Knowing your care home options begins with understanding the difference between custodial vs. skilled nursing care. The difference is critical because many patients end up unnecessarily in skilled nursing settings.
What is custodial care?
Some examples of custodial care would include help with dressing, bathing, help out of bed, help to the bathroom, incontinence, and assistance for patients with wheelchairs and/or dementia. Alzheimer’s patients who have a tendancy to wander usually have only custodial care needs.
What is skilled nursing care?
Some examples of skilled nursing care would be assistance with an i.v. g-tube, tracheotomy, open wound, ventilator; care usually provided by trained skilled nursing staff including registered nurses (RNs), certified nursing assistants (CNAs), or licensed vocational nurses (LVNs).
Is a skilled nursing home the right setting?
If you visit your local nursing home you may realize that most patients do not have g-tubes, i.v.’s, tracheotomies, ventilators, etc. Most patients have only custodial care needs. Reasons why these patients end up in nursing homes vary, but the primary reasons may include:
1. Most consumers (including doctors) are not familiar with alternative care settings for patients with 24-hour custodial care needs,
2. The assumption that nursing homes (since they have nurses) always provide the highest level of care despite the fact that many community based care settings (see below) have higher staff to resident ratios,
3. Many are low-income and medi-cal does not pay for any other care setting.
What alternative settings exist for patients with custodial care needs?
Alternative settings include larger assisted living (sometimes referred to as retirement homes) or small residential board and care homes (also referred to as residential care facilities for the elderly or RCFEs). In the case of RCFEs, small family homes with 4-6 residents, staffing levels (1 staff to 2-3 residents) far exceed that found in skilled nursing settings (usually 1 direct care staff to 17 patients). While it is true that nursing homes may provide a higher level of medical care for patients with skilled nursing needs, patients without skilled nursing needs tend to do better receiving care in home-like settings that have high staffing levels