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What is the Difference Between Level B Assisted Living and Skilled Nursing Assisted Living Facilities?

Updated on April 14, 2012

Walker and Chair Gives Independence to Loved ones

The longer you keep your loved one on their feet and moving independently the greater chances the quality of life will be higher for longer
The longer you keep your loved one on their feet and moving independently the greater chances the quality of life will be higher for longer | Source

Finding the right fit is the most important element in the search for an Assisted Living Facility

Finding the right fit for the elderly parent in an assisted living facility is the most important part of the process during the research phase. There are numerous details to consider. Knowing the individual needs of the potential resident helps a great deal when interviewing various facilities in order to determine what will or will not be provided by the staff. Our family faced the issue of placing an elderly disabled parent in an assisted living facility this past year. We learned much about how the various facilities differ from one to another and what similarities exist in the day to day care for the elderly residents. It is a process, but one question at a too can get through it and succeed.

For Important Visitation of the Elderly Parent, the Distance from the families home or office is very important.

Initally the travel distance was the most important criteria used to determine which facilities to visit. If the distance was greater than 20 miles or 30 minutes, it was crossed off the list. The ability to visit regularly and to quickly arrive in the event of emergency was imperative to the family. If the parent is placed too far away... no matter if the intentions are good....visitation will be far less on a regular basis. In this realm of day to day care, closer is better. We learned that there is still much to be done by the family to care for the elderly parent that is not provided by higher level assisted living staff on a daily basis. Little things like picking up the room or cleaning out the sink is not done on a daily basis by staff members. Read on, there is much more to talk about.

What Kinds of Services Are Provided in Basic Monthly Payment for Various Assisted Living Facilities

Assisted Living
Level B Assisted Living
Skilled Nursing
Nursing Center
Private Apt. or Room & Board
Private or Shared Room & Board
Private or Shared Room & Board
Shared Room & Board
Cafeteria or private dining ability to carry tray and/or feed self
Cafeteria or private dining, ability to feed self
Cafeteria or private dining, some assistance or hand fed
Cannot feed self
Mobile, ability to move about freely or with walking device
Mobile or limited but can withstand bodyweight for transferring
Mobile or immobile, needs assistance to transfer from bed to chair etc
Attends to Personal grooming, teeth, hair, dressing self
Abillity to dress self, brush teeth or may need some help.
May be able to perform some personal grooming, but usually needs help
Cannot perform any personal grooming or self care
Bowel & bladder are self managed
Bowel & bladder may or may not need asst/usually bladder incontinent
Bowel & bladder may or may not need asst/usually bladder incontinent or both
Usually incontinent both bladder & bowel
Showers can be independent in own apt
No shower in room, community area with supervision, minimal asst
No shower in room, community shower with supervision to full asst.
Sponge bath in bed
Ability to participate in outside activities unassisted
Ability to participate in outside activities with supervision to full asst
Ability to participate in some group activities, may have limitations
Limited interaction
Remembers to take medications and self medicates
Medications are supervised, but self administered, NO medical staff
Medications are supervised and administered by medical staff
Usually feeding tube or intravenously, possibly swallowed
Ability to utilize local transportation to outside medical appts
Ability to visit outside medical appt or use visiting medical professionals
Uses facilities medical staff/visiting professionals or outside if able and has transportation
Uses facility medical staff or visiting professionals
Facility is unlocked and residents can come and go at leisure,
Some are unlocked, most are locked for safety and protection from wandering
Locked facilities, need code to get out
Locked facility
Similar to hotel living
Similar to hotel living, but residents are limited ot totally unable to self care
Usually residents cannot care for self: physically and/or memory imparied
Cannot care for self at all
Can control own monthly finances, shopping needs to family provides
Usually family responsibility to handle finances
Usually family responsibility to handle finances
Family or Facility in charge of finances
Uses own furniture, personal belongings, decor
Uses own furniture or some facility provided
Can use personal furniture, or provided by facility to hospital environment
Like a hospital room environment
Cable, Phone provided in monthly fee
Cable, Phone provided in monthly fee
Cable, Phone provided in monthly fee
Cable, Phone provided but sometimes extra
Can have pets if ability to care for them
Can have pets if ability to care for them
Sometimes pets are allowed if ability to care for
No pets for residents, but can visit
Resident responsible for all personal items
Resident responsible for personal items
Resident responsible for personal items
Resident has minimal personal items
Resident Is usually not in a qualifiying condition for Long Term Care
Usually resident could qualify for Long Term Care or medicaid based on limited ability to care for at least two qualifying ADL's
Could usually qualify for Long Term Care benefits or medicaid based on medical need and inability to perform at least two ADL's
Long Term Care or Medicaid
Aware of self, community without mental impairment
May have minor dementia or memory impairment
May have dementia or memory impairment
May have dementia or memory impairment
Communicates wants and needs well
May or may not communicate wants and needs, needs intervention
May or may not communicate wants and needs, needs intervention
May or may not communicate at all, needs intervention
Participates in group outings without supervision or assistance
Participates in group activiites with minimal to full staff assistance
Participates in group activiites with minimal to full staff assistance
May or may not participate in limited inside group activities like movies or visiting entertainment
Can pick up after themselves, keep self and room or apt tidy
Mostly depends on staff to clean up room, make bed, clean bathrooms etc. to doing none
Mostly depends on staff to clean up room, make bed, clean bathrooms etc. to doing none
Performs no chores at all
Ability to make decisions for self, may need intervention
Lmited ability to make decisions, needs intervention
Limited or no ability to make decisions, needs intervention
No ability to make decisions needs intervention

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What is the difference between Nursing Homes and Assisted Living Facilities like Skilled Nursing or Level B Residential Assisted Living?

First I will say....just a few years ago these multiple options did not exist for the elderly parent. Many questions, with no easy answers. The answers come in a process of elimination based on the elderly persons needs. The answers to these questions not only determine the cost of the assisted living services provided, but the actual quality of life experience and environment that the loved one will be placed into on a day to day basis. Medicare only pays for certain elements of skilled nursing where the elderly resident may need specialized nursing care like diabetic injections or feeding tube cleaning for instance. If the elderly resident does not need specialized medical skilled nursing on a daily basis, other assisted living facilities provide services for the elderly parent at much less costs and are usually self pay. Residential Living or Level B Assisted Living is the next step down from high functioning assisted living facilities.

Skilled nursing assisted living is one step away from nursing home care where the majority are immobile and totally dependent for very basic needs like eating. The very important difference between Skilled Nursing and Level B Assisted Living is the need for 'daily medical care'. There is no medical care provided by the staff for Level B Assisted Living as they are not medical personnel. However, medical professionals come and go from these types of facilities throughout the course of each day like bees in a hive for medical visitations as needed b y the residents that are immobile or have no transportation. Overall supervision is available, but Level B facilities are not staffed to be able to assist your family member all the time. Other caregivers must be hired if more care is needed for showering, dressing, feeding etc.

Nursing homes are total care both physically and mentally. Residents are basically permanent patients in a medical facility with full medical staffing. All the basic needs are cared for by others. Caregivers may be needed to supplement the needs that cannot be provided by limited facility staffing. Depending on the type of care needed, personal medical insurance, medicare or medicaid could pay for some things, but for the most part....caregivers are a self pay service. Fortunately, caregivers are a tax deductible service if the taxpayer has the ability to itemize taxes when filed.

The moral to this story....caregivers will likely needed to supplement services provided by the assisted living staff. Protect your loved ones money, they will need it.

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Types of Services Provided on a Daily Basis by Skilled Nursing/Level B Facilities

Room and Board: All Assisted Living Centers provide room and board for a monthly fee. The apartment or room may have some furniture, though most people use personal furniture instead. A full room cleaning occurs either weekly or biweekly, unless a paid maid service is contracted. All utilities are usually included. Cable TV and phone is also provided. However, having a personal phone could be good or bad......let's just say.... no comment.

Personal grooming: NOTE, Skilled nursing and Level B facilities do not provide for most personal grooming other to check in with the elderly parent every couple hours for potential assistance. The assisted living facilities do not help needy residents totally get dressed or brush the teeth or pick out clothing all the way all the time. They just do not have the staff no matter what they may tell you it is hit or miss... again I emphasize, they do not have the staff to be available to your parent all the time. If the parent needs this kind of care, a paid caregiver is likely going to be needed. Hair cuts and salon visits are usually available for a fee. Professionals come into the facilities on a regular basis. if your elderly parent does not think about scheduling an appointment, you will have to intervene and/or do it for them or plan to take them to a barber yourself. For the most part either skilled nursing or Level B facilites will expect your parent to dress and undress themselves, feed themselves, use the toilet themselves and brush there own teeth. If they need help with these functions additional caregiver services will need to be contracted over and above the monthly fee..

NOTE: Level B facilities are for residents who have limited mobility or special needs, but have no needs for skilled nursing on a regular basis. Level B Assisted Living is usually less expensive since medical staff is not required on staff.

What about Meals? This is Covered in "Board"

Three meals a day and snacks are provided in the monthly payment. These meals are designed by nutritionists and provide a healthy diet which can be altered for dietary needs of the resident or sometimes by preference. Most facilities have communicated that residents can eat as much as they like. Facilities usually have water stations where coffee, tea and water is available all the time. Of course the resident must be able to communicate their desire for refreshments if unable to get them theirselves or the family must do so for them.

Larger facilities (75+ residents) usually have cafeteria style dining. Some have various dining rooms where they are individually served if mobility or dementia/memory are issues. Some facilities have areas reserved where residents needed to be hand fed are cared for. Others have family dining like a home setting. Again, Level B facilities are for residents who have limited mobility or special needs, but have no needs for skilled nursing on a regular basis. Level B facilities require the residents to be able to feed themselves. If the resident cannot do so, additional fees are charged to provide this service or extra caregiver services contracted.

Wills, Power of Attorney, Medical Directives, What are they and how do they work?

It is important, even if your family member has the ability to make decision for themselves now, to get these important legal papers in order before that day occurs when they cannot any longer. Unfortunately this seems to happen overnight and most people wait until it too late. At this point the court will have to intervene to declare you loved one incompetent. A horrible ordeal for them to go through. Life will be much easier for the entire family, especially the caregiver who has to make lots of decisions later to have he legal ability to do so. Hospitals, doctors, and other medical professionals will need direction. All of these legal documents can be prepared, signed and filed properly to make ife much easier when it comes time for specific decisions to be made. Medical facilities will not treat your loved one as they would have wished without certain medical directives in place. Some states require an attorney to enter the will into probate even if the estate is very small...funds will be needed no matter the size of the estate for final expenses both financial and death expenses!!!!

Last Will and Testament: If your family member does not have a will, the state will appoint an executor of the estate that is likely not going to be a family member. It is worth the investment to get all your ducks in order before your loved one is mentally unable to make these decisions prior to death. Sometimes family members who are not mentally stable make irresponsible financial decisions later in life that cripple the families ability to care for them financially later when the need exists to do so. Don't it now!!!

General Power of Attorney: This legal power gives the family caregiver full legal authority to make decisions and sign documents for the parent whether it be financial, medical, or whatever without the parent being deemed incompetent. Very important to understand....if the parent becomes mentally unable to make the decision to give a family caregiver this legal authority it is too late for this to be done. Then a court must decide who is appointed to do so and it could be a court appointed non-family member in charge of all the decisions for your loved one. Sometimes the parent does not want to lose control of their life and waits too long, though it does not mean they have to if they have a caregiver that can be trusted with this authority and continues to seek their advice while they still have the ability to make decisions.

Physicians Medical Directives: This legal document states the medical wishes of the parent for specific life sustaining measures to be taken or not by medical facilities or professional.

HIPAA Powers: This legal document gives consent to release information to specified family caregivers and is required by every hospital and medical professional.

Do Not Resusitate Order: This legal document is only used by those who do not want to be resusitated by emergency medical professionals.


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    • Golfgal profile imageAUTHOR


      6 years ago from McKinney, Texas

      Absolutely true PA, thanks for the added value. Some people think that assisted living is all about nursing homes. But the reality is, there are many variations in the community today and the sooner learned about the options, the better for when the decision to move into a care facility is a necessity. The tricky part is needing a skilled nursing facility could be within months of making a decision to planning for future needs is so important for the family. Keeping loved ones close to home is a challenge when no vacancies exist in the location that is most desired. Thanks for coming by.

    • PhlebotomyAdviser profile image

      Steve Richardson 

      6 years ago from San Diego

      There is a fundamental difference between assisted living and a skilled nursing facility. An assisted living facility is for those that need help with one or more activities of daily living. These activities of daily living include bathing, getting dressed, going to the bathroom, and mobility. If you require some assistance with one or more of these activities of daily living, it does not mean that you need 24/7 medical care. Those that require a high level medical care or are recovering from surgery, are likely to be the people in nursing facilities.


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