Nursing Homes
Do all nursing homes provide the same type of care?
Nursing homes, also known as skilled nursing facilities, care for individuals
who require 24-hour nursing supervision.
There are two types of care provided in nursing homes:
- Skilled Care (also known as "sub-acute" or "Medicare occupancy")
- Long-Term Care (also known as "Intermediate Care")
Skilled Care entails services that can be rendered only by a doctor,
licensed nurse, physical therapist, occupational therapist, social
worker or respiratory therapist. It usually follows a hospital visit
involving a short-term stay, during which the patient receives nursing
care and/or therapy until he or she is stable enough to return home.
Due to the skilled nature of the care, it is covered by Medicare
and secondary insurance for up to 100 days. Beyond that length of
time, it must be paid for privately. (For more on payment, click
here.)
Long-Term Care is appropriate for the individual who can no longer
take care of him or herself and will continue to require a high
level of care for the remainder of his or her lifetime. Such care
may include help with any "activity of daily living,"
such as bathing, dressing, transferring (moving from one place to
another), toileting, eating and walking. Medicare does not cover
this type of care. However, when the individual's financial resources
are exhausted, the state-funded source (Medicaid) will supplement
the cost. If the nursing home does not accept state funding, you
must find another long-term care facility that will. Unfortunately,
most nursing homes have waiting lists for people entering the facility
under state funding. Planning ahead with an appropriate strategy
may help the patient and family avoid these conflicts. (For more
on payment, click here.)
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How do I know which nursing home to choose?
The Centers for Medicare and Medicaid Services (CMS), the government
agency that administers these medical-assistance programs, has developed
a database of information on every Medicare- and Medicaid-certified
nursing home in the country, including more than 17,000 nationwide.
(To access this database, click
here.) To help people search for a nursing home that meets their
needs, the CMS has developed Nursing
Home Compare, an interactive tool that allows Medicare beneficiaries
and their caregivers to compare information among all the nursing
homes on the list. Nursing Home Compare enables you to search for
nursing homes based on:
- Nursing home characteristics such as number of beds, type of ownership
and whether or not the nursing home participates in Medicare, Medicaid or
both.
- Resident characteristics including percent of residents with pressure sores,
percent of residents with urinary incontinence and more.
- Summary information about nursing homes based on their last state inspection
(periodic inspections by state licensing agencies are required for Medicaid
certification).
- Information on the number of registered nurses, licensed practical or vocational
nurses and nursing assistants in each nursing home.
Source: Centers for Medicare and Medicaid Services, U.S. Department
of Health and Human Services 7/25/02
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What do I look for in a nursing home?
The Centers for Medicare and Medicaid Services (CMS), the agency that administers Medicare and Medicaid, also certifies individual nursing homes for inclusion in these government medical-assistance programs. The CMS has developed a detailed checklist for rating different nursing homes visited based upon:
- Quality of Life
- Quality of Care
- Nutrition and Hydration
- Safety
The Nursing Home Checklist, which can be found
and printed out here (Adobe Acrobat Reader is required to view this file. If you are having difficulties please call 1-800-ALZ-INFO), can be a useful tool when you are investigating possible homes and want to keep track of the capabilities and characteristics of each home you visit. It guides you through a point-by-point review of every aspect of a nursing home, from basic information about Medicare or Medicaid certification and special services offered to the comfort and attractiveness of furnishings (in other words, if your combined income and financial assets fall within certain limits). The categories the checklist makes note of include:
- Resident appearance
- Living spaces
- Staff
- Residents' rooms
- Hallways, stairs, lounges and bedrooms
- Menus and food
- Activities
- Safety and care
Source: Centers for Medicare and Medicaid Services, U.S. Department
of Health and Human Services 7/25/02
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How do I pay for nursing home care?
Medicare
Under certain limited conditions, Medicare will pay some nursing
home costs for Medicare beneficiaries who require skilled nursing
or rehabilitation services. To be covered, you must receive the
services from a Medicare-certified skilled nursing home immediately
after a qualifying hospital stay (at least three days). To learn
more about Medicare payment for skilled nursing home costs, contact
your regional office for Medicare Part A information.
You also can get a copy of the "Guide to Health Insurance for
People with Medicare" by calling 1-800-MEDICARE (1-800-633-4227).
Medicaid
Medicaid is a joint state and federal program that will pay most nursing home
costs for people with limited income and assets. Eligibility varies by state;
check your state's requirements to learn if you are eligible. Medicaid will
pay only for nursing home care provided in a facility certified by the government
to provide service to Medicaid recipients. For information about Medicaid coverage
and eligibility in your region, call your state Medicaid office.
The telephone number is also in the blue pages of the phone book.
Veterans' Benefits
The Department of Veterans Affairs may provide nursing-home care without cost
to a veteran if the veteran has a service-connected disability and certain other
eligibility tests are met. Veterans who do not have a service-connected disability
may also qualify for veterans benefits if an income test and asset
test are both met.
Private Pay
About half of all nursing home residents pay nursing home costs out of their
own savings - what is sometimes called "private pay." After these
savings and other resources are spent, many people who stay in nursing homes
for long periods eventually become eligible for Medicaid.
Managed Care Plans
A managed care plan will not help pay for care unless the nursing home has a
contract with the plan. If the home is approved by your plan, learn if the plan
also monitors the home for quality of nursing care.
Medicare Supplemental Insurance
This is private insurance. It's often called Medigap because it helps pay for
gaps in Medicare coverage such as deductibles and co-insurances. Most Medigap
plans will help pay for skilled nursing care, but only when that care is covered
by Medicare. Some people use employer group health plans or long-term-care insurance
to help cover nursing home costs.
Long-Term-Care Insurance
This is a private policy. The benefits and costs of these plans
vary widely. For more information on these plans, click
here. You can also request a free publication called "A
Shopper's Guide to Long-Term-Care Insurance" from the National
Association of Insurance Commissioners (NAIC), which represents
state health-insurance regulators.
Source: Center for Medicare and Medicaid Services, U.S. Department
of Health and Human Services 7/25/02
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Where do I find a nursing home?
To search the Centers for Medicare and Medicaid Service (CMS)
database of more than 17,000 nursing homes that are Medicare- and
Medicaid-certified, click
here. Keep in mind that many nursing homes have Special Care
Units (SCUs) that are designed especially for the care of people
with Alzheimer's disease and related dementias.
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Find more information here: www.nlm.nih.gov/medlineplus/nursinghomes.html
For a comprehensive list of professionals and services in your area, click below.
 Resource Locator
The Resource Locator lets you search for providers by name, state, city, or ZIP code from a list of more than 30 types of health care professionals and services.
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