Assisted living facilities are great for helping loved ones keep their freedom, but they may not be the best choice for everyone. For example, when a person’s health declines or they experience fatal attacks, such as a stroke or a significant fall, they may need the skilled assistance of nurses and caregivers at nursing homes for rehabilitation or 24-hour care.
It’s important to help older adults maintain their level of autonomy for as long as possible. Indeed, excellent care options are available if they require assistance.
About 4.5 percent of the world’s older population, or 1.5 million people, reside in nursing facilities. However, according to the National Institutes of Health, about 94%, or 33.4 million, of older Americans do not reside in any facilities, opting instead to remain at home or with a family member.
Find out what to expect from nursing homes, what paperwork you’ll need, and who to talk to about applying for government assistance programs like Medicare and Medicaid.
What is a Nursing Home?
When it comes to caring for older people, a nursing home is typically the best option available outside of a hospital. Nursing homes give residents custodial care, which includes assistance with everyday tasks such as moving in and out of bed, eating, bathing, and dressing, and other basic activities of daily living.
This type of care is also known as “personal care.” Nursing homes are comparable to assisted living communities in that they both provide housing for older adults and substantial medical care to those residents.
Every patient is cared for by a doctor, and there is almost always a nurse or other medical staff member available to assist as needed. In addition, on-site, round-the-clock skilled nursing services are provided.
Professionals from other medical fields, such as occupational and physical therapists, are also around. This facilitates the on-site provision of healthcare services that would otherwise be difficult to implement in conventional residential settings.
The aging of our population means that more of us may eventually need to place ourselves or a loved one in a nursing facility. This decision can come quickly after a hospital stay, or it can happen over time when different forms of housing prove inadequate.
When deciding to move, there is a lot to think about, but you can put your mind at ease and make the best choice for yourself or a loved one by learning as much as possible about nursing homes.
What Services do Nursing Homes Offer?
People who require extensive medical care can find it at nursing homes, which are also called skilled nursing facilities and long-term care facilities. In most nursing homes, both unskilled and trained nurses are available 24/7.
Nursing homes provide 24-hour medical care and aid with daily tasks, while assisted living facilities typically offer less assistance with day to day tasks. This also just depends on the type of assisted living.
Similarly, most people who live in assisted communities use their own funds to cover their expenses. In contrast, many people who live in nursing homes receive financial assistance from government programs like Medicare and Medicaid.
The many services available at nursing homes include:
- Dietary assistance
- Health treatment, including nursing and doctor’s care
- Laundry services
- Three meals per day
- Management of medications
- Personal care requirements, including showering, dressing, and going to the toilet
- Services for rehabilitation, including both short-term and long-term care
- Social activities like entertainment, music, crafts, and excursions
- Occupational, physical, or speech therapy
What Qualifies a Person For a Nursing Home?
Nursing home care is designed for older people who have major medical needs and require constant monitoring by medical professionals. The state’s requirements for nursing home care must be met, and the senior’s medical issues must be documented and validated by a physician before admission.
1. Nursing Home Admission Regulations by State
The criteria for entering a nursing home can change from one state to the next. The states must adhere to certain minimum standards the Centers for Medicare & Medicaid Services (CMS) set. However, within CMS’s guidelines, states are free to develop their own examinations.
For this reason, a senior citizen may be eligible for a nursing facility in one state but not another. For additional information on your area’s nursing home eligibility requirements and state-specific testing standards, don’t hesitate to contact the nearest Medicaid or government county office.
2. Health Care Assessment
A doctor will evaluate your loved one’s health care needs to ensure they fulfill state standards for nursing home care.
Your elderly relative’s assessment will most likely be finished by the hospital’s attending professionals while they are there. You can schedule a visit with your loved one’s primary care physician if they are not in the hospital at this time.
Senior citizens can get free healthcare evaluations in some states. For example, the Adult Evaluation and Review Service (AERS) is a service the Maryland state government provides.
A nurse or social worker can use the AERS to determine if an older person is eligible for a nursing home and would benefit from that setting compared to other types of long-term care that would better serve them.
Your loved one may be an excellent candidate for assisted living; in case they need it for daily activities but do not satisfy the criteria for placement in a nursing facility.
What Documents do You Need to Bring to The Nursing Home?
Please bring the following items to the nursing home in order to expedite your loved one’s admission. Your loved one’s primary care physician or hospital personnel will take care of the first five items on this list.
1. Medical Documentation Recommending Nursing Home Placement
In many ways, this instruction is not unlike a prescription. But, first, the necessity of a nursing home level of care must be verified.
2. The Prescriptions And Treatments Prescribed by The Doctor
At the nursing home, your loved one will be cared for by new medical professionals. A primary care doctor or hospital personnel will need to give them orders before they can begin treatment. Make sure to keep a log of medical files, and current prescriptions to give to the doctor.
3. Patient’s Medical Background And Physical Examination
The doctors caring for your loved one in a nursing home will benefit from having the most recent medical history. Primary care physicians are responsible for conducting physicals and reporting updated medical histories.
4. State-Required Form
Every state requires a nursing home admissions form. It validates that a person can reside in a given state in a nursing home. This also implies that the individual’s medical requirements can be met at a nursing facility.
The hospital or the primary care doctor will complete this form. In addition, the form can be obtained at any nursing home where your loved one will be receiving care from.
5. Health Tests
Within three days of admission, nursing homes must provide free tuberculosis (TB) tests, flu shots, and pneumonia immunizations. In addition, the nursing home may request documentation that a recently admitted patient has received these treatments.
6. Submitted Application Forms
In most cases, admission paperwork can be completed either in advance or on the day of enrollment. Essential paperwork is often completed on-site with a staff member, though this can vary by town and state.
After being informed about nursing home policies, obligations, legal certifications, the cost, and the care offered, the patient or their representative, the legally liable party under Power of Attorney, would sign their name multiple times.
Communities need documentation showing residents of nursing homes have been educated on state and federal regulations that affect their care. The patient’s authorization to receive care is required as part of the necessary papers.
In addition to the application, please bring your loved one’s insurance cards, Medicare or Medicaid documentation, and Social Security card.
It may take a long time to have a loved one admitted to a nursing home. Community workers may also request the following information as part of the admissions process to a nursing home:
- Documents establishing power of attorney
- Documentation indicating a desire not to undergo life-saving measures (DNR forms)
- End-of-life wishes
- Requirements in terms of diet
- Medical orders for life-sustaining treatment (MOLST)
- Living will
Will Medicare Pay For Care at a Nursing Home?
People aged 65 and above, as well as those under 65 who have certain disabilities, are eligible for Medicare, a federal health insurance program. Medicare is used by most American seniors who are 65 and up, to pay for doctor visits, outpatient treatment, and prescription drugs.
However, Medicare will not pay for nursing home care and long-term assistance with ADLs. But, it might pay for up to one hundred days of short-term rehabilitation following a stroke, a hip fracture, or any other type of medical condition that requires a hospital stay of at least three days.
Whether or not Medicare covers the cost of your nursing home, it should pay for related medical treatment such as visits to the doctor, medical tests, and medications while you are there.
Does Medicaid Pay For a Nursing Home?
Medicaid is a government health insurance program for people with low incomes. Income and asset eligibility requirements need to be standardized across the country. Seniors with substantial medical concerns and expenses may also be eligible if their state deems them “medically needy.”
Your elderly loved one will need a medical condition to qualify for Medicaid nursing facility coverage. This stipulation holds true across the country, but the meaning of “medical need” varies from one state to the next.
Reach out to the Medicaid office in your state to find out what medical problems you must have. The nursing home must be certified to accept Medicaid patients, and the admissions staff must be aware of the process for applying for Medicaid.
When applying for Medicaid, determining eligibility, and understanding the steps necessary to enter a Medicaid-funded nursing home, the assistance of an elder law attorney or social worker can be invaluable. If even a single piece of information is missing from an application, the whole thing can be denied and sent back.
The Bottom Line
When a family member’s health has deteriorated to the point that they need constant medical attention because of age or sickness, the subject of how to have them accepted to a nursing home inevitably arises.
Loved ones with medical needs should consider nursing homes because the round-the-clock care provided by licensed nurses is unparalleled. Individuals must be of a certain age and meet their state’s requirements before they may be admitted to a nursing home.
As part of their duties, nursing facilities must ascertain whether or not prospective residents are eligible for Medicaid or other government subsidies. Providing such details is analogous to when a person applies for a mortgage.
Taking this step guarantees that all patients can afford their nursing home care. It will be necessary for the patient and their family to fill out papers and provide some financial details. The information provided here has enabled you to comprehend a nursing home’s requirements for seniors and make a well-informed decision.
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