Nursing Home Requirements | US News

While assisted living facilities can help family members maintain a certain level of independence, sometimes it may not be enough support. Declining health or a major crisis such as a debilitating stroke or serious fall may require rehabilitation or 24-hour care by trained staff in nursing homes.

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“Preserving older adults’ ability to remain independent should be a critical goal, but when they need help, there are many high-quality facilities that can provide comprehensive care,” says Deborah Franklin, senior director of quality affairs for the Florida Health Care Association. in Tallahassee, Fla.

It is estimated that 1.5 million older adults live in nursing homes, which represents approximately 4.5% of the total population of older adults. Nearly 94% of older Americans, or 33.4 million, live in a home or with a relative outside the facility, according to the National Institutes of Health.

What do nursing homes offer?

Nursing homes, also known as skilled nursing facilities or long-term care facilities, offer medical services to residents who need comprehensive care. Most nursing homes have nurse aides and trained nurses available 24 hours a day. The key difference from assisted living facilities is that nursing homes provide 24-hour medical care and assistance with daily activities, while assisted living facilities encourage residents to remain as independent as possible and offer help when needed. necessary.

“Assisted living is also largely paid for through personal resources, while many nursing home residents are covered by Medicare or Medicaid, because of the way those government programs currently cover long-term care,” he says. Beth Martino, senior vice president of public affairs for the American Health Care Association based in Washington, DC

Nursing homes provide a wide range of services including:

  • dietary services.
  • Health care, including medical and nursing care.
  • Laundry services.
  • Meals, offered three times a day.
  • Medication management.
  • Personal care needs, such as bathing, dressing, and going to the bathroom.
  • Rehabilitation services, including short-term and long-term care.
  • Social activities, such as entertainment, music, crafts, and travel.
  • Therapy, including occupational, physical or speech.

Why consider a nursing home?

Some people stay in nursing homes for a short time to recover from an accident, medical complication, or surgical procedure. After regaining their strength and recovering, they return home or to another facility. “Two-thirds of people admitted to a nursing home for short-term post-acute nursing care or rehabilitation are able to return home,” says Martino.

However, most nursing home residents live there full time because they have physical, emotional, or cognitive challenges that require supervised care. There are a variety of reasons older adults reside in nursing homes, including:

  • Chronic and disabling disease.
  • Cognitive impairment or dementia problems.
  • Food assistance.
  • Help with all personal care needs.
  • Lack of mobility or bedridden.
  • Major health event such as a stroke or severe fall.

Nursing homes are sometimes associated with stories of unpleasant conditions, unqualified staff, and sloppy care. “There is a stigma associated with nursing homes that can make families hesitant to move a family member into one. That’s why it’s important for families to do extensive research and visit the best facilities in the area,” says Ann Orffeo, nursing care manager at WNY Elder Care Solutions in Snyder, New York.

Nursing Home Admission Requirements

What qualifies a person for a nursing home will vary. Before moving to a nursing home, a thorough evaluation is done to determine the appropriate level of care for the person’s needs. These assessments vary from state to state. In New York, nursing homes use a Patient Review Instrument, or PRI. In Florida, Form 3008 is the standard assessment. “Assessments provide a holistic view of a person’s current medical, physical, and cognitive abilities,” says Orffeo.

The assessment tools are very similar and are used to determine a person’s existing medical conditions and how independent they are in eating, moving around, moving from bed to chair, and going to the bathroom. These forms sometimes serve as the intake form, adds Franklin. “They want to know everything about the person, from their chronic conditions and medications to food allergies, hearing problems and current health insurance.”

The evaluations, which are required for admission to a nursing home, are usually performed by a nurse and often require a physician’s review and signature. In some states, the person’s primary care physician must sign the assessment.

Medicaid and Medicare qualifications

Another purpose of the review is to collect information to determine Medicare or Medicaid reimbursement for nursing homes. In the nursing home admissions process, the admissions nurse or case manager will ask questions about a person’s income and financial information to see if they qualify for nursing home care under Medicare or Medicaid. To qualify, an individual must meet the program’s financial eligibility requirements which vary from state to state.

Medicare Part A, or hospital insurance for people 65 and older, will cover nursing home care for a limited time if it’s determined to be medically necessary, such as changing sterile dressings. The person must also have a qualifying hospital stay.

For long-term nursing home coverage, many people are looking to see if they qualify for Medicaid. A single person, age 65 or older, must earn less than $2,523 per month to qualify for Medicaid, according to the American Council on Aging. Federal and state authorities want to see how long it’s been since a person gave money to family members.

“An individual can put a home into a life estate, but it is a federal requirement that must be done 60 months before being eligible for nursing home Medicaid,” explains Orffeo.

For those who are eligible, Medicaid will pay the full cost of nursing home care, including room and board, but some facilities only have a few Medicaid-certified beds, so sometimes there can be a long wait. For people with savings and retirement money who only qualify for private facilities, the monthly cost of a nursing home can range from $12,000 to $17,000, depending on the region.

Nursing Home Checklist

Whether you’re just beginning the journey to determine a family member’s eligibility for a nursing home or in the final stages of a decision, follow this list of recommended steps:

Role of the caregiver and the family. Designate at least one person as the nursing home resident’s primary caregiver to serve as the primary contact involved in engaging and discussing the individual’s plan of care. Caregivers need support and other family members need to be involved and available to help and share responsibilities.

COVID rules. While nursing homes have opened their facilities to visitors, a new variant of the outbreak could lead to stricter security precautions and visitation rights. Under a new federal law, all nursing home residents can choose up to two people as essential caregivers who can visit them in person and offer help 12 hours a day, seven days a week, regardless of a severe strain variant outbreak. COVID. Essential caregivers will need to follow state and local safety measures. The law applies only to nursing homes and not to hospitals.

Elder care services. Families can engage the professional services of senior care managers or senior living specialists to determine short-term and long-term care needs and explore Medicare and Medicaid eligibility requirements. These experts help individuals and families with decisions ranging from how to maintain independent living to rehabilitation services and skilled nursing care options.

Legal matters. Make sure your loved one has a current power of attorney and health care power of attorney. These legal documents will allow a family member to make health care decisions on behalf of their relative living in the nursing home. A living will is also recommended to show what types of treatments the person wants or does not want to keep them alive.

Personal stuff. Before your loved one moves into a nursing home, be sure to pack seven to 10 days’ worth of clothing and write their initials or names on each item to avoid confusion with other residents’ clothing. Ask the staff if you can bring your favorite chair, photos of family and friends, and other personal keepsakes.

Regular meetings. Most nursing homes will host semi-regular meetings to discuss your family members’ plan of care and changes in your needs and medical care. Make sure these meetings are held at least quarterly with key members of the nursing and administrative team.

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