SKILLED NURSING FACILITIES (NURSING HOMES)

For some older people, a nursing home is the best living arrangement to meet their physical, emotional, and social needs and to provide security and protection. Nursing homes are primarily designed to provide sub-acute or skilled nursing care for those convalescing from an illness or to provide long term nursing or supervision which is not appropriate for a hospital or available through home care programs. Short term placement in a nursing home may be necessary for a person immediately after an acute illness for a period of convalescence and/or rehabilitation. Long term nursing home care may be necessary for the person with multiple health problems which cannot be treated at home or which place too heavy a burden on family and friends.

For assistance in determining the appropriate level of care, caregivers and families should request a complete assessment of the patient. As part of the assessment process, a Patient Review Instrument (PRI) will be prepared, since it is a required instrument should nursing home placement be deemed appropriate. This process will also help to familiarize the family with the broad spectrum of community services that are available in and out of the home. This knowledge will help to avoid the need to make decisions under pressure in a crisis situation.

IT IS ESSENTIAL THAT ALL SERVICES AND PROGRAMS BE THOROUGHLY INVESTIGATED BEFORE A FINAL DECISION IS MADE.

CHOOSING A SKILLED NURSING FACILITY

Individuals who require twenty-four hour skilled nursing care receive relatively complete assistance in activities of daily living as well as necessary skilled twenty-four hour nursing care, rehabilitative services, and medical supervision. This is particularly useful for those patients discharged from hospitals who need care which cannot be provided at home. Patients who have long term chronic illnesses, who are not improving, or who are slowly deteriorating can be permanently placed in a residential health care facility. These patients require periodic review of their medical status by physicians and medical consultants.

Nursing Home Compare is a user-friendly tool to identify and compare various aspects of nursing homes in a given geographic area.  
www.medicare.gov/NHCompare/home.asp

DETERMINING MEDICAL ELIGIBILITY

The New York State Department of Health requires that applicants for admission to nursing homes undergo an assessment which is used to determine the physical, psychological, and social needs of the applicant. The required forms are the PRI (Patient Review Instrument) and the Screen. They must be completed by a certified public health nurse and are valid for a period of 90 days. Forms can be obtained at a hospital, from the nursing home, or from the Nassau County Department of Social Services.

When a patient enters a Nursing Home directly from a hospital, the hospital’s social worker and discharge planner complete the PRI and Screen, and make the necessary arrangements, working closely with area nursing homes. They try to place patients in facilities that can provide the needed care and are reasonably close to where the family resides. Patients and families should feel free to ask questions regarding their options in the selection of a facility, and should be certain they understand their rights and obligations as a Medicaid or a private pay patient.

New York State regulations require that a hospitalized patient on Medicaid, who no longer needs inpatient hospital care, be placed in the first available bed within 50 miles of the patient’s home. By telling the hospital which nursing homes to apply to, the patient or family can try to influence the location of the eventual placement.

When a patient enters a Nursing Home directly from the community, the PRI and Screen can be obtained by contacting the local Visiting Nurse Service or a certified home health care agency whose staff is qualified to make these evaluations and complete these forms. A caregiver who is familiar with the patient’s needs should be present when the nurse comes to the home. There are also professional individuals and agencies who specialize in long term care placement and are qualified to help families handle this process. It is important to inquire in advance regarding fees for this type of assistance.

SELECTION CRITERIA

The availability of beds impacts on choices available for consideration. Within this limitation, however, it is still necessary and advisable for the consumer to evaluate the facility and the services provided.

Once the decision has been made that nursing home placement is the most appropriate option, these questions should be considered:

1. Is the home licensed by the New York State Health Department? Can it supply the precise medical and nursing care needed by the prospective resident?
2. Do residents look well cared for, clean, and comfortable?
3. Does at least one doctor spend time in the home with the residents and the nursing staff, and does the home report to a resident’s personal physician on his or her condition?
4. How many nurses are there, what is their training, and how much supervision do they supply? Are they easily summoned at night?
5. What dental treatment and other special medical attention, such as foot care by a podiatrist, are available to residents?
6. Are there facilities for rehabilitation and are they used regularly? This is particularly essential for older persons who might otherwise be confined to bed.
7. Is the nursing staff trained in basic rehabilitation techniques and in sub-acute medical care?
8. Are adequate safety precautions taken by the home? Are fire escapes and ramps available for quick evacuation? Is there an evacuation plan posted? Are fire drills held regularly? Is the building fire-resistant?
9. Does the home maintain high standards of food service? Are the meals being served in accordance with posted menus? Is the kitchen clean nd properly equipped?
10. Will the home prepare therapeutic diets, such as those required by a diabetic?

There are other things to look for when visiting a nursing home. Is the location convenient? Are the visiting hours sufficient to enable friends to visit frequently? Is the general atmosphere homelike? Is the facility clean, orderly, and relatively free of unpleasant odors? Does each resident have sufficient space for personal possessions? Are telephones, radios, and television available? Are residents encouraged to dine and socialize together? Is the staff friendly toward residents? Are recreational services available? Are there arrangements for volunteers to come in to socialize with the residents, to help them write letters, etc.?

It must be kept in mind that the atmosphere of a nursing home might be quite satisfactory to one person but completely unsuitable for another. One individual might prefer a large nursing home, while another might prefer a smaller one.

NOTE: Facilities should be visited and carefully evaluated as quality varies.

ADMISSION AGREEMENTS

Each person entering a nursing home will be asked to sign an agreement before being admitted.  This admission agreement may be referred to by one of several names, e.g. Admissions Contract, Financial Agreement or Entrance Contract.  It specifies the conditions under which the resident is to be accepted.

Since placement in a nursing home is a very stressful process, consumers are urged to obtain a copy of the agreement in advance, to read and ask questions about it, and/or to consult a lawyer if anything is unclear, prior to signing the form.

A comprehensive Admission Agreement should:

• State the rights and obligations of residents of the facility, including safeguards for residents’ rights and grievance procedures.
• Specify how much money residents must pay each day or month to live in the nursing home.
• Detail the prices for items not included in the basic monthly or daily charge.
• State the facility’s policy on holding a bed if residents temporarily leave the home for reasons such as hospitalization or vacation.
• State whether the facility is Medicaid and/or Medicare certified.  If so, the facility must accept Medicaid payments when the resident’s funds run out, or accept Medicare payments if the resident qualifies for Medicare coverage.

RESIDENTS’ RIGHTS

Personal possessions, friends, finances, privacy, activities of daily living and other needs are taken for granted by people who are living in their own home settings.  Living in a nursing home can be a different experience.  It often means loss of a certain lifestyle and of things which are important to a person and help define him/her as a unique individual.

Residents’ Rights is a listing of particulars, mandated by law, which were developed to give institutionalized persons as many rights as possible to help them restore and keep their “persona” or identity.  Residents’ Rights help people keep control over their lives. There are approximately 19 rights which are roughly divided into the following eight (8) categories:

• General Responsibilities of the Facility to the Resident
• Admission Rights
• Protection of Legal Rights
• Right to Privacy
• Right to Clinical Care and Treatment
• Residential Rights
• Financial Rights
• Transfer and Discharge Rights

Understanding Residents’ Rights and standing up for them will help not only the residents but the staff personnel as well, for they provide a clear definition of what is required for good resident care. In effect, these rights form the basic operating Constitution for nursing homes.

BILL OF RIGHTS FOR RESIDENTS

Nursing Home Residents have the right to:

• Dignity, respect and a comfortable living environment
• Quality of care and treatment without discrimination
• Freedom of choice to make your own, independent decisions
• The safeguard of your property and money
• Safeguards in admission, transfer and discharge
• Privacy in communications
• Participation in organizations and activities of your choice
• An easy-to-use and responsive complaint procedure
• Exercise all of your rights without fear of reprisals

For a more thorough explanation of these rights, ask the nursing home for the booklet “Your Rights as a Nursing Home Resident in New York State” or contact:

Bureau of Standards Development
New York State Department of Health
Corning Tower - Empire State Plaza
Albany, New York 12237
www.health.ny.gov/facilities/nursing/rights/

PAYING FOR NURSING HOME CARE

Most people depend on Medicare, Medicaid, or a long term care insurance policy to help pay for nursing home care because long term care placement is costly.

1. Medicare

Although most older people have Medicare, it is not generally understood that MEDICARE PAYMENT FOR NURSING HOME CARE IS LIMITED. If a person has been hospitalized for at least three days and requires skilled nursing care on a daily basis for continued treatment of the same condition, Medicare, Part A, may pay for a limited number of days in a health care facility MEDICARE DOES NOT PAY FOR CUSTODIAL CARE IN A RESIDENTIAL HEALTH CARE FACILITY. If a person is hospitalized, contact the hospital social worker or discharge planner to discuss eligibility for Medicare nursing home coverage.

2. Medicaid

To receive Medicaid assistance with residential health care facility payments, persons must first spend their own assets until they have been reduced to the Medicaid eligibility level. At this point, if placement is medically approved, the person may apply for Medicaid assistance to meet the monthly cost of care. Since the application can be a lengthy and involved procedure, it should be started two months prior to meeting financial eligibility requirements. Married couples should be aware that in New York State the spouse of an institutionalized elderly person can refuse to contribute his/her income and assets to the care of the ill spouse.  This “spousal refusal” enables the community spouse to retain more of the available assets for his/her own care and well-being, and prevent becoming impoverished by the high cost of nursing home care. Once all other requirements of the spouse’s Medicaid application are met, Medicaid must pay for the care of the institutionalized spouse.  Couples should seek the advice of an elder law attorney since the Department of Social Services reserves the right to sue the spouse or the estate beneficiaries for full payment owed of any benefits the institutionalized spouse received.

For information about Medicaid eligibility and application procedure, contact:

3. Long Term Care Insurance

Long term care insurance is a type of insurance that was developed specifically to cover the costs of long term care, most of which may not be covered by traditional health insurance or Medicare.  Long term care may include services in the home or in a variety of facility or community settings. There are many long term care insurance policies available from many insurance companies. Policies vary considerably in the coverage they provide, and must be carefully examined before purchase.

The New York State Department of Financial Services - Insurance Division can provide information on policies that are available in the state including the New York State Partnership for Long Term Care Program.  It is best to examine different policies and speak to a professional before making a decision to purchase.  Contact:

The US Department of Health and Human Services developed the National Clearinghouse for Long Term Care Information which provides some helpful information on understanding, planning for, and paying for long term care services.
Contact: www.longtermcare.gov/LTC

4. Private Payment

Those who require nursing home care, who are not covered by Medicare or a long term care insurance policy and who have assets above the Medicaid eligibility level, must pay the full cost privately to the facility. When negotiating financial arrangements with a nursing home, it is important to have a written agreement clearly indicating what services will be provided.

IN ALL CASES, IT IS ESSENTIAL TO EXPLORE ONE’S FINANCIAL SITUATION WITH A KNOWLEDGEABLE ADVOCATE BEFORE EXPENDING ASSETS OR SIGNING A CONTRACT.

SKILLED NURSING FACILITIES IN NASSAU COUNTY (Nursing Homes)

VETERANS FACILITY

This 350-bed residential health care facility provides skilled nursing care to veterans. This facility is operated by the Health Sciences Center at the State University at Stony Brook. It is located one half mile east of University Hospital. New York State veterans requiring skilled nursing care are eligible for admission.

The Veterans Home also operates a Medical Model Adult Day Care Program for veterans and their dependents.

Call for information: 1-800-329-2273

NURSING HOME –ADVOCACY PROGRAMS

The Ombudservice Program, funded by the NASSAU COUNTY OFFICE FOR THE AGING, and operated by Family and Children’s Association is designed to improve the quality of the day-to-day lives of elderly residents of nursing homes and adult homes. Individual complaints and concerns about care are investigated. Volunteers are recruited, trained, and state-certified to work closely with administrators, staff, residents and families to help resolve issues and to protect resident rights. For information, contact:

NURSING HOME COMPLAINTS

For complaints about nursing homes, including patient abuse and neglect, contact:

New York State Department of Health Complaint Hotline 1-888-201-4563

For complaints about patient abuse or financial fraud for Medicaid residents, contact:

NURSING HOME QUALITY CARE ASSURANCE

Centers for Medicare and Medicaid Services (CMS) have developed new sets of improved nursing home quality measures that enable consumers to compare the features of many different facilities. Information such as staffing ratios, inspection results, resident care, costs, etc. is available. Go to Medicare website www.medicare.gov or call: 1-800-633-4227

IHFA is an organization of residential health care facilities in Nassau and Suffolk Counties. It assists its members in providing quality care to residents through educational programs and resources. The association informs state and federal legislators about issues affecting long term care.