The distinction between a rest home and a nursing home is a frequent source of confusion for families navigating the long-term care landscape. Although the terms often appear interchangeable, they represent fundamentally different types of facilities, levels of care, and financial obligations. Understanding these differences is necessary because the choice of facility dictates the kind of services a resident receives and how those services are paid for. This article will clarify the functional and financial delineation between these two environments.
Defining Rest Homes and Custodial Care
A rest home, often known today as a residential care facility or assisted living community, provides a non-medical environment focused on housing and personal support services. These facilities are designed for individuals who are largely independent but need routine assistance with Activities of Daily Living (ADLs), such as bathing, dressing, eating, and mobility.
The care provided in a rest home is termed custodial care, meaning it is non-skilled and supportive rather than medical in nature. Custodial care can be safely provided by non-licensed caregivers or aides and is aimed at maintaining a resident’s current functional status. Rest homes offer a comfortable, community-focused setting with scheduled meals, social activities, and general supervision. They do not typically provide complex medical interventions or continuous nursing care.
Defining Nursing Homes and Skilled Care
A nursing home, which is the common term for a Skilled Nursing Facility (SNF), is a medical institution licensed to provide 24-hour medical care. These facilities cater to individuals with complex medical conditions, severe mobility issues, or those requiring intensive rehabilitation services following a hospital stay. Unlike a rest home, a nursing home’s primary purpose is to deliver skilled care, which is medically necessary and must be ordered by a physician.
Skilled care involves services that can only be performed safely and effectively by licensed medical personnel, such as Registered Nurses (RNs) or Licensed Practical Nurses (LPNs). Examples of this specialized care include intravenous (IV) injections, complex wound care, ventilator management, and intensive physical, occupational, or speech therapy. The facility is structured to provide continuous monitoring and treatment.
Operational Differences in Staffing and Services
The operational disparity between the two facilities is most evident in their staffing composition and regulatory oversight. Rest homes primarily employ certified nurse aides and other support staff to assist with ADLs and manage daily logistics. While many states set general guidelines for staff-to-resident ratios in assisted living settings, these ratios are generally lower than those required in medical facilities.
Nursing homes, in contrast, are subject to stringent federal regulations set by the Centers for Medicare and Medicaid Services (CMS) and must maintain specific ratios of licensed medical personnel. Federal law mandates that a nursing home must have at least one Registered Nurse on duty for a minimum of eight consecutive hours every day, and an RN or LPN/LVN must be on duty 24 hours a day, seven days a week. This ensures immediate access to professional nursing staff for critical medical needs and complex care procedures. Furthermore, SNFs offer specialized services like intensive medical rehabilitation, which is generally not available on-site in a rest home setting.
How Funding and Payment Structures Differ
The source of payment is another significant difference, often dictating the affordability and accessibility of each facility type. Rest homes are predominantly paid for through private funds, including personal savings, long-term care insurance policies, and retirement accounts. Medicare generally does not cover custodial care or the residential costs associated with a rest home because the services are non-medical. Some states may offer specific Medicaid waiver programs that help cover the cost of care in a rest home for eligible individuals, but this is not a universal benefit.
Nursing home care, due to its medical designation, has more complex funding streams involving government programs. Medicare Part A will cover short-term stays in a Skilled Nursing Facility, up to 100 days per benefit period. This coverage requires the stay to follow a qualifying hospital stay and the resident must require skilled rehabilitation services. For long-term custodial care in a nursing home, Medicaid is the primary payer for financially eligible individuals, covering the costs indefinitely as long as the care is medically necessary.