Medicare will pay a maximum of 100 days of care in an approved nursing facility for patients in need of skilled care following a hospitalization of at least three full days. To qualify, the patient must be admitted to the nursing home within 30 days of discharge from the hospital.

Many people leave a hospital and enter a nursing home expecting Medicare to continue to pay for health services. This is generally not the case. Medicare will not pay for a nursing home stay if it is determined that only custodial care is required, or if skilled nursing home care and/or rehabilitative services are needed only on a periodic basis. Under Medicare rules, the need for skilled nursing care must be daily. The program has a number of specifics about what services are included and requires that you be responsible for a co-payment. For further information, contact your local Social Security office.

Visiting the Facility

Call the nursing homes you are interested in and make an appointment to meet with the admissions staff (usually a social worker).

Each nursing home has its own policies and procedures, but all must follow certain state and federal regulations and respect residents rights. A copy of the home's policies should be available upon request. Following is a list of some policies to check:

- complaint procedures;
- the use of personal belongings and furniture;
- the availability of ethnic foods or special diet preferences;
- room assignments and changes;
- reserving a bed if transferred to a hospital;
- visiting hours (should cover a 10-hour period and two meal times);
- emergency procedures;
- self-care;
- phone calls;
- leaving the facility for short visits with family or friends;
- procedures for handling theft;
- access to personal funds.

Section II of this directory provides more detailed information on what you should look for when you visit a nursing home. 

Nursing Home Administration

Nursing homes may be owned by state/local governments (public nursing homes), individuals, corporations and religious or charitable organizations. Most nursing homes are not-for-profit businesses (voluntary nursing homes) or businesses operated for profit (proprietary nursing homes). An individual or a nonprofit organization may own or operate more than one nursing home. 

Final responsibility for the operation of a nursing home lies with its governing body (voluntary nursing home) or owner (proprietary nursing home). The governing body (the board of directors or trustees) is legally responsible for the home. The governing body meets to set policies and to adopt and enforce rules and regulations for the health care and safety of the residents. The type of ownership and management are not necessarily an indication of the quality of service that you would receive.

The person in charge of the day-to-day management of a nursing home is called the administrator; the administrator is appointed by the governing body or owner. Other key personnel include the director of nursing services, the medical director, the director of social services and the director of admissions.

The administrator of the nursing home must be licensed by the State, the director of nursing services must be a registered nurse and licensed by the State and the medical director must be a State licensed physician. 

Evaluating A Nursing Home

When you visit a nursing home, look for its license. It will be prominently displayed, usually in the lobby.

Standards governing the operation of a nursing home are set by state and federal law. These standards intend to assure the highest possible quality of care and most meaningful quality of life for all residents in nursing homes. Standards cover a range of requirements including but not limited to residents rights, clinical services (including nursing, dietary, medical and rehabilitation services, for example), and administrative (including quality assurance and the physical environment, for example). Optional services are also covered by law (rehabilitation services for residents with head injuries, long term care services for people with AIDS and for ventilator-dependent residents) and adult day health care services.

Look for the latest state survey (inspection) report of how the home met the state standards set by code. 

The Department of Health, acting as the agent for the U.S. Health Care Financing Administration, has the responsibility to monitor quality of care in nursing homes. State surveyors inspect each nursing home every nine to 15 months. Surveyors interview residents, review residents records, inspect the premises and assess compliance with state and federal standards.

Surveyors may issue statements of deficiencies any time they visit a nursing home. If the need arises, state or federal survey staff may visit nursing homes more often to respond to complaints by residents or families or to monitor the progress as nursing homes correct deficiencies.

Based on the results of the inspection and the seriousness of problems noted, the Department of Health decides whether to take enforcement action. Repeat problems can result in fines and, in extreme cases, closure.

Remember, deficiencies are not necessarily the only indication of the quality of the care and administration of the home. Ask to look at the results of a few surveys so you can see if there is a pattern of deficiencies in certain areas.

Complete results of the most recent survey must be available in the facility in a place readily accessible to residents and visitors without staff assistance. Ask questions about deficiencies, if any, and how they were corrected. If you have additional questions after leaving the home, call back with follow-up questions. Or, contact the local office of the Department of Health or the Office for the Aging Long Term Care Ombudsman.

Health Care Decisions

Illness and the possibility of death are subjects few people find easy to discuss. Yet, these issues deserve consideration by both you and your family because they often involve decisions that may have to be made if life-sustaining procedures become necessary. This kind of decision does not have to be left to the family to decide. Decide in advance with the help of your family. Any course of treatment for you will be much easier to determine if your wishes are known in advance . 

Under the State Health Care Proxy Law, adults may appoint someone they trust to decide about medical treatment should they become unable to decide on their own. See Appendix C for a copy of the Health Care Proxy form and information about the Health Care Proxy Law. This form can be duplicated and does not have to be executed by an attorney. Additional copies are available from the nursing home administrator or from the State Department of Health. Most attorneys also have these forms.

Adults can also give specific instructions about treatment in advance. Those instructions can be verbal or written, and are referred to as Advance Directives.

The right to decide about treatment also includes the right to decide about cardiopulmonary resuscitation (an emergency treatment to restart the heart and lungs when breathing or circulation stops). You and your doctors should decide in advance whether or not you want resuscitation measures taken. If you wish, the doctor will give the medical staff a "do-not-resuscitate" (DNR) order.

Some nursing homes' moral or religious philosophy may conflict with your wishes about advance directives. Ask about the home's policy regarding advance directives.

Residents' Rights

Policies covering the rights of residents are established by state and federal regulations. The nursing home must implement and explain these policies to its residents and must post a summary of residents rights (a residents bill of rights) in the building for easy reading. Be sure to notice it and ask any questions you have about its provisions.

Every resident in a nursing home should receive appropriate care, be treated with courtesy and enjoy continued civil and legal rights. 

Nursing home residents have the right to:

- dignity, respect and a comfortable living environment;
- quality of care and treatment without discrimination;
- freedom of choice to make independent decisions;
- safeguard of money and property;
- safeguards in admission, transfer and discharge;
- privacy in communications;
- participate in organizations and activities of their choice;
- an easy-to-use and responsive complaint procedure.
- exercise all rights without fear of reprisals.

Long Term Care Ombudsman Program

The Long Term Care Ombudsman Program in the State Office for the Aging can help you throughout the nursing home placement process. It provides another source of information about how to go about choosing a facility, understanding the rights of residents and learning about good standards of care. However, the program does not rate or recommend specific facilities and will not choose a facility for a family or a prospective resident.

The State Ombudsman also investigates and resolves complaints made by, or on behalf of, nursing home residents, and monitors the development and implementation of laws, regulations and policies that affect nursing homes.

Continue to » Finding A Nursing Home - When You Visit A Nursing Home