Table Of Content

Guide Choosing to A Home Nursing Reader Notice The Health Care Financing Administration (HCFA), the Federal Agency that oversees Medicare and Medicaid, wants you to be aware oftwo issues involving nursing homes. First, nursing homes cannot require pre-payment from residents who are relying on Medicare orMedicaid to pay for their nursing home services. Second, nursing homes may not use physical or chemical restraints on residents, except when medically necessary. Pre-Payment: If you are a Medicare or Medicaid beneficiary applying for admission to a nursing facility for care that will be covered by Medicare or Medicaid, it is unlawful for the facility to require you to pay a cash deposit. Federal law prohibits nursing facilities from requiring a pre-payment as a condition of admission for care covered under either Medicare or Medicaid. The facility may, however, request that a Medicare beneficiary pay coinsurance amounts and othercharges forwhich abeneficiary is liable. You pay those charges as theybecome due, notbefore. A facility may alsorequire a cash deposit before admission if your care will not be covered by either Medicare or Medicaid. Restraints: You should also be aware that Federal Law prohibits nursing homesfromusingphysicalorchemicalrestraints onresidentsfordisciplineor fortheconvenienceofnursinghome staff. Restraints increasethechancesthat residents will develop incontinence, impaired circulation, and swelling. Restrained residents also tend to suffer decreased functional ability, lower self-esteem, and feelings of depression, anger, and stress. Restrained residents are not safer than they would be if left unrestrained. Restrained individuals are more likely to suffer serious injuries when they fall. It is important that nursing home residents, whenever possible, be left unrestrained. Restraints may be used only when necessary to treat medical symptoms or to ensure the safety of other nursing home residents. Except in emergencies, physical and chemical restraints may be used only underthe written orders of physicians. Physical restraints include articles, such as belts or vests, that secure a resident's limbs or bind a resident to a bed, chair, or other stationary item. In addition, commonnursing homeitems, such as laptrays andbedrails, when employed solely to keep a resident from moving about, are considered restraints. Chemical restraints include drugs that are administered to keep a residentsubdued. If you know of a nursing facility that is improperly demanding pre-payments or restrainingresidents, you shouldcontactyourState's survey agency immediately. You will find their phone number in the back ofthis booklet. Table of Contents 7 Introduction 1 Step 4: Visiting Nursing Homes 7 Quality ofLife 8 Stepl: Building a Network 1 Quality ofCare 9 The Nursing Home Checklist 9 Step 2: Long-Term Care Options 2 Home and Community Care 2 Step 5: Follow-up Analysis 10 Subsidized Senior Housing 2 Follow-up Visits 10 AssistedLiving 3 (Non-Medical SeniorHousing) 3 Step 6: After Admission 11 Board and Care Homes 3 Resident Rights in a Continuing Care Retirement Nursing Home 11 Communities (CCRCS) 3 Respect 11 Services and Fees 11 Step 3: Gathering Information 4 Managing Money 11 The Long-Term Care Ombudsman 5 Privacy, Property, and Other Community Resources 5 LivingArrangements 12 OtherInformation You Will Need 5 Guardianship and Advanced Religious andCultural Preferences 5 Directives 12 Medicare andMedicaidParticipation.... 5 Visitors 12 HMO Contracts 5 Medical Care 12 Availability 6 Social Services 12 Special Care Needs 6 Moving Out 13 Location 6 Discharge 13 Paying For Nursing Home Care 6 Your Rights as a Relative 13 Personal Resources 6 Long-Term Care Insurance 6 Phone Lists 13 Medicaid 6 Long-Term Care Ombudsman 14 Medicare 7 State Survey Agencies 15 & Medicare Supplemental Insurance 7 Insurance Counseling Assistance 16 .... Nursing Home Checklist 17 1 CMS Library j C2-07-13 7500 Security Blvd. I Baltimore, MarytercS 21244 ! This bookletdiscusses how to selecta nursing home. It is not alegal document. The official provisions ofthe Medicare and Medicaid programs are contained in the relevant laws, regulations, and rulings. Introduction Selecting a nursing home is one of the most important and difficult decisions that you may be asked to make. Though it may be difficult to admit, you may spend several years Building a Network in a nursing home. So it is important Before you begin searching for a nursing that you make the best decision home, it is a good idea to put together a possible, and base your decision on network ofpeople who can help you make the right choice. This team should include the the most complete and timely family andfriends who areimportantto you. It information available. should also include the doctors and health professionals who understand your needs. The Health Care Financing Clergy andsocialworkersmayalsobevaluable network members. Administration (HCFA) wants Consult with your network. Family and you to make a good choice when friends maybewilling to share responsibilities choosing a nursing home. This and should be treated as partners. Remember that two heads are better than one, and many booklet is designed to help you heads are better than two. choose a nursing home. It pro- Ifyou are helping to select anursing home vides you with a step-by-step forarelative, makeevery efforttoinvolveyour relativeintheselectionprocess. Ifyourrelative process that will assist you. It also is mentally alert, it is essential that his or her provides you with some key wishes be respected. People who are involved resources that will help you conduct in the selection process are better prepared when the time comes to move into a nursing a wise search for the nursing home home. or long-term care facility that best Finding a nursing home that provides the fits your needs. rightservicesforyouinapleasant, comfortable 1 — environment often requires research. Ideally, Unfortunately, a great many people must youwillhaveampletimetoplanahead,examine select a nursing home with little notice several nursing homes, and make the frequently during afamily crisis orrightaftera appropriatefinancialplans. Byplanningahead, serious illness or operation. If you are in this you will have more control over the selection situation, this booklet should still be helpful. process,moretimetogathergoodinformation, Thoughyoumaynotbeabletofollow allofthe andmoretimetomake certainthateveryonein steps in the upcoming pages, by reading this your network is comfortable with the ultimate booklet you will gain valuable information choice. Planning ahead is the best way to ease about nursing homes, learn about the people the stress thataccompanies choosing anursing who might be able to help you, and pick up home, and helps assure that you will make a some tips about what to look for in a nursing good choice. home. S tep 2 Long-Term Care Options Until recently, few alternatives to nursing moving into a nursing home unnecessary. homes existed for people who could no longer Home services include meals on wheels take care of themselves. Even today, some programs, friendly visiting and shopper people are placed in nursing homes simply services, and adult day care. In addition, because neither they nor their family know there are a variety of programs that help about the alternatives to nursing homes. care for people in their homes. Some — Today, people who cannot live completely nursing homes offer respite care when independently may choose from a variety of they admit a person for short period of livingarrangementsthatofferdifferentlevelsof time, to give the home caregivers a break. care. For many, these alternatives are Depending on the case, Medicare, private preferable to nursing homes. insurance, and Medicaid may pay some home care costs. HomeandCommunityCare Most people want to remain at home as Subsidized SeniorHousing long as possible. A person who is ill or There are Federal and State programs that disabled and needs help may be able to get subsidize housing for older people, with avarietyofhome servicesthatmightmake 2 A low to moderate incomes. number of cases, private long-term care insurance thesefacilitiesofferassistancetoresidents andmedical assistance programs will help who need help with certain tasks, such as pay for this type ofliving. shopping and laundry, but residents ContinuingCareRetirement generally live independently in an apart- Communities (CCRCS) ment within the senior housing complex. In this way, subsidized senior housing CCRCs are housing communities that serves as a l—ower cost alternative to provide different levels of care ba—sed on assisted living though assisted living the needs of their residents from communities are frequently newer and independent living apartments to skilled moreluxurious. nursing in an affiliated nursing home. Residents move from one setting to AssistedLiving anotherbased on theirneeds, but continue CCRCs (Non-Medical Senior Housing) to remain a part of their community. Many CCRCs require alarge Some people need help with only a small payment prior to admission, and then number of tasks, such as cooking and laundry. Some may only need to be charge monthly fees above that. For this reason, many CCRCs are too expensive reminded to take their medications. For those people who need only a small for older people with modest incomes. amount of help, assisted living facilities maybeworthconsidering. Assistedliving What Is A Nursing Home? isageneraltermforlivingarrangements in A nursing home is a residence that which some services are available to provides room, meals, recreational residents (meals, laundry, medication activities, help with daily living, and reminders),butresidents stillliveindepen- protective supervision to residents. dently within the assisted living complex. Generally, nursing home residents Inmostcases, assistedlivingresidents pay have physical or mental impairments a regular monthly rent, and then pay whichkeepthemfromlivingindepen- additional fees for the services that they dently. Nursing homes are certifiedto require. provide different levels of care, from Board and Care Homes custodial to skilled nursing (services These are group living arrangements that can only be administered by a (sometimes called group or domiciliary trainedprofessional). homes) thataredesignedtomeettheneeds ofpeople who cannot live independently, Before deciding which care settingis most but do not require nursing home services. appropriate for you or your relative, talk to These homes offer a wider range of your doctor or a social worker and get a services than independent living options. realistic assessment of care needs. If you are Most provide help with some of the consideringhomecare, be sure youunderstand activities ofdaily living, including eating, all the work that comes with caring for a walking, bathing, and toileting. In some chronically ill person. If you are considering 3 independent living, consider the risks associ- Remember that caring for someone who ated with anunsupervised environment. is very sick requires a lot of work. Nursing homes are designed to meet the needs of the Be sure to discuss long-term care options with the family members who will be the main acutely or chronically ill. The options discussed above may work for people who home care givers and/or visitors to your new home. Consider how you will pay for your require less than skilled care, or who require own long-term care (for information on how skilled care for only briefperiods oftime, but manypeoplewithlong-term skilledcare needs peopleusuallypayforlong-termcare, seepage require a level and amount of care that cannot 6). be easily handled outside ofa nursing home. Step 3 Gathering Information Once you have decided that a nursing There are a number of ways that you can home is the right choice for you, it is time to learnaboutthenursinghomesinyourarea. The gatherinformation aboutthe nursing homes in easiest ways to find out about local nursing A your area. good first step in this process is homesbeginwiththephonebook. Youryellow finding out exactly how many nursing homes pages list many of the nursing homes in your there are in your area (because nursing homes area. Inaddition,yourlocalOfficeonAging(in are frequently located in out of the way areas the Blue Pages of your phone book) should there mightbe more than you think). have alistingofnursinghomesinyourareaand will be able to refer you to your local Long- Term Care Ombudsman. Some Facts About Nursing Homes You can get information on the nursing On any given day, nursing homes are homes in your area from a variety of sources. caring for about one in twenty Word of mouth can be a good source of Americans overthe ageof65 Almost . information. Askyourfriends andneighbors if half of all Americans turning 65 this they know people who have stayed in local year will be admitted into a nursing nursing homes. Learn all you can from these home at least once. One fifth ofthose different sources. people admitted into nursing homes stay at least one year - one tenth stay three years or more. 4 The Long-Term Care • clergy andreligiousorganizations, Ombudsman • volunteer groups that work with the elderly andchronically ill, and One of the best sources of information is your local long-term care ombudsman. • nursing home professional associations. Nationwide, there are more than 500 local By using these resources, you will tap into ombudsman programs. Ombudsman visit a community of people who understand — nursing homes on a regular basis theirjob is nursing homes and have a good deal of to investigate complaints, advocate for knowledge about the homes in your area. You resident, and mediate disputes. Ombudsman should now be able to make alist ofthe homes often have very good knowledge about the in your area which have good reputations. quality of life and care inside each nursing You Other Information Will home intheir area. Need Ombudsman are not allowed to recom- mend one nursing home over another. But There are also some types of basic when asked about specific nursing homes they information that should help you narrow your can provide information on these important list ofnursing homes. Consider some ofthese — subjects: factors a quick phone call to the nursing home should answer these concerns: • the results ofthe latest survey, • the number ofoutstanding complaints, Religious and Cultural Preferences • the number and nature ofcomplaints lodged If you have religious or cultural preferences, contact the nursing homes on your in the last year, list and see if they offer the type of • the results and conclusions of recent environment which you wouldprefer. complaintinvestigations. In addition, the ombudsman may provide Medicare and Medicaid Participation generaladviceonwhattolookforwhenvisiting IfyouwillbeusingMedicareorMedicaid, the various area nursing homes. The phone make certain that the nursing homes on number of your State Long-Term Care your list accept Medicare or Medicaid Ombudsman is provided at the back of this payment. Often, only a portion of the booklet. home is certified for Medicare or Medicaid, so make sure that the home has Other Community Resources Medicare or Medicaid "beds" available. In addition to the Long-Term Care For more information how Medicare and Ombudsman, there are many other resources Medicaid pay for nursing home care, see that you should consult before selecting a page 6. nursing home. Some other people who might HMO Contracts behelpfulare: Ifyou belong to a managed care plan that • hospital discharge planners or social contracts with particular nursinghomes in workers, • physicians who serve the elderly, your area, make sure the homes you are Paying For Nursing Home considering have contracts with your Care HMO. Nursing home care is expensive (a skilled Availability nursing home will cost about $200 a day in Make certain that the nursing homes on many parts of the country). For most people, your list will have space available at the finding ways to finance nursing home care is a time you might need to be admitted. major concern. There are several ways that nursing home care is financed: Special Care Needs If you require care for special medical Personal Resources conditions ordementia, make sure thatthe About half of all nursing home residents nursing homes on your list are capable of pay nursing home costs out of personal meeting these special circumstances. resources. When most people enter nursing homes, they usually pay out of Location their own savings. As personal resources Ifyouhavealargenumberofnursinghome arespent, manypeoplewho stayinnursing choices, it is usually a good idea to homes forlongperiodseventuallybecome consider nursing homes that your family eligibleforMedicaid. and friends can visit easily. Long-TermCareInsurance Long-Term Care Insurance is private Why Location is Important insurance designed to cover long-term In most cases, it is a mistake to select care costs. Plans vary widely, and you anursinghome that is difficultto visit would be wise to do some research before on a regular basis. Frequent visits are purchasing any long-term care policy. the best way to make sure that you or Generally, only relatively healthy people your relative does well in the nursing may purchase long-term insurance. For home. Visitors are important advo- further information on this type of cates for chronically ill residents. insurance, contact the National Associa- Frequent visits often make the tion ofInsurance Commissioners and ask transition to the nursing home easier for their free booklet, The Shopper's fornew residents and their families. Guide to Long-TermCareInsurance. Call (816) 374-7259 for your copy. You will now be able to figure out which Medicaid homes in your area may or may not be worth visiting. You will also now be better informed Medicaid is a State and Federal program when you begin visiting your area's nursing that will pay most nursing home costs for homes. 6