One of the hardest decisions families make for loved ones is selecting a nursing home. There are so many factors to be considered that the process can be overwhelming. The following is a list of ideas and resources that may help make the process easier. If you are a client of Keystone Elder Law, the Elder Care Coordinator can assist you in evaluating and selecting a nursing home.
Decisions are reversible. Just because you could not get into your first or second choice of a facility when needed does not mean you can never get in. It is possible to transfer from one facility to another as long as the receiving facility is willing to accept your loved one when an opening becomes available.
Check any insurance restrictions. Some insurance plans restrict coverage to “in-network” facilities. If you use an out-of-network facility, the insurance may not pay or you may have higher co-pays.
Look for a good fit. Just as people are all different, facilities are different, even when the care is comparable. Look at size, location, activity programming, staffing, and any church or lodge affiliations that match your loved one. The goal is to get the best fit between the facility’s characteristics and your loved one’s unique preferences.
Use available resources. Medicare’s web site (www.medicare.gov) offers comparisons of nursing homes. It also has a link to a “Guide to Choosing a Nursing Home.” The Pennsylvania Department of Health’s web site (www.health.state.pa.us) provides their “Patient Care Survey” and “Building Safety” information on every nursing home in Pennsylvania. If your loved one is in a medical facility, be sure to contact the person doing discharge planning (usually a social worker or a case manager) to help coordinate plans.
Medicare requires a three day hospital stay before it will pay for nursing home care. Please note that if the your loved one is in the hospital under “Observation,” the observation days do not count toward the three day stay requirement. In the nursing home Medicare covers “skilled care” but not “custodial care.” As long as your loved one qualifies for “skilled care,” Medicare covers up to twenty days in full and up to eighty additional days with a co-pay. Many Medicare Supplement and Medicare Advantage policies cover these co-pay days and will cover for up to a year after Medicare benefits are exhausted. However, your loved one must qualify for “skilled care” the entire time . The reality is that most patients move from “skilled” status to “custodial” status within a few days to a few weeks of admission.
Long-Term Care Insurance policies generally cover either “skilled” or “custodial” care. Be sure you understand any waiting periods, the benefit amounts, and how long benefits continue. Your loved one will likely be financially responsible for the difference between what his or her insurance pays and the total cost of the nursing home.
Financial planning – Once insurance stops paying for nursing home care, your loved one will need to use his or her financial resources to pay for care until he or she spends down to the point where he or she is eligible for Medicaid (Pennsylvania calls this Medical Assistance). If your loved one will need long-term care, the attorneys at Keystone Elder Law can help you understand all of the options available to conserve and preserve your loved one’s assets. For maximum protection it is wise to obtain this counsel before the loved one is in the nursing home, but as long as there are assets to protect it is never too late to contact an elder law attorney.