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How to Choose a Nursing Home for Your Loved One

When it is time to put a loved one in a nursing home, the challenge of finding nursing homes and rehabilitation centers near you can seem overwhelming. In this guide, we help by identifying questions to ask when looking for nursing and rehab facilities near you, how to find a nursing home, and how to evaluate them.

What is a nursing home?

The phrase “nursing home” is very misleading. It can mean a Skilled Nursing Facility, or it can me a board-and-care facility. To make matters more confusing, some facilities have a nursing home unit, a skilled nursing unit, and senior citizen assisted living facilities. In this guide to finding the nearest nursing home to my location, we are going to focus on the use of “nursing home” to mean a Skilled Nursing Facility where residents receive 24-hour nursing care. Also, in this guide we will touch on the services of both a board-and-care and an Assisted Living Community.

  • Fact: As of 2014 there are more than 1.7 million nursing home beds spread throughout the 15,600 -licensed nursing homes in the US. – CDC

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More on Nursing Homes

A nursing home is just as the name implies a place where seniors live and receive 24-hour nursing care. An Assisted Living Community is basically a place where a senior or senior couple goes to retire and where they can have regular service that helps improve their quality of life, but they do not need 24-hour nursing care. A nursing home is different from an Assisted Living Center because the care of the senior is more regulated and frequent in a nursing home than in an Assisted Living Community. To help you get the idea of what a nursing home is we can follow George and Martha. George is a senior who lives in a nursing home. He is mostly independent but needs help to bathe and dress though he provides most of his own care but he needs help with daily personal care, medication management, and is forgetful. 

  • Fact: As of 2014 there were more than 1.4 million people admitted to nursing homes per the CDC.

Martha lives in an Assisted Living Facility She has access to the facility’s staff when she needs help but otherwise manages her own day and is free to come and go as she pleases.

When searching for the best rated nursing homes near you, consider the level of physical and Social care needed. There are different types of rest homes. For example, you might be searching for a general nursing home and only finding rehabilitation nursing homes near you. There are also nursing homes that specialize in certain populations, such as nursing homes with dialysis units. Knowing those differences is a big help to you.

While George is fairly active, he and his family think it is best that he not live alone. At the nursing home, he has access to care for personal daily needs and access to licensed nurses to help him with his medication. His friend Martha, on the other hand, is perfectly capable of meeting her own personal daily needs and does not require the help of licensed staff. George is a perfect fit for a senior nursing home, while Martha is a prime candidate for an assisted living or senior living community. It is possible that George too could live in an assisted living community, but he would require more addon services.

Martha is active. She takes full advantage of the many social activities. One of her favorite adventures is the group trip to the movies and overnight excursions to nearby venues such as casinos. For the most part, Martha is very pleased with the convenience of her facility. There are therapy services on site for physical and speech therapy and a variety of doctors come at least monthly such as a podiatrist. The facility also has a transportation system that enables its’ residents to visit their regular doctor or specialist as needed. These types of services are one of the main reason Martha choose this facility. Even though Martha still drives, she knows that at some point it will be easier and more affordable to use the facilities transportation system. Having transportation available is a big plus for her.  

Overall, George represents the average type of person who lives in a nursing home while Martha represents an ideal candidate for an Assisted Living or Senior Living Community. Because there are other options, such as larger apartments or shared room, Assisted Living Facilities and Senior Living communities can house and care for a wider range of people.  

  • NOTE: Another important consideration is the number of services and social activities that a facility offers. When trying to choose a nursing home, look for a reasonable balance between what people love to do and what they might enjoy on occasion. One of the factors that goes into an improved quality of life is the ability to try new things while still having access to those activities that you love.  

What is an Assisted Living Facility? 

An Assisted Living Facility and a Nursing Home share a lot of similarities but the big difference is the level of nursing care provided to the residents. As we see with Martha, those in an assisted living facility provide most of their own personal care and may have occasional help with grooming, bathing, or meal prep. In addition, the senior is also responsible for their own unit cleaning, including laundry, though many assisted living facilities have an addon service that provides maid and laundry service too. In a nursing home, the cleaning is the responsibility of the facility not the senior and the focus of care between the two is very different. In an assisted living, the senior is primarily responsible for their own care and in a nursing home, the nursing staff – certified nursing assistants (CNAs) and licensed staff (RN and LVNs) provide and direct the care each person needs in conjunction with a doctor.

  • Fact: In 2015, there were 15,836 Assisted Living Facilities in the US. – Statista

 George on the other hand lives in a skilled nursing facility. Most of his care is provided by the staff and though he tries to do as much for himself as possible, he still need regular nursing care from an RN or LVN and help bathing and dressing from the facilities Certified Nursing Assistants. The medical care provided by the nursing home is regulated. They have therapies and rather than seeing the doctor, the RNs or LVNs evaluate and report to the doctor and Georges care is managed in that way. There is a doctor visit when needed or at least monthly.

George lives in a nursing home while Martha lives in an assisted living facility. They both have a friend name Daisy who comes and visits them often. Daisy lives in an apartment in a senior living facility and still drives. She takes care of all her own needs and has a maid who helps her clean her apartment. Daisy is very active and lives a high-energy social life with daily games of golf, and she takes all her meals in the dining room facilities dining room though sometimes she goes out to eat with friends and family.

Martha needs a little more care than does Daisy and of the three of them, George needs the most care. These differences are also the differences between an assisted living facility, nursing home, and a skilled nursing facility.

Who Is Your Senior?

A great place to start when searching for a nursing home is to ask who is my senior – Is it George, Martha, or Daisy? The answer to this question can help direct your search to the type of facility that best fits the physical and social needs of your senior. It is possible that the answer is in between at which case you might consider a blended facility that has both an assisted living and a nursing home within the same complex.

Now that we have a guide on what a nursing home is in comparison to assisted living and senior living facilities you can begin to really focus on how to choose a nursing home. These definitions however focus on the physical care and social needs of the senior. There are other factors that come into play during the selection process. Those include the cost of care. 

Care and Lifestyle at a Nursing Home

George lives in a nursing home and relies on care from the facilities, staff. Martha lives in an assisted living facility and enjoys a private room where she is surrounded by some of the things that she loves. She provides all of her own care but uses some of the extra services provided by the facility. Their friend Daisy lives in a senior living community and lives in a lush apartment. She has a maid and on occasion cooks meals in her unit.

George Lives in a Nursing home because he is at considerably more risk to injury if he were to live alone or in an assisted living facility. George requires more nursing care on a regular basis than does Martha. He is also unable to manage his medications and thus needs more help from licensed nurses. While George is independent, he is not as able to care for himself as is Martha.  

The difference between Martha and George involves their safety in caring for themselves. Martha cares for herself, while George struggles to take meds, bath, and clean his home. George represents many people who live in a nursing home. Some of the patients in nursing homes are significantly more debilitated than is George. The level of care needed is a big part of understanding what type of facility fits the senior.

Another important consideration is the number of services and social activities that a facility offers. When trying to choose from the best care homes, look for a reasonable balance between what people love to do and what they might enjoy on occasion. One of the factors that goes into an improved quality of life is the ability to try new things while still having access to those activities that you love.  

Are their Eligibility Requirements to Live at a Nursing Home?

Yes, but they differ depending on how the cost is paid. In terms of Medicare, we call this Long-term care. The first requirement under Medicare is a professional referral based on an evaluation either by a licensed social work or RN. That evaluation focuses on how much help the person needs in performing their ADLs – Activities of Daily Living – bathing, dressing, eating, etc. This is also referred to as functional eligibility and it is balanced with the financial need of the patient. If the senior is too independent, such as is Martha and Daisy, Medicare will not cover the cost of the stay in a nursing home. If the payment source is Medicaid search for Medicaid accepting nursing homes. Not every rest home will take Medicaid. However, Because George needs help dressing and bathing, he has a need for long-term care and Medicare may cover part of that stay. In fact, if he is financially eligible his stay may be funded by Medicaid. It is also important to note that Medicare only covers so many long-term care days in a nursing home per year. – Source Longtermcare.gov

  • TIP: The eligibility for long-term care varies from one state to the next so it is important to understand those requirements before you begin to look for the top rated skilled nursing facilities.

Facilities may also have their own eligibility as many states have some say in how the population of each facility is determined. For example, it is not okay to have a healthy population of seniors and then add in seniors who have dementia and are violent. Patient-to-patient abuse is not permitted. Also, from a search perspective you want to match the senior with a facility that comes close to matching their lifestyle and social needs.

Are Nursing Homes Regulated?

Yes. Any institution that receives funding from Medicare is subject to federal oversight and that often includes state oversite as well. In fact, most states require that nursing homes be licensed through the state and as mentioned if the facility accepts payment from Medicare, they must be licensed on the federal level too. Regulations generally begin at the state level and generally through the state’s department of health. These requirements change from one state to the next and in many states, there are many different agencies involved.

Services Provided at a Nursing Home

Services revolve around personal care, therapies, healthcare, and social care. They include nutritional management, nursing care, personal care, such as dressing and bathing, and therapies, such as speech therapy or physical therapy.

  • Personal Care: Some seniors can manage many activities of daily living on their own, while others may need help eating, bathing, dressing or transferring from a wheelchair to a bed or even help walking. Toileting is another common area where seniors need help, especially if they are incontinent.
  • Therapies: They types of therapy provided by a nursing home vary from one facility to the next. Some may specialize in certain types of rehabilitations, such as facilities that focus on the care and treatment of stroke victims while another focuses on memory care for those who have Alzheimer’s.

TIP: When is it time for a nursing home and you being that search make a list of the types of therapies that the senior will need.

Nutritional Management: Nutritional management is important for all people. For seniors, issues like heart disease and diabetes are very common and those two families of disease require specialized diets. For others, medication and food interaction is another issue. Also, making sure that seniors are eating enough and that they have a balanced diet is also part of the care that they receive in a nursing home.

Nursing Care: When you are a resident of a nursing home you have access to daily nursing care from licensed nurses. This includes wound care, medication management, diabetes care, and general checks that ensure nothing new has developed that might need a doctor’s attention. Examples of care include:

  • Room types – Private, Semi-private and shared
  • Meals – Diabetic, cardiac, low salt, etc.
  • Medication management – daily pill dispensing, shots, such as insulin, and documentation of medicine given or refused. It can also include bowel care, such as stool softeners and other methods to keep seniors regular.
  • Senior and recuperative therapies – speech therapy, physical therapy, occupational therapies, and even end-of-life-care are all examples of therapies found in most nursing homes.
  • Household services and laundry – Facilities provide linens, towels, washcloths and launder each patient’s personal clothing. Some specialized laundry care is provided either at extra cost or sent home with the family to care for it.
  • Social activities and outlets – part of a healthy being includes social care and that is also part of the Medicare requirements for care of seniors. All have a social director who schedules events to help stimulate and meet the needs of seniors under their care. These may include activities such as games or visual activities such as movies. Social activities tend to be directed at all our senses and may include music, clubs, dances, etc. In some nursing homes, specialized activities fit specialized populations of seniors and you may find activities for dementia residents in nursing homes that serve that population and activities that are suited more for patients like George. It is important that the facility have activities for all of their patients and some rest homes offer activities for bedridden seniors too.

What You and Your Loved One Should Expect

Care in a nursing home is very regimented. It begins with a plan of care which is approved by the doctor and followed by the nursing staff. Care is overseen by the nurses who follow state and federal guidelines to provide care as prescribed by the facilities doctor. Care is scheduled based on the plan of care. For example, if the doctor orders a shower twice per week, then the patient is entered into the shower schedule for two days. If the senior should want three showers per week most facilities provide three showers per week. If the patient refuses a shower, that is noted in the patient’s chart and addressed by the nursing staff. Patients have a long list of rights and one of those is the refusal of care. The entire Patient Bill of Rights is available through Medicare.

Overall, this sounds much more stern then it is meant to be. The patient have a very large part in directing their own care and when the doctor orders services that the patient refuses, the nurses generally find another way to provide that care. A good example of this is showering. If the patient does not like showers, then the nurses can ask the doctor to order baths instead of showers. In most facilities, the patient is very much a part of the process that defines their care. In the case where a patient is not able to do that, the guardian of the patient may do so. The federal government has an ombudsman program that helps to oversee patient complaints and works as a liaison between the facility and the patient to resolve issues.

How Much Does It Cost to Live at a Nursing Home?

Generally, the cost of a nursing home is about two times the cost of an assisted living facility. This is because of the higher medical needs of the patient.

In 2016, a semi-private room was $225 per day or $6,844 per month for a nursing home. For a private room, the rate was $253 per day or $7,698 per month. In comparison, an assisted living cost $119 per day or $3,628 per month for a one-bedroom unit. These are average costs from across the use, and you can expect that costs will vary from one state to the next. Source: Longtermcare.acl.gov

How do Seniors Pay for the Cost of Care at a Nursing Home?

Many people think that Medicare will pay for long-term care. It usually does not. If it does the need must be specific and the duration of the care classed as short-termed and medically necessary. Generally, Medicare long-term Care is limited to only 100 days per year and when Medicare does pay, it only pays a portion of those daily costs. You are then responsible for the balance unless you have a Medigap policy or other form of insurance.

Payment Options for Nursing Home Costs

  1. Cash or Out-of-Pocket – 100% of the bill is covered by the patient unless they meet Medicare requirements at which point Medicare will cover part of the cost for a specific amount of time and for specific treatments. The senior is expected to pay for these services from savings or retirement benefits such as income from a pension. There are other options too if the senior is no longer able to live along, then the sale of property or rental income from property they own can help to cover the cost of nursing home stays. There are also other options such as a bridge loans which supplies funds during the process of a home sale and banking programs such as a reverse mortgage can also be a source of income.
  2. Medicaid – Income requirement – If the senior qualifies for Medicaid may pick up the cost for additional care not covered by Medicare. The two systems can work together to provide nursing home coverage for the entire year. Those costs and benefits vary by state. The requirements by Medicare to cover a nursing home stay is very specific. You must be admitted to an acute care hospital for three nights. You must have a referral by a doctor for Skilled Nursing Care, and your admittance to a nursing home must be within 30 days of your last hospital inpatient stay. Medicare also covers only the first 20 days but will extend that stay at a reduced rate of coverage. This means that on day 21 you will be required to pay around $150 out of your own pocket of through another source. Most insurance policies do not cover nursing home costs because Medicare deems these to be a short-term need, not long-term.
  3. Veteran’s Benefits via the VA – There are more options for veterans and the VA is very good about providing a range of options some of which the VA covers at 100% while others are set up on a base pay and a co-pay system. Generally, space is given to veterans who have a disability caused by their service in the armed forces.
  4. Long-term Care Insurance – This is one of the more valuable investments that a senior can make. Long-term Care Insurance does pay for nursing home care, but there are requirements. Physically, the senior must need help with activities of daily living and usually that means two or more areas of the ADLs require help. Because this is a private sector insurance, the payout and policies vary from one company to the next. Also, factors like age and health may play a role in premium costs.
  5. A mixture of options

How Does the VA help Pay for Nursing Home Stays?

Generally, the VA does not pay for nursing home stays as they have their own system of nursing homes. Those include Community Living Centers, State Veterans’ Homes, and Community Nursing Homes.

  • The Community Living Centers – Appropriate for veterans of all ages and the stay can be short-term or lifelong. Vets are assigned a room which they can furnish with things from their own home and they have access to all levels of care that they need, including palliative and end-of-life care. These facilities can be paid 100% by the VA or they may use a VA payment and Copayment system.
  • State Veteran’ Homes – The VA has over 1,500 state Veteran Homes which act as much as a civilian nursing home. The VA pays a portion of the cost and the vet pays the remainder.
  • Community Nursing Homes – Because the VA has so few nursing homes throughout the 50 states, they partner with community nursing homes so that those facilities can provide care to veterans without the vet having to leave their community. The care offered varies from one community nursing home to the next but expect them to all provide 24-hour nursing services, therapies, and social work.

The VA determines what it will pay, and that determination is service based, financial based, and the level of the vets’ disability also plays a very large role in how the VA determines what it will pay.

How Do you Choose a Nursing Home?

Initial Nursing Home Search

Before you even begin to look for a nursing home sit down and determine what type of needs the senior has. Important questions to ask yourself when choosing a nursing home include does the senior qualify for VA benefits – some spouses may quality. If the senior has VA benefits you can use the VA system to fine a matching facility. The VA has a Geriatrics and Extended Care site that is a portal to various kinds of long-term services.

Determine also if the senior is eligible for a nursing home and whether or not that will be a short-term stay or long-term stay. Remember that for Medicare to cover at least part of the cost, they senior must meet certain requirements. If the payment is via a Long-term Care Insurance Policy, the outlines for providing coverage will vary from policy to policy but that information should be in the policy or through the 800-number to the carrier.

Once you understand what the options are you can begin to search for the best nursing home.

 

Selecting the right choice

Make a Plan

Your plan should also include a short list of “best” options within the geographic area where you want the senior to live. From there, you can make a list of requirements, including staffing ratios, history of complaints or citations by a licensing body – state o feds – the cost, and the activity calendar for nursing home residents. It is a good idea to really think about things like:

  1. Quality of Life – Do the social programs match the those of the senior?
  2. Quality of Care – Essentially this is the nursing home level of care criteria. Ask: Does the facility offer all of the therapies or nursing care that the senior requires?
  3. Staffing Ratios – Is the facility adequately staff to provide a proper level of care?
  4. Complaint history – Does the facility have a history of patient abuse, state citation, or federal citations? California has an organization that lists complaints and citation by facility: CANHR– there are other similar sites for other states.

The good news is that Medicare has a nursing home search tool that can make finding nursing homes in your area easier. Find Nursing Homes.

So, you made a list of your best choices for nursing homes now what do you do? Start by making a list of question to ask when looking for a nursing home.

  1. Start with a tour – Touring a facility will give you an picture of life in a nursing home from the inside. Is the place clean? Do the staff seem happy and engaging. Are the seniors happy and active? Are the call bells ringing constantly?
  2. Check the nursing homes ratings
  3. Plan for Success – Go prepared to ask important questions. How do you settle disputes between residents? How many hours per week do staff work and how many of those hours are overtime hours. What types of checks do you perform during hiring?

Be sure to take notes and then sit down and compare those notes against the needs of the senior and the expectation of care. From there you will find a few options that fit the needs of the senior.