Making the decision that a nursing home is the right place for you and looking around at different homes is important to do before you are hospitalized for a medical crisis.

Nursing homes generally operate at close to full capacity and a particular nursing home may not always have an available opening. It is best to have several nursing homes in mind should the need arise. With the help of your doctor and the hospital discharge planning staff, realistically assess your medical, nursing and social needs and seek facilities that can best meet these needs. For example, a facility with a strong physical therapy department might be important if you are recovering from a stroke.

Discuss nursing home placement with your family so that the eventuality of this possibility will be fully explored and your feelings known before a crisis occurs.

Watch for articles in newspapers and magazines and for television programs that deal with nursing homes. Pick up information on nursing homes from social service agencies or local offices for the aging and local health departments. Contact community group s and advocacy groups.

Ask family and friends about their own experiences. If you know someone who is in a nursing home, visit that person and ask questions. Ask questions of key personnel at the facilities you visit: the administrator, social work director, nursing director, medical director, for example. Make your own judgments. A caring home should welcome both your desire to visit and the questions you ask.

Admission

Medical need and method of payment play a large part in admission.

Medical Need

A medical assessment must be performed before you can be admitted to a nursing home. This assessment is done by a registered nurse who has been certified to perform the assessment. The assessment is a two-step process and is specifically designed by the State Health Department to evaluate your functional status as well as your appropriateness for a nursing home. The state requires that assessment forms be completed for everyone who applies for residence in a nursing home. The forms are valid for 30 days for hospitalized individuals and 90 days for those at home.

The nursing home administrator, admissions director or director of social services will be able to explain arrangements for your admission to the facility. If you are receiving care in a hospital, your doctor and the hospital social worker/discharge planner will assist in making arrangements for your placement, hopefully in the nursing home of your choice.

Waiting Lists

Although most people find that the need to enter a nursing home comes about after a serious illness treated in a hospital, you will be better off if you plan in advance. If you are applying for admission to a nursing home from a hospital, speak with the hospitals discharge planner. Nursing homes typically do not have many vacancies, so it is advisable to have several suitable facilities in mind. Regulations require formal application before you can be placed on a waiting list. Once you have made your choices, ask to be placed on the waiting list. Continue to check the status of your application by calling in regularly to the specific offices where you submitted your applications.

State regulations require that a hospitalized patient on Medicaid who no longer needs inpatient hospital care be placed in the first available bed within 50 miles of the patients home. By telling the hospital which nursing homes to apply to, you or your family can influence the location of the eventual placement.

Admissions Agreement

The admissions agreement (also called the financial agreement, admission contract, entrance contract or some other term) is a legal agreement between the nursing home and the resident to spell out conditions for admission. The contract should state the costs, services included and all legal responsibilities of the resident. Ideally, it should also include care (in accordance with intensity of need), emergency procedures and standards of food service (for example, availability of therapeutic diets, kosher diets, etc.).

Ask questions about the contract. Ask your attorney, the nursing home administrator or admissions director to explain anything that is not clear. Call an advocacy group with questions.

Paying for Nursing Home Care

Since the cost of nursing home care is so high (ranging from $3,000 to $10,000 a month), few people can afford to pay out of their own pocket for very long. Ninety percent of nursing home residents are or become reliant up on state and federal subsidies.

If you have the means and plan to pay with your own funds, you will have a much better chance of getting admitted to the nursing home of your choice.

Meet with an elder law attorney to get advice on estate planning, Medicaid, Medicare and long term care insurance before you apply to a nursing home. The State Bar Association Referral Service as well as many local bar associations will provide you with a list of elder law attorneys.

Private Payment

Nursing homes charge a basic daily rate for the services they provide and these vary from home to home. Some homes have all-inclusive rates, others have a rate for room and board and add additional charges for physicians services, laboratory tests, physical therapy, prescription drugs, etc.

Private pay rates are not regulated. Homes may charge their private pay residents whatever they wish. These rates can be expected to go up at least once a year. If you are planning to pay for nursing home care out of your own pocket, ask for a list of services that are covered by the basic daily rate. Also ask how the rates are adjusted and how residents are notified of adjustments. (Under current law, this notification must occur in writing 30 days prior to any upward adjustment in the daily rate for a service being implemented.)

The basic daily rate must cover room and meals, housekeeping, linen, general nursing care, medical records and services, recreation and personal care. There may be extra charges for items that vary from resident to resident, such as physical therapy and medications. Discuss with the homes admissions director, administrator or social worker what services are standard and what additional services might be required and what they cost.

Homes are permitted to ask for a prepayment or a security deposit. The home can ask for no more than three months prepayment. Prepayment used as security must be deposited by the home in an interest-bearing account.

If you leave the home or die, any amount paid to the home over the cost of services already provided must be refunded. It is illegal for a nursing home to demand or accept donations (to a building fund, for example) from family members to assure placement of a relative.

Most homes require full financial disclosure from residents who will be paying privately. Since many nursing home residents who enter as private pay residents eventually use up their funds and go on Medicaid, the homes want to know how long the resident will be able to pay privately and when to apply for Medicaid.

Once you are eligible for Medicaid, you have the right to have Medicaid pay for your care (if the home accepts Medicaid). When this happens, the nursing home should assist in completing the necessary forms.

You may not be moved out of a nursing home because you have exhausted your personal resources. Also, your spouse need not spend all his/her personal resources on your care if you are institutionalized.

Some homes suggest that funds be placed in a trust that the home controls, or that the residents Social Security checks be made payable directly to the home. The law guarantees residents the right to control their own financial affairs as long as they are willing and able to do so, or to assign that responsibility to a friend or family member. The nursing home may be given control over a residents finances if no one else is willing to handle them. 

Private Insurance

Private long term care insurance policies are becoming more and more available. They are advertised as a possible alternative to Medicaid or as a way to avoid exhausting resources when nursing home care is needed. They vary in the coverage they provide and should be carefully examined before purchasing. The State Insurance Department publishes materials comparing long term care policies offered by different companies.

The federal government is now permitting states to authorize Medicaid without someone exhausting his/her assets if that person first purchases a long term care insurance policy sponsored by the state. Such a policy must cover at least three years of long term care, six years of home care or an equivalent combination of both. Once an individual purchases such a policy and once the benefits for such a policy are exhausted, that person, if income eligible, will be eligible for Medicaid payment for long term care for the remainder of his/her life without consideration of his/her assets. Most importantly, however, whatever assets that person has will be protected and will not have to be used to meet long term care costs. You may hear this type of insurance referred to as a "partnership" long term care policy.

Medicaid

Medicaid, established by Congress in 1965, is a government health insurance program for people of all ages whose income is too low to provide for routine health care costs, or whose health care costs are too high to be covered by their income. This health insurance covers the cost of nursing care for as long as the care is required, if a resident is eligible.

A comprehensive application process is used to determine eligibility for the Medicaid program. This process requires that applicants provide detailed information and documentation regarding income and assets.

A Medicaid applicant must be a citizen or permanent resident in the United States, must meet State income and resource limitations and must show medical need.

Currently, a Medicaid recipient in a nursing home is allowed to retain $50 of monthly income as a personal needs allowance to meet personal expenses that are not covered by Medicaid. Call your local Department of Social Services office for additional info information on Medicaid.

Continue to » Finding A Nursing Home - Planning in Advance Part 2