A Lawyer's Guide to Selecting a Nursing Home
Chicago Nursing Home Attorney
Selecting a nursing home for a loved one can be a daunting and exhausting project, but planning ahead and thoroughly researching facilities will pay off in the long run. The following guidelines, published in the July 2010 issue of Trial Magazine: Main St. Trial Laywer, an American Association for Justice (by William S. Friedlander), offer a legal perspective on common financial, medial, administrative, and quality of life concerns that arise in elder care situations, and tools for evaluating how well equipped specific nursing homes are to confront these issues. However, it is important to keep in mind that these guidelines must be adjusted to your loved one’s specific needs and circumstances. Financial planners and healthcare professionals are also important resources to utilize in the nursing home selection process.
Make Sure to Plan Ahead –
First, it is critical to plan ahead for elder care issues. All too often, family members are not proactive and wait for a catastrophic event to occur before placing their loved ones in necessary care facilities. Waiting until a catastrophic incident occurs forces elder care decisions that are not thoroughly researched or well thought out. Waiting lists frequently pose obstacles to the best care facilities, and family members end up settling for lesser qualified nursing homes. Plan ahead and avoid these road blocks!
Consider the Financial Implications –
Next, financial constraints are often an important consideration in selecting a nursing home, so budgeting out what you can afford is an important first step. Most nursing home residents use Medicare or Medicaid to cover all or part of their expenses. For Medicare eligible patients, up to 100 days of nursing care following a minimum three- day hospital stay is covered. The first 20 of the 100 days is covered fully by Medicare, and the patient must pay a daily copay for the remaining days. The copay may be covered by a Medigap insurance policy, if the patient has one. Even if Medicare does not cover the Nursing home stay, after the 100 days or otherwise, patients may still look to Medicare for medications, medical care, health coverage, and hospital stays.
Medicaid may also financially cover some or all of the nursing home costs. As long at the patient remains income eligible and has long-term healthcare needs, Medicaid will cover nursing home care. However, Medicare patients pay a monthly deductible set by state law, and covered services vary by state. Additionally, Medicare patients will likely face longer waiting lists to be accepted into the nursing home, so it is wise to plan ahead always, but especially when dependent on Medicaid. Planning for Medicaid dependency in the future is smart as stastics show that most nursing home residents deplete their resources enough to be eligible for Medicaid at some point during their stay. Furthermore, Medicaid certified facilities are evaluated annually, and must meet federal and state licensing, certification, and performance standards. Therefore, Medicaid certified facilities are a good place to start your research. Additionally, federal law prohibits Medicaid certified homes from evicting patients already in their care or terminating necessary services once residents become Medicaid eligible. If your loved one is Medicaid eligible or may become Medicaid eligible in the future, selecting a Medicaid certified facility allows them to remain at the chosen facility even if their payment details change.
Evaluate the Services your Loved One Needs –
Third, once the payment and coverage details are ironed out, and you have selected some faculties within your price range, it is time to consider the individualized services and personal environments each nursing home has to offer. Initially determine what services are included within the daily rate. If your family member or loved one needs additional services, figure out if they are available at the nursing home and the additional costs required. It is also important to ask about and consider rate-increase history, policies, and notification requirements. Rate increase polices and histories are particularly important if the nursing home is fairly close to your upper price limit. It is wise to get a loved one in a facility where they can stay for the foreseeable future. Likewise, notification requirements are critical in the event that an increase makes a facility unaffordable and requires relocation. You will need ample time to do so.
Read Over Admissions Paper Work Carefully –
Fourth, read over admissions paper work carefully, and consider having an experienced attorney take a look as well. It is essential to know your rights and remedies. Be on the lookout for admissions papers that include agreements to arbitrate all grievances. I would advise everyone to stay away from these agreements as they can severely limit your ability to recover for injuries resulting from improper nursing care.
Compare and Contrast Facilities –
Fifth, once you have narrowed down nursing homes within your price range, with the services your loved one requires, and without an arbitration agreement, then thoroughly compare and contrast quality of care indicators between the homes. Medicare’s Nursing Home Compare program is a good place to start. This program provides quick access to critical information including staffing levels, stability of the current administration, and turnover. Print the reports and highlight the differences. Generally, higher staffing ratios and stability indicators are good signs. Further consider the ease of family visitation, and compliance with administrative rules and regulations – stay away from nursing homes with a history of consistent violations. Additionally, “culture change” programs are another positive signal as “culture change” is a term used by nursing home researches to describe steps taken to improve quality of care, de-institutionalize services, and individualize care plans to create a more “homelike, intergenerational, and intimate” environment.
Visit the Nursing Home –
Finally, and perhaps most importantly, visit the remaining nursing homes remaining on your list. Bring the CMS study checklist titled “Artifacts of Culture Change” with you. Make sure to use it when you visit each home, as it will help you remember the homes and make the best possible selection. Take your loved one with you, if possible, and gage their reaction to the different homes. Find a home that they are comfortable with and you feel good about. Consider safety features like rails in the hallways, width of doors, and ease of moving around. Ask how often nursing home staff will check on your loved one, and be very clear with your family member about what they can and cannot do by themselves. Stairs, thresholds, and curbs are consistent culprits causing falls, so try to find a home where these will not tempt your loved one to try to do things they cannot or should not. Pay very close attention to how the other residents are acting; gage their contentment, happiness, and the demeanor of the staff. If you notice unsanitary conditions, unruly residents, and other signs of understaffing, take note and avoid that facility. Allow the facility personnel to give you a tour and then ask to walk around by yourself. You will probably not have access to all the facility, but try to evaluate areas not shown on the tour and make sure the quality and environment is the same.
Make a well-informed Selection –
After your visits, compare your notes and make a selection. Get your loved one on the waiting list as soon as possible, and then ease them into the transition from home to facility. Utilize the social work staff at the nursing home to help you to make this transition as easy as possible. Planning ahead is critical as it gives you ample time to make the best decisions for your loved one. However, the topic of and transition to elder care facilities is never easy and can be emotionally draining, but being prepared and doing your research will allow for the best long-term solution for you and your loved one.