What Caregivers Should Know About Nursing Home Care

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What Is Long-Term Care?

Long-term care refers to a comprehensive range of medical, personal, and social services coordinated to meet the physical, social, and emotional needs of people who are chronically ill or disabled. A nursing home facility may be the best choice for people who require 24-hour medical care and supervision.


What Type of Care Do Nursing Homes Provide?

There are two types of care provided by nursing homes:

1. Basic care: Services required to maintain a resident's activity of daily living. This includes personal care, mobility, supervision, and safety.
2. Skilled care: Care that requires the services of a registered nurse for treatments and procedures on a regular basis. Skilled care also includes services provided by specially trained professionals, such as physical, occupational, and respiratory therapists.


What Services Do Nursing Homes Offer?

The services nursing homes offer vary from facility to facility. Services often include:

* Room and board
* Monitoring of medication
* Personal care (including dressing, bathing, and toilet assistance)
* 24-hour emergency care
* Social and recreational activities


How Can I Find the Right Nursing Home?

Finding the right nursing home takes time. It is important to begin the search for a suitable nursing home well in advance of seeking admission to the facility. There are often long waiting periods for available accommodations. Planning ahead also can make the transition of moving into a nursing home much easier.

Talk with your family and caregivers about what services you will need. Take time to consider what services are important to you before calling different nursing homes.

Think about these questions:

* What daily activities do I need help with (bathing, dressing, toileting assistance, eating)?
* How often do I need help?

Before scheduling a visit to the nursing homes you are interested in, ask about vacancies, admission requirements, level of care provided, and participation in government-funded health insurance options.


How Can I Pay for Nursing Home Care?

As you and your family evaluate your long-term care needs, it's important to consider financing options. Payment for nursing home care can be made through Medicare, Medicaid, private insurance, and personal funds. When evaluating nursing homes, it's important to ask the administrative staff what payment options they accept. Here's a brief summary of some of the financing options.

* Medicare is a federal health insurance program providing health care benefits to all Americans age 65 and over. Insurance protection intended to cover major hospital care is provided without regard to income, but only restricted benefits are allowed for nursing home care. In addition, Medicare only pays for skilled care in a nursing facility that has a Medicare license.
* Medicaid is a joint federal/state health insurance program providing medical care benefits to low income Americans who meet certain requirements. Nursing home care is covered through Medicaid, but eligibility requirements and covered services vary widely from state to state.
* Private long-term care insurance is a health insurance option that, if purchased, supplements Medicare coverage. Private long-term care insurance policies vary greatly. Each policy has its own eligibility requirements, restrictions, costs, and benefits.


What Should I Look for in a Nursing Home?

The following checklist will help you and your family evaluate different nursing homes. Review the following checklist before visiting a facility. Be sure to take a checklist with you.

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Nursing Home Checklist

* Does the nursing home provide the level of care needed, such as skilled or intermediate care?
* Does the nursing home meet local and/or state licensing requirements?
* Does the nursing home's administrator have an up-to-date license?
* Does the nursing home meet state fire regulations (including a sprinkler system, fire-resistant doors, and a plan for evacuating residents)?
* What are the visiting hours?
* What is the policy on insurance and personal property?
* What is the procedure for responding to a medical emergency?

Admission

* Is there a waiting period for admittance?
* What are the admission requirements?

Fees and financing

* Are fees competitive?
* Have fees increased significantly in the past few years?
* Is the fee structure easy to understand?
* What are the billing, payment, and credit policies?
* Are there different costs for various levels or categories of services?
* Are the billing and accounting procedures understandable?
* Does the nursing home reveal what services are covered in the quoted fee and what services are extra?
* What governmental financing options are accepted (such as Medicare, Medicaid, Medicare Supplemental Insurance, Supplemental Security Income, and others)?
* When may a contract be terminated? What is the refund policy?

Needs assessment

* Is there a written plan for the care of each resident?
* What is the procedure for assessing a potential resident's need for services? Are those needs reassessed periodically?

Professional staff

* Do the nurses, social workers, and administrators have geriatric experience and/or education?
* Are staff members available to meet scheduled and unscheduled needs?
* Do staff members seem to genuinely enjoy working with the residents?
* Do staff members treat residents as individuals?
* Is staff available to assist residents who experience memory, orientation, or judgment losses?
* Does a doctor or nurse visit the resident regularly to provide medical checkups?
* Do residents appear happy and comfortable?
* Do residents, other visitors, and volunteers speak favorably about the nursing home?
* Are residents clean and adequately dressed?
* Are the rights of residents clearly posted?

Facility design

* Do you like the appearance of the building and its surroundings?
* Is the decor attractive and home-like?
* Is the floor plan easy to follow?
* Do doorways, hallways, and rooms accommodate wheelchairs and walkers?
* Are elevators available?
* Are handrails available?
* Are shelves easy to reach?
* Are carpets secured and floors made of a non-skid material?
* Is there good natural and artificial lighting?
* Is the residence clean, odor free, and appropriately heated/cooled?

Medication and health care

* What is the policy regarding storage of medication and assistance with medication?
* Is self-administration of medication allowed?
* Who coordinates visits from a physical, occupational, or speech therapist if needed?

Services

* Is staff available to provide 24-hour assistance with activities of daily living, if needed? Daily activities include:
* Dressing
* Eating
* Mobility
* Hygiene and grooming
* Bathing, toileting, and incontinence
* Using the telephone

Room features

* Are rooms for single and double occupancy available?
* Is a 24-hour emergency response system accessible from the room?
* Are bathrooms private? Do they accommodate wheelchairs and walkers?
* Can residents bring their own furnishings? What may they bring?
* Do all rooms have a telephone? How is billing handled for long-distance calls?

Social and recreational activities

* Is there an activities program?
* Are the activities posted for residents?
* Do most of the residents at activities seem to be participating?

Food service

* Does the nursing home provide three nutritionally balanced meals a day, seven days a week?
* Is the food hot, attractive, and tasty?
* Are snacks available?
* How are special diets handled? May a resident request special foods?
* Is drinking water always accessible?
* Are common dining areas available or do residents eat meals in their rooms?
* May meals be provided at times a resident prefers or are there set meal times?
* Is assistance available for residents who need help with eating?

Residents and Atmosphere

Common terms:

Skilled nursing care: Care that is received in a nursing facility that provides 24-hour nursing care for convalescent residents and those with long-term care illnesses. It is one step below hospital acute care, and regular medical supervision and rehabilitation therapy are usually available.

Personal care: Care that is customized to the individual needs of activities of daily living; self-administration of medications.

Activities of daily living (ADL): Everyday activities that include bathing, grooming, eating, toileting, and dressing.

Instrumental activities of daily living (IADL): Include activities such as shopping, preparing meals, performing housework, laundering, heavy chores, managing finances, and yard work and maintenance.

Home health care: Medical and nursing care that is administered in the individual's home by a licensed provider.

Health maintenance organization (HMO): A health maintenance organization is an organized system for providing comprehensive healthcare in a specific geographic area to a voluntarily enrolled group of members.