Nursing Homes

Deciding whether your loved one really needs to enter a nursing home may be one of the toughest decisions you'll ever have to make. If the person is being discharged from a hospital, you can call upon the services of the discharge planner for help in evaluating the situation. And although every person and situation is different, here are a few of the important factors to consider.

• Is the person unable to live alone?
• Does he or she need 24-hour care and supervision?
• Is this person chronically ill but not sick enough to be hospitalized?
• Does he or she need help with daily activities such as eating, walking, dressing and bathing?

If you answer no to these questions, your loved one might benefit from more extensive home or community-based services or an assisted living environment. There, a person lives independently but with additional support such as light housekeeping, daily meals and occasional assistance with daily care.

If you answer yes to these questions, your loved one may need to be in a nursing home, and you may need a quick course in nursing home basics. Before you sign up with the first home that has an opening, you need to know a little about nursing home facilities in general. Most people don't know what to expect, but by getting a handle on some basic facts, you'll be able to find a good fit between person and place.

Of course, meals, laundry, housekeeping and medical and nursing services are standard. But over and above the basics, quality facilities offer dietary, pharmacy, recreational and social services, plus occupational therapy, physical therapy and speech therapy. (Note that Medicare- or Medicaid-approved facilities must meet federal standards. Ask to see the nursing home's certification and make sure it is up to date.)

There are typically many people involved in providing these services to residents. They may include:

• The administrative staff, with overall responsibility for the nursing home, includes an administrator and directors of admissions, personnel and finance.
• The medical director is a physician who makes sure residents receive adequate medical services.
• The nursing staff provides around-the-clock bedside care. The director of nursing is usually a licensed registered nurse who supervises the work of other registered nurses, licensed practical nurses and nursing assistants (nonprofessional caretakers).
• The therapists provide physical, occupational, recreational and speech therapy programs aimed at helping residents maintain their physical and emotional well-being and cope with their individual disabilities.
• The activity director is one of the most important employees. Many are trained therapists who assess residents' needs and create and implement recreational programs that are entertaining as well as therapeutic.
• The social service staff includes social workers, psychologists and counselors who help residents cope with emotional and psychological issues.
• The food service director manages the meals program and sees to it that nutritious food, attractively prepared, is served at every meal and that individual dietary requirements are met. Good food and pleasant mealtimes give residents opportunities to socialize.
• Volunteers usually are members of the community or relatives of residents who assist the staff. They may help residents with their daily activities, assist at mealtimes, organize parties or games and help therapists with programs. They are invaluable in providing one-on-one interaction and attention.

Nursing home care can be expensive. The average national cost for care in a nursing home is more than $77,745 a year for a private room and more than $68,985 for a semi-private room, although the actual cost can vary depending upon the area in which you live and the level of care required.* For most people, finding a way to pay for these costs is a big concern. Before you sign any legal documents, be sure you understand the terms. The admissions staff of the nursing home you select should provide you with terms and fees, in writing. For example, nursing homes charge either a basic daily or monthly rate. Ask what the rate is and what it includes. Find out what various levels of care are offered, what level your loved one needs and how the charges differ for each level.

Are there extra charges for doctors' fees, medication, laundry, special feeding, incontinent patients, wheelchairs or walkers? For speech or physical therapy? Is a deposit required? How much? When are payments due? What is the policy on holding a bed if your loved one has to enter the hospital briefly or is able to join the family for a vacation? Does the facility offer insurance counseling? Think about all of the necessities of daily living that you include in your own monthly budget, and then add in extras necessitated by illness or aging and discuss who will pay for these things and how.

To help determine how nursing home care will be paid for, the administrator or admissions director will usually ask for detailed financial information. Financing options may include:

Personal Resources. Many residents or their families initially pay for nursing home care from personal resources, such as income and savings. But because the care can be expensive, they may use up their savings and eventually apply for Medicaid assistance. Medicaid assistance is only for the poor, so one must typically use up their assets before they can become eligible. Note that the law typically provides some breaks to married people to allow a spouse remaining at home to retain some of the couple's assets and income, and there may be plans you can make to preserve some of your assets. It may be beneficial to consult an experienced attorney if you think this may be a situation in which you or your loved one may find yourself in the future.

Private Insurance. A relatively new type of insurance designed to help cover the potentially significant costs of a nursing home is private long-term care insurance. Coverage and cost vary greatly from company to company. Some considerations with respect to long-term care insurance policies that you should be aware of include:

• What the policy covers, specific diseases, home health care, nursing home care and level of care
• Eligibility requirements
• Premiums and whether they continue once the insured enters a nursing home
• When payments are instituted and whether inflation is figured in
• Time limits of payments
• Conditions under which the company can cancel a policy

Medicare. Many people are under the impression that Medicare, the federal government's health care insurance program for persons over the age of 65, covers the cost of long-term care. Actually, Medicare's coverage of long-term care costs is limited. In some cases, Medicare insurance will pay for a fixed period of skilled nursing care in a Medicare-certified nursing home. For more information, contact your local Social Security office.

Medicaid. A joint federal/state program that pays for health care for people with limited income and resources. Medicaid does typically pay for custodial nursing home care, but it must be in a Medicare-certified facility. To find out if your loved one is eligible for Medicaid and how to apply, contact the Medicaid office or Department of Social Services in your area.

Think about how much your own home means to you and how much time you spent selecting it. Choosing a nursing home should involve just as much care and consideration because, after all, it will be home to your loved one. Ask doctors, hospital discharge planners, social workers and friends for recommendations. Then, as you start making your selections, you will want to:

• Obtain a catalog of nursing homes from your state department of health, state agency on aging or an association representing nursing homes in your area.
• Start looking well in advance if possible—before a crisis pressures you into a hasty decision.
• Make your first visit to a nursing home without an appointment. Try to get an overall impression by looking at as many public areas as possible, such as the dining room, kitchen and activity room. Talk to the residents and ask them how they like the facility—good points as well as bad. Talk to family members of residents and ask for their opinions. If one facility seems appealing, make several visits at different times of the day to see what activities are taking place and if the staffing and atmosphere changes.
• Ask your health department whether the home has ever received an Intent to Deny License because of sanitary or fire violations or patient care inadequacies.
• Ask about the M.D. who serves as medical director. Does he or she have complaints against them or have they been disciplined by state medical boards or federal agencies?
• Ask to see the results of the latest state inspection of the facility. This is public information, and facilities are required to post it.
• Ask friends with firsthand experience for recommendations.

Before making a final decision, visit several nursing homes and take careful comparison notes. Use the following checklist to help you make the best selection.

Download the Nursing Home Comparison Checklist to help you evaluate the nursing home options for your loved one.

Moving into a nursing home is one thing; adjusting to it is quite another, for everyone in the family. Although it takes time to settle into any new living arrangement, good nursing homes often offer assistance, starting with preadmission sessions for family members.

A social worker or nursing specialist explains the emotional and physical stresses involved and shows the family how to make it easier for their loved one. For example, family members should accompany the person on moving day and be sure familiar items such as family photographs or sentimental keepsakes are displayed in the new room.

Even though someone else will meet the new resident's daily needs, only you can provide the sense of family that is still his or her most important requirement. Nursing homes usually encourage you to take your loved one on outings, if you have a doctor's approval. Many encourage you to join residents at mealtimes, take part in parties or social gatherings, and volunteer. Remember, regular visits from children, grandchildren, other family members and friends tell your loved one that someone cares. If you live far away, stay in frequent touch by mail and phone, and visit as often as you can.

Sometimes life throws you a curve. A sudden, debilitating illness forces you to place your loved one in the first nursing home with an opening. Now you've noticed how inadequate the care is. You've complained to the nurses, the head nurse and the administrator, with no success. Can you do anything else? The answer is yes!

Check the internet or call your local Area Agency on Aging to find out the name and phone number for the federal nursing home ombudsman in your state. The ombudsman mediates disputes and has the clout to require action from the nursing home. The ombudsman can also provide you with the most recent copy of the rights of nursing home residents as guaranteed by the federal government and state.

Finding a good fit between person and place will take some homework on your part. But once the decision is made, you'll have the satisfaction of knowing that your loved one is happy and well cared for in a safe environment. And that means a lot for both you and the special person who’s relying on you.

References

Caring for Your Parents: The Complete AARP Guide
by Hugh Delehanty and Elinor Ginzler
Published by Sterling Publishing Company, Inc.

The Baby Boomer's Guide to Nursing Home Care
by Eric M. Carlson and Katharine Bau Hsiao
Publisher: Taylor Trade Publishing

Consumer Information from the Federal Government

The quarterly Consumer Information Center Catalog lists more than 200 helpful federal publications. For your free copy, write: Consumer Information Catalog, Pueblo, CO 81009, call 1-888/8-PUEBLO, or visit www.pueblo.gsa.gov.

Helpful Links

Eldercare Locator
www.eldercare.gov
Funded by the Administration on Aging, the Eldercare Locator assists older persons and their caregivers with access to support services in the geographic area in which they live. You can also call 1-800-677-1116.

National Citizens' Coalition for Nursing Home Reform (NCCHR)
www.nccnhr.org
The NCCNHR was formed because of public concern about substandard care in nursing homes. The website includes the ability to search for the nursing home ombudsman in you area should you have questions or concerns about local nursing facilities.

American Association of Homes and Services for the Aging 
www.aahsa.org
This website contains a consumer section with information about long-term care services, a searchable service provider directory for both home care and facility care and links to other important resources for caregivers.

Alzheimer's Foundation of America (AFA) 
www.alzfdn.org
AFA provides information about brain health, Alzheimer's disease, and other forms of dementia. It gives tips for caregivers, as well as information about local resources to assist individuals with Alzheimer's disease and their families.

Benefits Checkup
www.benefitscheckup.org
Developed by the National Council on Aging (NCOA), this site assists seniors and their families in determining benefit eligibility for services in their area.