A nursing home according to the American Health Care Association is a long-term care facility that provides health care and personal care services to older adults and individuals who can no longer live independently. Nursing homes may also be called skilled nursing facilities or convalescent homes.
Reasons Why People Need Nursing Home Care
People may need long-term care for a variety of reasons, such as age-related health problems, chronic medical needs, physical disabilities, and cognitive impairments. Nursing home care may also be necessary after a hospital stay, for end-of-life care, or for individuals who require round-the-clock medical supervision and assistance with daily activities.
A person who qualifies for nursing home care must meet certain eligibility criteria which we will explore in more detail.
Eligibility Criteria for Nursing Home Care
Eligibility requirements for persons who qualify for nursing home admittance can vary depending on the country, state, or region. It is important to ensure that older adults receive the appropriate level of care and support they need.
Physical Requirements
Individuals with physical disabilities, chronic pain, or chronic illness may require assistance with daily activities and may be eligible for nursing home care. Persons who have difficulty with mobility or require assistance with transferring or positioning may also be eligible.
- Functional ability limitations are a person’s ability to perform daily activities such as bathing, dressing, toileting, grooming, and eating. If a person has difficulty performing this level of care independently or requires assistance, they may be eligible.
- Chronic medical conditions such as heart disease, diabetes, or respiratory illnesses may also make an individual eligible. These conditions often require ongoing medical treatment, prescription drugs, and monitoring.
- The need for skilled nursing care is the level of medical attention required by an individual. Nursing homes are staffed with trained medical professionals who provide a range of medical services.
Cognitive Requirements
A person’s ability to think, reason, and make decisions is someone who qualifies for nursing home care. Individuals with cognitive impairments, such as dementia, Alzheimer’s disease, memory loss, or confusion, may require a specialized level of care and support.
Financial Requirements
A significant factor when considering eligibility for nursing home care is how the nursing home admission experience will be funded.
- Medicaid is the primary source of funding for nursing home care in the United States. eligibility for the Medicaid program is determined based on income and assets.
- Medicare may also cover some nursing home care costs, but only for a limited time and under certain conditions.
- Private insurance may also cover some costs of nursing home care and prescription medications, but this varies by policy and provider.
Assessing Nursing Home Care Needs
It is important to work with trained professionals to determine what qualifies a person for a nursing home.
Conducting a Comprehensive Assessment
This is a collection of assessments that determine the level of care that is needed and ultimately the nursing home placement that is the best fit.
- Functional assessments evaluate a person’s ability to perform activities of daily living, such as bathing, dressing, and eating.
- Health assessments evaluate a person’s medical conditions, including chronic health conditions and medical needs.
- Cognitive assessments evaluate a person’s cognitive function, including memory, attention, and decision-making.
Determining the Level of Care Needed
The level of care needed is determined after evaluating the need of an elderly individual needs and the level of care available in different nursing home settings. Some individuals may require a skilled nursing level of care, while others may require less-intensive care, such as assisted living or community-based services.
Choosing the Right Nursing Home
There are things to consider before deciding on a nursing home including its reputation, location, quality of care, staff qualifications, and cost. It is important to visit different nursing homes, talk to staff and residents, and review inspection reports to make an informed decision.
Alternatives to Nursing Home Care
While nursing homes can be a good option for some individuals, several alternatives may be more suitable for others. These alternatives provide different levels of care and support and can be tailored to meet individual needs.
- In-home care: allows individuals to receive personal care and medical care as well as support in their own homes. In-home care can be provided by family member, friends, or professional caregivers.
- Adult daycare: provides social, medical, and physical support for individuals during the day while allowing them to return home at night. Adult daycare not to be confused with adult foster care can be a good option for individuals who need some assistance during the day but do not require round-the-clock care.
- Assisted living facilities: provide a combination of housing and medical care for individuals who require some assistance with daily activities, inclusive of dietary services. This can be a good option for individuals who need some assistance with daily activities but do not require skilled nursing round-the-clock care.
- Continuing care retirement communities: provide a range of care options, including independent living, assisted living, and nursing facility level care, all within one community. This type of care can be a good option for individuals who want to age in peace and have access to a variety of care options as their needs change.
Understanding Nursing Home Regulations
When you’re considering what qualifies a person for a nursing home, it’s necessary to work with trained professionals and be knowledgeable about your rights and protections.
State and Federal Regulations
These govern different aspects of nursing home care, including staffing, facility safety, and maintenance, infection control, medication management, and resident care and treatment.
Nursing Home Certification and Licensing
Nursing homes must be certified and licensed by the state in which they operate. The individual state defines the certification and licensing requirements but they generally involve meeting certain standards for staffing, facilities, and resident care.
Quality of Care Standards
Quality of care standards are established by state and federal regulations, as well as by government programs, such as the Centers for Medicare & Medicaid Services (CMS) and the Joint Commission. Quality of care standards cover a wide range of areas, including infection control, medical need, resident care planning, and staff training and supervision.
Resident Rights and Protections
Resident rights and protections are also established by state and federal regulations. These rights include the right to privacy, the right to be treated with dignity and respect, the right to make decisions about one’s care, and the right to be free from abuse, neglect, and exploitation.
Paying for Nursing Home Care
It can be a significant financial burden having to pay for nursing home and hospital insurance for many individuals and families. There are several options including government programs, to cover nursing home care but it is important to carefully review eligibility requirements and coverage limitations for each option to make an informed decision.
Medicaid Coverage
Medicaid coverage is a federal-state health care program that provides health care coverage to low-income individuals with limited resources. To be eligible for Medicaid assistance and Medicaid-certified nursing homes varies by state, but generally, the patient’s assets and income must be limited. Medicaid determines its coverage limitations during the application process as well, such as a limit on the number of days that are covered.
Medicare Coverage
Medicare coverage is also a federal program that provides coverage for individuals aged 65 and older, as well as for individuals with certain disabilities. Medicare covers skilled nursing care in a nursing home setting for a limited period, typically up to 100 days. Eligibility for Medicare coverage for nursing home care requires a prior hospitalization of at least three days and a skilled care need that is certified by a physician.
Private Insurance
Private insurance is another option for financing nursing home care. Long-term care insurance is a type of private insurance that covers the cost of nursing home care and other long-term care services. Coverage and eligibility requirements vary by policy, so it is important for the family member to carefully review the terms of any policy before purchasing. Life insurance and disability insurance may also provide some coverage for the assisted living facility, depending on the policy terms.
Out-of-Pocket Expenses
Out-of-pocket expenses may be necessary for those who do not qualify for Medicare and Medicaid services and do not have private health insurance program coverage. The exact coverage depends varies widely depending on the location, level of care needed, and other factors. It is important to carefully plan for potential expenses to avoid financial hardship.
Planning for Nursing Home Care
Planning is an important part of long-term care planning. Working with healthcare professionals, financial advisors, and legal professionals can help ensure that the individual’s needs are met and that they are prepared for potential future care. There are several key areas to consider when planning.
Creating a Long-Term Care Plan
One should take into account the person’s present medical condition, possible future requirements, and care preferences. This may involve working with a care coordinator or healthcare professional to develop a plan that addresses the individual’s physical, emotional, and social needs. A long-term care plan should also consider the individual’s support system and available resources, such as family members, community services, and financial resources.
Financial Planning
Financial planning for nursing home placement care is also an important aspect of long-term care planning. This may involve reviewing retirement savings, health savings accounts, and other financial resources to determine if there is adequate funding available to cover the cost. It may also involve considering options such as annuities or trusts to help pay for long-term care expenses.
Legal Planning
One way to plan ahead is by making advance directives such as a living will and healthcare power of attorney. This helps ensure that if a person becomes unable to make decisions for themselves, their desires for medical treatment will be respected. It may also involve considering guardianship or other legal arrangements to ensure that the patient’s assets are protected and cared for in the event of incapacity.
Making the Transition to Nursing Home Care
After passing the nursing home admission requirements, the actual transition to nursing home care can be challenging, both for the individual and for their loved ones.
Adjusting to Life in a Nursing Home
Adjusting to life in as a nursing home resident may involve finding ways to personalize the living space, such as bringing familiar items from home or decorating the room with personal touches. It may also involve getting to know the staff and other residents, participating in activities and events, and exploring the amenities and services available.
Maintaining Social Connections
Maintaining social connections is also an important aspect of adjusting to nursing home care. This may involve staying in touch with family and friends through visits, phone calls, or video calls. It may also involve participating in social activities and events within the same nursing facility or homes, such as game nights, art classes, or exercise groups.
Coping With Changes in Physical and Mental Health
Coping with changes in physical and mental health can be a major challenge for individuals transitioning to nursing home care. It is important to work closely with healthcare providers to manage any health conditions including mental illness and maintain optimal health. This may involve following a medication regimen, attending physical therapy or other treatments, and engaging in activities that promote physical and mental well-being.
Staying Engaged in Hobbies and Interests
Staying engaged in hobbies and interests is also important for maintaining a sense of purpose and identity. Nursing homes often offer a range of activities and programs that cater to different interests, such as art classes, gardening groups, or music therapy. Engaging in these activities can help individuals maintain a sense of fulfillment and enjoyment.
Common Concerns About Nursing Home Care
Nursing home care can be a source of concern for individuals and their loved ones especially as in most cases they are not able to interact with them as regularly. Some of these concerns include:
Quality of Care
Quality of care is a top concern for individuals and their loved ones. This may include concerns about the cleanliness and safety of the facility, the quality of medical care and treatment, and the responsiveness of staff to residents’ needs. It is important to research nursing homes carefully and ask questions about quality of care measures, such as staff-to-resident ratios, infection control protocols, and resident satisfaction surveys.
Abuse and Neglect
Abuse and neglect is another concern. This may involve physical, emotional, or financial abuse, as well as neglect of basic nursing facility level of care needs such as nutrition, hygiene, and medication management. It is important to be vigilant for signs of abuse and neglect, such as unexplained bruises or injuries, changes in behavior or mood, or unexplained financial transactions.
Staffing and Turnover
Staffing and turnover is also common concern related to nursing home care. High turnover rates can impact the quality of care and continuity of care for residents. It is important to ask about staff training and retention programs when researching nursing home services or homes.
Resident and Family Involvement
This may be a concern if there is limited opportunity for residents and families to participate in care planning, decision-making, and social activities. It is important to ask about resident and family involvement policies when researching nursing homes.
Communication With Healthcare Providers
Difficulties in communicating with the primary care doctor, nurses, or other healthcare providers, or concerns about access to specialized care or medical equipment can become a cause for concern. It is important to ask about communication policies and procedures when researching nursing homes.
Nursing home care is an important option for individuals who require a higher level of care than can be provided at home. Eligibility for nursing home admission is based on specific criteria, and there are alternatives available for those who do not meet these criteria. Proper planning and research especially into Medicaid eligibility and the Medicaid application process can ensure the best possible care for individuals in need.
