expensive out-of-pocket costs. it is recommended that one purchases long-term care insurance before they need it, which may require paying premiums for years prior. depending on the policy, there are different ways that the insurance can be used in order to help with costs such as taking out a portion of the death benefits or choosing a life settlement. personal funds many will start off paying for nursing home care with personal funds. these funds may include personal savings, assets or stocks. many families will pool funds until a family member can become eligible for a public benefit program. other common ways to help pay are reverse mortgages. reverse mortgages involves a homeowner exchanging the equity they have acquired for cash which can then be accessed as a monthly payment or line of credit. this step is often viewed as more drastic which is why it is important to speak with the nursing facility first to see what type of services and care are included in the overall price. monthly cost of nursing homes by state: state semi private room (double occupancy, rate per person) private room min cost median max cost min cost median max cost alabama $3,954 $5,810 $8,790 $4,258 $6,356 $12,045 alaska $14,022 $23,451 $38,173 $14,022 $23,451 $38,173 arizona $3,954 $5,840 $16,729 $4,988 $7,087 $19,771 arkansas $3,437 $4,715 $13,231 $3,954 $5,488 $26,310 california $2,829 $7,450 $27,770 $4,380 $8,669 $27,770 colorado $5,262 $6,996 $19,771 $5,445 $7,794 $19,771 connecticut $5,931 $12,167 $14,600 $6,540 $13,231 $15,360 delaware $6,844 $9,125 $9,916 $7,057 $9,825 $10,646 florida $5,171 $7,300 $14,448 $5,475 $8,060 $15,360 georgia $3,498 $5,566 $7,756 $3,650 $5,931 $20,653 hawaii $8,000 $10,403 $17,094 $8,000 $11,254 $18,737 idaho $5,049 $6,935 $8,821 $5,353 $7,376 $11,224 illinois $3,407 $5,399 $31,481 $3,954 $6,205 $31,481 indiana $3,042 $6,540 $10,311 $4,563 $7,604 $13,688 iowa $3,498 $5,323 $8,213 $4,502 $5,688 $9,064 kansas $4,106 $5,019 $7,330 $4,410 $5,475 $8,760 kentucky $5,110 $6,327 $24,029 $5,323 $7,270 $24,485 louisiana $3,528 $4,715 $12,167 $3,407 $5,171 $15,208 maine $5,749 $8,365 $12,440 $6,540 $8,973 $13,475 maryland $5,749 $8,448 $11,193 $6,083 $9,186 $14,113 massachusetts $6,844 $10,737 $15,969 $6,844 $11,632 $14,874 michigan $5,688 $7,559 $11,041 $5,992 $8,258 $14,113 minnesota $3,255 $7,034 $11,558 $5,080 $8,002 $12,897 mississippi $5,019 $6,235 $7,878 $5,384 $6,692 $9,125 missouri $3,468 $4,639 $7,908 $3,954 $5,064 $11,558 montana $5,171 $6,388 $8,730 $5,323 $6,692 $8,730 nebraska $3,437 $5,982 $8,304 $4,045 $6,631 $18,250 nevada $3,346 $7,178 $8,425 $4,106 $8,213 $15,452 new hampshire $7,756 $9,612 $14,752 $8,365 $10,190 $15,634 new jersey $7,026 $9,733 $12,958 $7,574 $10,646 $13,657 new mexico $4,867 $6,220 $12,167 $5,323 $7,118 $14,387 new york $6,083 $10,980 $32,850 $6,874 $11,370 $32,850 north carolina $3,103 $6,266 $9,612 $3,285 $6,844 $19,163 north dakota $4,715 $8,365 $12,380 $5,140 $8,745 $12,380 ohio $2,859 $6,388 $13,535 $3,589 $7,148 $14,144 oklahoma $3,346 $4,441 $5,323 $4,106 $5,019 $10,342 oregon $5,323 $7,992 $9,034 $5,627 $8,502 $10,494 pennsylvania $2,950 $8,790 $29,565 $4,715 $9,429 $30,873 rhode island $5,080 $7,756 $10,281 $5,779 $8,593 $10,828 south carolina $2,920 $5,779 $10,068 $3,711 $6,251 $10,615 south dakota $5,049 $6,064 $7,574 $5,353 $6,448 $7,817 tennessee $4,563 $5,840 $7,848 $4,623 $6,296 $12,532 texas $2,738 $4,258 $7,908 $3,072 $5,718 $11,893 utah $4,106 $5,323 $9,125 $4,471 $6,388 $15,208 vermont $7,908 $8,502 $11,011 $7,908 $8,760 $15,208 virginia $5,019 $6,707 $23,117 $5,323 $7,724 $23,269 washington $5,414 $8,078 $15,969 $5,810 $8,803 $15,969 washington d.c. $8,213 $8,213 $8,213 $8,213 $8,213 $8,213 west virginia $5,962 $8,562 $10,798 $6,388 $8,969 $11,102 wisconsin $5,323 $7,505 $24,790 $5,627 $8,292 $25,428 wyoming $5,293 $6,692 $9,125 $5,779 $7,437 $9,125 personnel direct staff in most jurisdictions, nursing homes are required to provide enough staff to adequately care for residents. for example, a state may require that a nursing home has at least one registered nurse available for at least 8 straight hours a day throughout the week, and at least a licensed practical nurse on duty 24 hours per day for up to 100 residents. understaffed facilities are one common causes of nursing home neglect due to the staff's inability to meet the needs of all residents. the federal government considers categories of direct service personnel to include staff and aides, and licensed and unlicensed personnel, to have similar needs and functions (see, classifications of mental health professionals for comparisons which are also available for hiring in facilities). the direct care staff have direct, daily contact with the patient in activities such as meals, personal care, daily activity (e.g., bingo), medications, and travel (often in wheelchairs) in the units. in a nursing home, the personnel may include registered nurses, licensed practical nurses and nursing assistants. indirect staff custodians, maintenance staff, and groundskeepers keep the inside and outside of the building in clean, working order, though direct staff are responsible for areas of personal cleanliness. additional support personnel also include people who may have some contact with the patient in the nursing home. for example, nursing homes may have an activities director who is responsible for planning social activities, coordinating special visitors and religious services. larger facilities may have multiple staff members, such as chaplains or activity assistants, who take on some of those roles. the government requires a minimal activity schedule for residents in order to obtain funds. ombudsmen in the us, some states and organizations provide an ombudsman who can provide assistance with concerns about long-term care facilities. ombudsmen work to resolve problems and concerns involving long-term care providers, residents and their families, and other involved parties, and to improve residents' quality of life. outsourced services a nyc transit paratransit bus. at certain facilities, residents who are mobile are able to ride paratransit vehicles to visit places outside of the facility. however, the cost is not always covered by the facility. services nursing facilities offer (by county planning process) the most extensive care a person can get outside a hospital, if one discounts regional medical centers, alternative programs in the community (sometimes now, medical homes, and 24 hour care programs), and the newer assisted living facilities. nursing homes offer help with custodial care—like bathing, getting dressed, and eating—as well as skilled care given by a registered nurse and includes medical monitoring and treatments. skilled care also includes services provided by specially trained professionals, such as physical, occupational, and respiratory therapists. the services nursing homes offer vary from facility to facility. services can include: room and board monitoring of medication personal care (including dressing, bathing, and toilet assistance) 24-hour emergency care social and recreational activities (posted schedules) religious assistance (chapel) occupational therapy rest home for seniors in český těšín, czech republic some individuals that are housed in a nursing home require ongoing occupational therapy. occupational therapists "promote the health and participation of people, organizations, and populations through engagement in occupation". these specialists provide intervention in areas of occupation such as: activities of daily living (such as bathing, dressing, grooming; instrumental activities of daily living (home and financial management, rest and sleep, education, work, play, leisure) and social participation. in certain facilities, part-time employment in areas such as a facility mailroom are utilized by residents who prefer to stay busy and to improve dexterity. they also develop and implement health and wellness programs to prevent injuries, maintain function, and improve safety of residents. for example, occupational therapists can take a leadership role in developing and implementing programs to educate clients on compensatory techniques for low vision, customized exercise programs, or strategies to prevent falls. occupational therapy practitioners may also consult with other staff within the facility or in the community on a variety of topics related to increasing safe engagement in activities. occupational therapy practitioners can provide a variety of services to short- and long-term residents of a snf. based on a client-centered evaluation, the occupational therapist, the client, caregivers, and/or significant others develop collaborative goals to identify strengths and deficits and address barriers that hinder occupational performance in multiple areas. the intervention plan is designed to promote a client's optimal function for transition to home, another facility, or long-term care. physical therapy some of the individuals that are housed in a nursing home need ongoing physical therapy. this can be for any number of reasons. perhaps a person has motor skills that never fully developed or have stopped functioning for some reason. perhaps an individual has undergone a surgery or medical procedure that requires some manner of physical restitution on a personal level. nursing homes offer specialists that are well versed in the field of rebuilding muscle or helping one regain their confidence when it comes to doing something physical. this is one of the most common therapies that are done in these nursing homes. medical needs nearly all residents in a nursing home have some type of medical need, ranging from basic care requirements to more specialized needs. most nursing facilities are equipped to deal with most general medical needs likely to emerge. most of the staff will have ample training in how to deal with patients with specific needs. in fact, the staff that interact daily with the patients are normally registered nurses, who have spent years training for all contingent situations that they may encounter in a nursing home. however, children and adults with medical and physical needs have been supported in families and community settings for decades, including through the early katie beckett waivers, serving children with technological needs. personal assistance services in workplaces also may be medicaid -funded and support individuals to live in the community, often throughout their adulthood. these are called community services, not necessarily nursing services. residential versus institutionalized care in the us there are over 43 categories of residential care of the institutional variety in the us, including the modernized "assisted living facility" of the late 1990s. these categories generally reflect the target of institutional reform to better quality supports in homes and communities. in various states, medicaid waiver programs have been developed to allow impoverished elders access to home-based care, instead of being forced into an institution. though begun in new york in the 1970s, the legislative program was reported nationally together with other early community program development such as family support which grew to 950 programs serving younger adults and their families in new york alone. in addition, in fields such as intellectual and developmental disabilities, , small homes (no larger than 12, 2–4), small intermediate care facilities (icf-dds) and community supports (e.g., supported employment) were developed as new, integrated service systems.