There are many options and resources available to those searching for a nursing home. One important resource will be websites like the Retirement Care Guide. Our knowledgeable staff has created a full-page electronic brochure highlighting important pricing, financing, and service offering information. Another important online resource, the Medicare website, offers a link to a certified “Nursing Home Checklist” (Exhibit One) that should be brought along on all nursing home visits, whether skilled nursing or assisted living. You will also find a 42 page booklet highlighting detailed information on everything you need to know about skilled nursing care. There is a brief overview below in the section titled, “Medicare Summary”. Aside from Medicare and the Retirement Care Guide, there are many non-profit, state and federally chartered organizations available to help you in your search.
With such an important outcome of your decision, choosing a skillednursing home community is simply not enough. It is critical that you choose the nursing home that will best support either yourself or your loved ones for years to come.
How do I Know a Skilled Nursing Home Offers the Care I Need?
First, we will concentrate on specialization. While most nursing homes will offer a full spectrum of nursing care, some put a greater emphasis on particular aspects of the nursing experience. You will want to make sure to check accreditations, licenses, nursing staff statistics and ratios, and read all of the literature on each skilled nursing facility prior to making a decision. The Retirement Care Guide has taken great care in providing most of that information. If the resident has a particular medical concern, do not be afraid to ask the nursing home administrator or marketing director exactly what processes they have in place to deal with the ailment. You may want to ask them to elaborate on the number of nursing staff they have available with the residents who are afflicted with each illness. If possible, during a site visit, you should ask to visit or speak with an existing resident who is in the same position as you or your loved one will be in. As the elderly continue to age, the sad fact is that their medical problems tend to become magnified and diseases generally progress. When looking for a particular type of nursing home care, keep in mind that more intensive care may be needed in the future and plan accordingly.
If intensive skilled nursing care is not necessary and the resident simply has problems with the Activities of Daily Living, which include dressing, eating bathing, grooming, medication, and toileting, there are many additional Assisted Living options available.
The best option, which is generally only available to those with more than modest means, is a Continued Care Retirement Community, otherwise known as a CCRC. A CCRC is a community that offers every type of medical care necessary. From the independence of a young retiree to the complete dependence of the very aged, a CCRC will save residents the hassle and the stress of moving from facility to facility.
For those of us with modest to no income, the most popular options will be a Medicare/Medicaid Certified Assisted Living Facility, Board and Care home, Community-Based program or Home Health Care agency. These are discussed in greater detail in their respective articles.
What Options are Available to Pay for Skilled Nursing Home Care?
Financing a Nursing Home is another issue that should be at the forefront of your decision. There are many options, some limiting and others not-so-limiting. In the limiting category we will find Medicare, Medicaid, MediGap and Managed Care plans. Personal resources or savings are used by 50% of skilled nursing residents and long-term care insurance is another popular form of payment that is significantly less limiting that government sponsored programs.
According to the Medicare organization, “Under certain limited conditions, Medicare will pay some nursing home costs for Medicare beneficiaries who require skilled nursing or rehabilitative services.” It goes on to say that the nursing home chosen will have to be a Medicare Certified skilled nursing home and can only be used after a minimum of three days at a hospital. For additional information on Medicare coverage, you can use your Medicare Fiscal Intermediary or you State Health Insurance Assistance Program (SHIP). The contact information is below.
Medicaid covers nursing home costs for people with low to no assets or income. Usually a skilled nursing resident will need to have exhausted all of their financial resources to receive skilled nursing payments from Medicaid.
Medigap is a private insurance that covers the “gaps” in what Medicare will and will not pay for. These gaps include deductibles, co-payments and other fee’s that are generally considered “out-of-pocket” expenses. Usually the skilled nursing community must be Medicare certified to receive payment from Medigap.
For those who have planned ahead, there is something called a managed care plan that acts much like a Health Maintenance Organization, or HMO. In order to receive skilled nursing home care through a managed care plan, the nursing home you have chosen will have to have an agreement in place with the company providing the managed care plan.
Lastly, we will cover the least restrictive forms of payment for skilled nursing home care. These include long-term care insurance and private pay. Long-term care insurance is a private policy and each plan is structured very differently. Usually, for long-term care insurance to be beneficial the resident needing skilled nursing will had to have had the foresight and the discretionary income to have the plan in place a long time before the care is actually needed. Once the care is needed, however, these plans work really well and offer skilled nursing residents the security of having their savings intact.
If the nursing home patient is lucky enough to have personal resources that can be used for private payment, often times this can open the door to care that would most certainly be unavailable to those without savings. The downside to this is that the resident will receive less government aid until their resources have been exhausted.
Medicare Summary (Summary of “Medicare Coverage of Skilled Nursing Facility Care”)
The Medicare website is full of useful information regarding nursing home care and the benefits you can expect to receive. They also offer a skilled nursing home checklist, which is included below, that should be brought to every site visit. While Medicare offers a great deal of benefits to those who need them, there are also some restrictions on the coverage and types of care offered. The first thing you should note is that custodial care, help with ADL’s, is not covered under Medicare unless skilled nursing care is needed also. There are many other important considerations highlighted in the booklet, Medicare Coverage of Skilled Nursing Facility Care that I will summarize below. When reading this information, keep in mind that it is a summary, not the full story. If you fulfill all the requirements listed below, you may want to read the full text.
First, in order to receive Medicare assistance from a skilled nursing facility, the resident must meet all of the following requirements:
· You must have Medicare Part A and additional days left in your plan.
· You must have completed a minimum (three consecutive days) hospital stay and must enter the Skilled Nursing Facility within 30 days of the release.
· Skilled nursing services must be recommended as treatment by a medical doctor.
· Must require daily skilled nursing care and the services must be ones that can only be offered in a Skilled Nursing Facility on an inpatient basis.
· Services must be performed to treat a medical condition that was either:
o Treated during a qualified three-day hospital stay
o Started while receiving skilled nursing facility care for a condition that was treated by a qualifying three-day hospital stay.
· Skilled nursing services must be reasonable and necessary for the diagnoses or treatment of your medical condition.
· Facility must be Medicare certified.
Once you have met all of the basic requirements, you will need to have had at least three days of inpatient care prior to receiving the skilled nursing and the attending doctor must give their approval for the treatment. Once you start skilled nursing home care, you will only receive your benefits for up to 100 days. Once this period has ended, you will need to start over with the three day inpatient care visit. According to Section One of the booklet, Medicare will cover all of the skilled nursing expenses for the first 20 days. Over the course of the next 80 days, the skilled nursing home resident may be required to pay a co-payment of up to $109.50 per day. After the 100 days, the patient will receive no coverage unless they reapply for another 100 days starting with a three day inpatient stay.
During a Medicare-certified skilled nursing home stay, Medicare will help pay for necessary Registered Nursing care, Licensed Practical Nursing care, Physical and Occupational Therapists, Speech Pathologists and Audiologists. Each of these terms is defined below. The services that Medicare will cover are:
· Semi-private room
· Meals
· Skilled Nursing Care
· Physical, Occupational and Speech-language Therapies
· Medical Social Services (Care plan and so forth)
· Dietary Counseling
· Ambulance Transportation
· Medications
· Usage of Medical Supplies and Equipment
Altogether, Medicare coverage for skilled nursing home care is very comprehensive. It is important that you ask exactly what portion of the bill you will be required to pay. It is required by law that they disclose this information to you prior to administering services. Medicare-certified skilled nursing facilities must also disclose, when asked, their last inspection report. Be sure to ask for this at each site you visit. Skilled nursing home residents have a number of rights that you should explore prior to taking residency at a skilled nursing facility. That information, as well as other more specific information, is included in the booklet, Medicare Coverage of Skilled Nursing Facility.
Conclusion
When researching skilled nursing homes, or any care home for that matter, be sure to include the resident in the process. Take their input and incorporate it into your decision. Make sure to bring them along on community visits and encourage them to ask questions. At the end of the day, sit down with your loved one and have a conversation on what they liked and disliked about each skilled nursing home. The transition to a nursing home community is one of the hardest moves a person will ever have to make. It means they have to give up their independence. Including them in the process will help to take away some of the fear involved and will give them a sense of independence and purpose.
The staff of the Retirement Care Guide is proud to offer you a service that will play a major role in helping alleviate much of the stress involved in finding the perfect skilled nursing facility for you or your loved ones. Making a final decision on where to place your loved one, however, will require much more work and a great deal of due diligence. We offer the tools through our website; it is up to you to use those tools to the best of your ability. Rest assured, there are people who are willing to help every step of the way.
Exhibit One:Nursing Home: Checklist (Medicare)
It is important for you and your family members to visit the nursing home to make sure that it meets your needs, as well as those of your family. A few things to consider when choosing a nursing home are listed here.
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Is the nursing home accepting new residents?
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Yes_____ No_____
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Is the nursing home easy to visit for family and friends?
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Yes_____ No_____
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Does the nursing home use hospitals where my doctor practices?
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Yes_____ No_____
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Does the nursing home have the services I need?
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Yes_____ No_____
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Does the nursing home have a variety of activities I might enjoy?
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Yes_____ No_____
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Do residents appear clean and well groomed?
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Yes_____ No_____
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Do the residents have the same staff on a daily basis?
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Yes_____ No_____
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• Is there enough staff available to assist residents?
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Yes_____ No_____
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• Does the staff respond quickly to residents' calls for help?
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Yes_____ No_____
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Does the nursing home have an active resident and/or family council?
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Yes_____ No_____
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Is the nursing home clean and pleasant?
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Yes_____ No_____
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Is the nursing home certified by Medicare and Medicaid?
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Yes_____ No_____
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Are the nursing home and current administrator licensed?
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Yes_____ No_____
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How much is the cost of care in this nursing home?
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__________________
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• What services are included in this price?
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__________________
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• What additional costs will I have to pay?
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__________________
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Ask to see the nursing home's last annual state inspection report. Did the report find any problems? Ask how the problems were fixed.
1) Medicare.gov. Nursing Home Checklist. March 21, 2005
2) Medicare.gov. Medicare Coverage of Skilled Nursing Facility Care.
August 1, 2004.
