Skilled Nursing vs. Custodial Care (Assisted Living, Board and Care, etc. )
Know your care home options
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?
The California Little Hoover Commission has estimated at least 30% of all SNF patients have only custodial care needs. It may be that most SNF residents have only custodial care needs since most do not have g-tubes, i.v.'s, tracheotomies, ventilators, etc. Reasons why patients with custodial care needs end up in SNFs vary. Primary reasons may include:
1) most consumers 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 (read a bit about our Olmstead Now Campaign: our grassroots efforts to change the medi-cal law in California to permit it to pay for assisted living settings).
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. Read here for more in depth information about the different types of care homes.
Read here for more information about our services.
Additional information:
The Department of Health Services licenses and certifies all skilled nursing facilities (also called skilled nursing homes or convalescent hospitals) see below. (They do not provide referrals, reviews or ratings of skilled nursing homes, retirement homes, assisted living, board and care and alzheimers homes).
The Department of Social Services licenses and certifies all retirement homes, board and care, assisted living, alzheimer's homes, or residential care facilities.
LOS ANGELES DEPARTMENT OF HEALTH COUNTY DISTRICTS
In Los Angeles County, the five districts for the Health Facilities Division are as follows:
CENTRAL DISTRICT
Eagle Rock
Highland Park
Glendale
Pasadena
South Pasadena
Lincoln Heights
East Los Angeles
Los Angeles
NORTH DISTRICT
Antelope Valley
Burbank
Calabasas
Canoga Park
Chatsworth
West Valley
Encino
Glendale
Granada Hills
La Cañada
La Crescenta
Lakeview Terrace
Lancaster
Mission Hills
Montrose
Newhall
North Hollywood
Northridge
Pacoima
Panorama City
Palmdale
Quartz Hill
Reseda
Saugus
San Fernando
Sepulveda
Sherman Oaks
Studio City
Sunland
Sun Valley
Sylmar
Tarzana
Toluca Lake
Topanga
Van Nuys
Verdugo City
Verdugo Hills
West Lake Village
West Valley
Woodland Hills
Tujunga
Valencia
Los Angeles
WEST DISTRICT
South Bay
Baldwin Hills
Bel Air
Beverly Hills
Carson
Culver City
Dominguez
El Segundo
Exposition Park
Gardena
Harbor City
Hawthorne
Hollywood (L.A. Metro Area)
Lomita
Malibu
Marina del Rey
Pacific Palisades
Palos Verdes
Redondo Beach
San Pedro
Santa Monica
South District
Southwest District
Torrance
Venice
Vernon
West L.A.
Wilmington
Playa del Rey
Westwood
West Hollywood
Los Angeles
SAN GABRIEL DISTRICT
Arcadia
Altadena
Azusa
Baldwin Park
Claremont
Commerce
Covina
Diamond Bar
Duarte
El Monte
Glendora
Hacienda Heights
La Mirada
La Puente
La Verne
Monrovia
Monterey Park
Industry
Pasadena
Pomona
Rosemead
San Dimas
San Gabriel
Sierra Madre
South El Monte
Temple City
Walnut
West Covina
Los Angeles
EAST DISTRICT
Artesia
Bell
Bellflower
Bell Gardens
Cerritos
Compton
Downey
Hawaiian Gardens
Huntington Park
Lakewood
La Mirada
Long Beach
Los Angeles
Lynwood
Maywood
Montebello
Norwalk
Paramount
Pico Rivera
Santa Fe Springs
Signal Hills
South Gate
Whittier
Watts
ORANGE COUNTY (NORTH)
Anaheim
Brea
Buena Park
Costa Mesa
Cypress
Fullerton
Garden Grove
Fountain Valley
Huntington Beach
La Habra
Los Alamitos
Midway City
Orange
Placentia
Santa Ana
Seal Beach
Stanton
Tustin
Villa Park
Westminster
ORANGE COUNTY (SOUTH)
Dana Point
Irvine
Laguna Beach
Laguna Hills
Laguna Niguel
Laguna Woods
Lake Forest
Mission Viejo
Newport Beach
R. Santa Margarita
San Clemente
San Juan Capistrano
VENTURA COUNTY
Camarillo
Fillmore
Moorpark
Newbury Park
Oak View
Ojai
Oxnard
Piru
Point Mugu
Port Hueneme
Santa Paula
Simi Valley
Somis
Thousand Oaks
Ventura
Westlake Village
