Long-Term Care, Nursing Homes and Residential Programs

No longer being able to live independently is one of the hardest challenges facing the elderly. But it is important to look at your options while you can still decide for yourself what is best for you. There are a range of services available to help senior citizens with their day-to-day tasks. For those who require more help, long-term care facilities range from assisted living to full-scale 24-hour nursing facilities.

What are alternatives to a nursing home?

Many elderly people may not want or need the services of a full-scale nursing home. There are many alternatives:

• Community services. This may include adult day care facilities where seniors may stay during certain times of the day or home health caregivers. Programs such as Meals-on-Wheels may help with cooking needs. Look in your local phone book to see what other community services may assist with elder needs.
• Assisted living facilities. These facilities allow seniors to live independently within a larger complex. They generally focus on elderly citizens who need some help with their daily activities, but who do not need the specialized care of a nursing home. The facility may help with tasks such as bathing, meals and prescription drug medication reminders.
• Government-subsidized senior housing. This housing allows low-income seniors with no major medical conditions to live independently in a large housing complex. You will need to fill out an application and meet your state's income limits. Many of these programs have waiting lists. You generally have to pay a percentage of your income for rent.
• Retirement communities. These communities serve elderly people who can live independently through skilled nursing facilities. The largest, most extensive communities provide housing, meals and medical care for the rest of the retiree's life. You normally pay an entrance fee along with a monthly fee. For more information on the accreditation of retirement communities, contact the Continuing Care Accreditation Commission at 202.783.7286 or online.

How can we determine what the best long-term care is for our situation?

That will depend on many factors. You may be able to live independently for many years, or you may need specialized medical care that is best suited to a skilled nursing facility. Discuss this with your spouse and adult children. Also talk with your doctor about facilities in the area and how they meet your specific needs. Your financial condition will also play a role in determining which long-term care option is best for you. Contact your local Agency on Aging for information on facilities in your area.

What is the difference between skilled nursing care and intermediate care?

The terms are not interchangeable. They were created along with the creation of Medicare and Medicaid.

• Skilled nursing facility. This facility has 24-hour nursing services available to residents.
• Intermediate nursing facility. These facilities provide health services and some nursing supervision. They also provide help with eating, dressing and other personal needs. Medicaid may pay for intermediate care but Medicare never does.

What should I consider when I tour nursing home facilities?

There are many things you need to remember when touring nursing home facilities. Many social services groups can provide checklists. Some things to keep in mind include:

• Does the facility have a current license?
• What are the different levels of care provided by the facility?
• What kind of social activities does the facility provide?
• Are the meals nutritious and good? Can they meet any dietary restrictions you have?
• What are basic charges and what are extra charges?
• How often are fees increased?
• What kind of payment does the facility accept?
• Does your physician have a good relationship with the facility?
• Under what circumstances can the facility discharge you?
• Is the facility clean?
• Are staff members courteous to each other and residents?
• What kind of weekly religious services are held at the facility?
• How do the current residents look-happy, content and well-cared for?
• What are the emergency and evacuation policies of the facility?
• Is there a pharmacy in the facility?
• What kind of physical and occupational therapy is available onsite?
• What is the size and condition of each room and how many roommates will you have?
• What are the visiting hours?

If we choose a nursing home, what issues should influence our selection?

Many factors go into deciding which nursing home suits your needs. First, consider all the alternatives. You may not need a full nursing home, but instead may enjoy the independence of an assisted living facility. Your ability to finance nursing care, both through your own assets and public aid, should be a strong factor in your decision. Find out which programs you qualify for and which facilities are approved by and accept Medicare and Medicaid funds.

What should I know about long-term care insurance?

Long-term care insurance is relatively new but gaining in popularity. These policies can cover home care and nursing home care. Some may only cover stays in Medicare-approved facilities. The best policies cover all levels of nursing care: skilled, intermediate and custodial. Some policies may require a hospital stay before entering a nursing home. The policy should last your lifetime and guarantee your ability to renew. Contact your nearest SHIP to see if one of these policies is right for you.

TIP: For more information about long-term care insurance, get a copy of A Shopper's Guide to Long-Term Care Insurance from the National Association of Insurance Commissioners, 2301 McGee Street, Suite 800, Kansas City, MO 64108-3600.

Will Medicare help pay for nursing home expenses? For a caregiver?

Medicare will pay some nursing home costs under limited conditions but generally does not pay for long-term nursing care. Medicare beneficiaries must require skilled nursing or rehabilitation services and receive them from a Medicare-approved skilled nursing home after a qualifying hospital stay of at least 3 days. It pays for certain hospice and home health care services. Medicare covers physician and nursing services, pain medication, medical supplies, physical and occupational therapy and social services counseling. Only "medically necessary" home health services are also covered. The Medicare program must approve the agency making home visits.

The facility we chose wants us to submit a full financial disclosure of our assets. Should we refuse?

No. Most long-term care facilities require full financial disclosure from prospective residents who will be paying privately. Many nursing home residents start paying with their own funds but eventually must rely on Medicaid. The facility wants to know how long you can pay using your own funds and when you will need to apply for Medicaid.

Will I give up any of my personal rights if I enter a long-term care facility?

No. Nursing homes are subject to both state and federal government regulation. They can require you to abide by its facility rules, and you must respect the rights of other residents and staff as you would in any other living arrangement. But you do not relinquish your civil rights by living in a nursing home. Many states have adopted a nursing home residents' bill of rights. The facilities must generally inform residents of their rights both in writing and orally.

What rights do I have as a resident of a nursing home?

The Nursing Home Reform Act of 1997 provides nursing home residents with minimum basic rights. The nursing home must provide you written information about your funds, how to file a complaint with the state, any room changes, health care advance directives and Medicare and Medicaid eligibility.

As a nursing home resident, you have the right to choose your own doctor, participate in your care and file complaints about your care. The nursing home must allow your doctor to have access to you at all times.

I am worried about my privacy in a nursing home. What are my privacy rights?

States require that facilities maintain their residents' right to privacy. This means that you have a right to choose and maintain your own physician, manage your financial assets, be medically treated in private, keep confidential records, have private visitation with any visitor, send and receive mail unopened and make telephone calls unmonitored.

My nursing home wants to move me to another room on the other side of the nursing home. Can I stop this?

You have the right to not be arbitrarily moved to another room within a licensed nursing home. The nursing home, however, does have the right to move you involuntarily if the move is due to an incompatibility with your current roommate, if the move is in your best interest or if medical reasons exist.

Generally, the nursing home must give you written advanced notice stating the reason for the transfer. This notification requirement may be waived in an emergency situation.

My nursing home said it was transferring me to another facility. Can I object?

A nursing home can only transfer or discharge you for specific reasons.

Example: You can be transferred if you have not paid your fees or the nursing home is closing or no longer providing the kind of care you require. Your doctor may indicate that a transfer to another facility is in your best interest, or a Medicare or Medicaid review may conclude that you no longer require the services of the nursing home you are in.

A nursing home cannot discharge you because you are a Medicaid recipient. If the nursing home indicates that it will be transferring you or discharging you, talk to them and make sure you understand the specific reasons. You can also appeal a facility's decision to transfer you through your state's appeals process.

TIP: Contact your state's Long-Term Care Ombudsman for assistance in this situation.

How do I file a complaint against a long-term care facility?

First, try to resolve the matter with the facility's staff and management. If you cannot come to an agreement that suits both parties, contact your SHIP for information on how to file a complaint and start an investigation in your area.

What is the "Ombudsman Program" for long-term care?

The Older Americans Act created the Long-Term Care Ombudsman Program. Each state is required to have an ombudsman program to receive and investigate complaints. The program also seeks to educate consumers about long-term care options and facilities. Contact your local Agency on Aging to learn more about your state's program.