Does My Loved One Need a Nursing Home?

Frequently families are counseled by doctors or nurses regarding the status of their loved one as they are recovering from a stroke, a fall or an accident, or generalized weakness because they aren’t able to take care of themselves. The doctor or nurse will state that their loved one requires 24/7 care, or care in a nursing home. Today, in the state of Wisconsin, very few people actually NEED the care provided in a nursing home, also called a skilled nursing facility. Today we can rely on the Community Based Residential Facility (CBRF). CBRF is the higher licensure for assisted living in the state of Wisconsin that provides unlimited hours of personal care and up to 3 hours of nursing care per week.

Medicare Payment Practices Affect the Course of Treatment

As the landscape of healthcare changes and our population ages, Medicare has changed the way care is provided to our elders. Once upon a time, treatments such as an IV antibiotic or wound care would have only been provided in a hospital setting. Now, the hospital stay for Medicare recipients has been shortened, in most cases, and people are in the hospital long enough for a diagnosis and plan of treatment to be identified. Following the shortened hospital stay, many older adults find themselves in a rehab unit within a skilled nursing facility or nursing home receiving IV antibiotics or wound care or other such rejuvenating treatments and therapy to return to what Medicare calls their “Functional Baseline” or recover from whatever ails them. At times, though, even after completing a skilled nursing rehab stay, a discharge plan to a high level of care will be needed.

One challenge for families as they try to understand what care their loved ones need is that our healthcare system has become very fragmented. Hospitals, skilled nursing facilities, and assisted living communities are each regulated and governed by different entities. So, what can happen in a hospital v. a skilled nursing facility v. a CBRF assisted living may not translate one to the next. This leaves families confused as to what should be happening and what are the next steps. Doctors and nurses in each of these facilities are not experts on what happens outside of their area of expertise, and this can leave families floundering as they try to understand what is best for their loved ones.

The Benefits of Community-Based Residential Facilities 

A CBRF may be the best next place for your loved one to live and receive care.  As we stated, a CBRF is a type of assisted living license in Wisconsin. CBRFs come in all shapes and sizes ranging from a home where as few as 5 individuals live and are cared for to a building where as many as 100 people live and are cared for. Generally, a CBRF provides more care than an RCAC community can. The hours of personal care provided are not limited, and the individuals living in CBRF can receive up to 3 hours of nursing care from the nurse on staff per week. The CBRF still provides a very home-like environment, but people living here typically have a studio style suite.  CBRFs don’t allow for someone to be on IV medications and most don’t provide care for people on feeding tubes. However, a lot of care is provided in most CBRFs. It is up to us as consumers to ask questions and understand the amount of care provided in each CBRF assisted living

The people who live in CBRF today are typically the people who would have lived in a nursing home 20 years ago. It’s not uncommon to walk through a CBRF and see the studio apartment doors open as the individuals need to be checked on more frequently and require supervision for safety. Most memory care communities in Wisconsin are licensed as CBRFs. Memory care communities differentiate themselves with programming and staff training, rather than with a specific license with specific requirements.

While a nursing home costs between $10-14k/month, a CBRF comparatively costs between $5-7k per month.  Some  CBRF communities charge a flat rate, and an individual who lives there pays the same amount each month, regardless of the amount of care that is provided. Other communities charge a base rate and then add additional charges for each additional service required, more of an ala carte model. Some communities have what are called “levels of care” and the services are bundled into a level, and an individual pays a base rate plus an additional amount for the services provided in a specific “level of care.”

RCAC or Residential Care Apartment Complex is the other licensure for assisted living care in the state of Wisconsin. In general it is a much lower level of care and assumes that their residents are safe behind closed doors, can get out in an emergency and know to press a button or call for help when they need it.  Sometimes people are ready to discharge from rehab and aren’t ready to go home, but only need some lighter assistance. This is where an RCAC would potentially be the correct fit.

Can We Afford Assisted Living?

Though the cost for assisted living is significantly less than a skilled nursing facility, families nonetheless will need to determine how to pay for this care.  There are several possibilities for funding:

Private Pay

The better assisted living communities expect that a person has some amount of their own money to pay for their care. Medicare does not pay for assisted living.

Veteran’s Benefits

Some military veterans are eligible to receive assistance in paying for assisted living if they are financially and service eligible.

Long Term Care Insurance

Long term care insurance can be very helpful and creates more choices for someone needing care.


Wisconsin has a program within its Medicaid budget called Family Care. Family Care can pay for assisted living after someone has exhausted their assets.


Over the years, people have come to recognize that the assisted living environment is really a better place for someone to live out their lives. As described above, a nursing home is more commonly utilized when someone needs rehabilitation after a fall or an illness, or when someone has medical needs that require the skill of a nurse or doctor. Anymore, very few people need skilled nursing facilities for their long term care. Assisted living, either RCAC or CBRF, would be options for your loved one’s unique needs. For more information about our assisted living placement services, please reach out to our friendly team. We’re confident we can help you find the perfect assisted living solution for your loved one.

Pam Foti and Jenny Wagner