nursing. We really do try to educate physicians, physical therapists, occupational therapists and family members to determine the true need.

When a family comes to me and says: “The doctor said my mom can’t live alone. She needs to go into a nursing home”, I ask why. A lot of times the answer is “She has a history of falls and she’s not taking her medicine well.” What’s the medical need? There is none. She needs to be in assisted living on the med program with someone checking in on her. That’s not a medical need so that is a big misconception.

KH: It sounds like some of the problems start with doctors.

MV: At times it can if they’re not educated. Or you don’t know.

KH: It never occurred to me that the physicians would be part of the problem. You would think that they would know what they’re doing.

MV: Right. They do, but many of them have never stepped foot in an assisted living. They don’t know or they think it’s the same. Skilled nursing is not assisted living and assisted living isn’t skilled nursing. If you’re out looking for an assisted living and someone tells you that they can do things that are medical and skilled, they’re not telling you the truth. Or, they’re doing that and they’re breaking regulations.

KH: Does that happen a lot?

MV: Probably.

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