SNFs, ALFs, CCRCs… Oh My!

Comparing Apples and Oranges May Lead You to the WRONG Decision!

First, the terms:

  • SNF = skilled nursing facility, also known as nursing homes and convalescent homes.
  • ALF = assisted living facility, also known as assisted livings.
  • CCRC = continuing care retirement communities, which offer multiple levels of care.

Next, the fine print: In each state, there are different rules and terms and descriptions about the type of care that is offered at each level of service.

Now, the really fine print:  Medicare pays for NONE of these, long-term.

Caregivers are overwhelmed by their options in most communities and confused by regulations about Medicare, Medicaid and Long-Term Care Insurance. CCRCs are campus-like and seem to allow people to keep their options open (but usually require a buy-in which is expensive). ALFs are gorgeous, updated and provide “amenities” such as transportation service and restaurant-style dining. So why would anyone choose a SNF? Because: they provide 24/7 nursing care for our frailest elders. Can you have both, or a marriage of all three?  Maybe.

How will you know what you’ll need – and what you can afford – for long-term care?  Are you prepared to answer lots of questions about your health and your investments? Are you prepared to live with someone you don’t know in a community, neighborhood or in your room? We can help you conquer the anxiety of this uncharted territory. Contact us to learn about your rights, the truth about the apples and oranges, and the essential keys to avoiding a nursing home.

Figuring out your options is complicated, and often depends on several factors.  Our consultants are waiting to help you figure this out. Whether you have limited assets or millions, smart seniors learn their options. Aging Care Academy is your Personal Consultant for these difficult decisions. Schedule your Personal Consultation today!  It’s worth the investment to create a new “home” in the least-restrictive and most-comprehensive care environment.

For more information on what to look for in an ALF, see the article at by Joan Carney (4/18/13).

Is It Time To Consider Other Care Options For Your Relative?

This checklist will help you determine if homecare, adult day care, respite care or long-term care is necessary to maintain health and well-being.

Safety Concerns

  • Are there stairs or conditions in the home which are hazards (scatter rugs, cords, broken tiles)?
  • Has your relative had falls or accidents because of weakness, dizziness or the inability to get around?
  • Has use of the stove, oven or appliances become a problem because of forgetfulness?
  • Does your relative refuse to use adequate safety devices such as railings or a walker?
  • Has your relative lost interest in living or expressed a desire to die?

Nutritional Needs

  • Is your relative unable or unwilling to prepare meals?
  • Is there a demonstrated nutritional problem such as weight loss, illness or anemia?
  • Does your relative eat only inappropriate foods that will not supply nutritional needs?
  • Does your loved one forget to eat?

Personal Hygiene

  • Is your relative unable or unwilling to get to the toilet when necessary?
  • Is your relative unable to change clothing or bed linens as necessary to remain clean and dry?
  • Does your loved one refuse showers/bathing?

Health and Safety Concerns

  • Would your home require modifications to provide an adequate environment for your relative such as heating, plumbing or an accessible bathroom?
  • Would you need to modify your home to make it a safe environment??
  • Is your relative likely to wander away from the house if left alone?
  • Does your relative regularly disturb the sleep of others by calling out, needing care or wandering at night
  • Does your relative require nursing services that are too difficult or demanding for you physically?
  • Does your relative create safety hazards for others in the family because of forgetfulness or carelessness?

Time and Energy

  • Does your relative need someone to care for him/her at all times?
  • Must clothing or bed linens be changed and laundered so frequently that care becomes an excessive demand?
  • Do you have responsibilities for care of other family members that result in split loyalties or emotional overload?

Family Considerations

  • Has the loss of privacy become a problem for the adult household members?
  • Is there excessive conflict with younger adults and teenagers because of your relative?
  • Does your relative interfere with the running of the household?


More than one yes/check mark in each category would strongly indicate the need to begin considering the potential for change. Each family’s resources, needs and capacities differ. Not every frail individual must be placed in a nursing home, but adjustments in your living situation may need to be made. In-home care options are increasing and may delay or prevent the need for placement.

(Adapted from the St. Louis Chapter of the Alzheimer’s Association.)