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Nursing homes may be the best option for elderly loved ones

NIH/National Institute on Aging

Based on content from the NIH/National Institute on Aging AgePage "Nursing Homes: Making the Right Choice."

A nursing home, also known as a skilled nursing facility, is a place for people who don’t need to be in a hospital but can no longer be cared for at home.

Being admitted to a nursing home is based on medical need.

Most nursing homes have aides and skilled nurses on hand 24 hours a day.

Talk to the doctor to find out if a nursing home is the best choice.

Nursing Homes Can Be: 

  • Hospital-like. This type of nursing home is often set up like a hospital. Staff give medical care, as well as physical, speech, and occupational therapy. There can be a nurses’ station on each floor. As a rule, one or two people live in a room. A number of nursing homes will let couples live together. Things that make a room special, like family photos, are often welcome.
  • Household-like. These facilities are designed to be more like homes, and the day-to-day routine isn’t fixed. Teams of staff and residents try to create a neighborhood feel. Kitchens are often open to residents, decorations give a sense of home, and staff are encouraged to develop relationships with residents.

Some nursing homes have visiting doctors who see their patients on site. Other nursing homes have patients visit the doctor’s office. Nursing homes sometimes have separate areas called Special Care Units for people with serious memory problems, like dementia.

When looking for a nursing home, it’s important for families to think about special needs.

How Do You Choose?

If you are looking for a nursing home here are some things to keep in mind:

  • Look. What choices are in your area? Is there a place close to family and friends? What’s important to you—nursing care, meals, a religious connection, hospice care, or Special Care Units for dementia care?
  • Ask. Talk with friends, relatives, social workers, and religious groups to find out what places they suggest. Ask doctors which nursing homes they feel provide good care.
  • Call. Get in touch with each place on your list. Ask questions about how many people live there and what it costs. Find out about waiting lists.
  • Visit. Make plans to meet with the director and the nursing director. Some things to look for include Medicare and Medicaid certification, handicap access, strong odors that are either bad or good, many food choices, residents who look well cared for and enough staff for number of patients.
  • Talk. Don’t be afraid to ask questions. Ask how long the director and department heads (nursing, food, and social services) have worked at the nursing home. If key staff change a lot, that could mean there is a problem.
  • Visit again. Make a second visit without calling ahead. Try another day of the week or time of day so you will meet other staff members and see other activities. Stop by at mealtime. Do people seem to be enjoying their food?
  • Understand. Once you choose, carefully read the contract. Check with your State Ombudsman (see Resources That Can Help) for help making sense of the contract.

Do Nursing Homes Have to Meet Standards?

The Centers for Medicare and Medicaid Services (CMS) asks each state to inspect any nursing home that gets money from the government. Homes that don’t pass inspection are not certified. Ask to see the current inspection report and certification of homes you are thinking about. Visit www.medicare.gov for more information.

Paying for Nursing Home Care

People pay for nursing home care in many ways:

  • Medicaid. This is a State/Federal program that provides health benefits to some people with low incomes. Contact your county family services department to see if you qualify. Once you have met the requirements of your State’s Medicaid program, it can take up to 90 days to be approved.
  • Private pay. Some people pay for long-term care with their own savings for as long as possible. When that is no longer possible, they may get help from Medicaid. If you think you may need to apply for Medicaid at some point, make sure the nursing home accepts it. Not all homes do.
  • Long-term care insurance. Some people buy private long-term care insurance. It can pay part of the costs for a nursing home or other long-term care. This type of insurance is sold by many different companies and benefits vary widely. Look carefully at several policies before making a choice.

Many people believe Medicare will pay for long stays in a nursing home, but it doesn’t. For example, Medicare will only cover the first 100 days in a skilled nursing home for someone who needs special care after leaving the hospital. State/Federal Medicaid programs may pay for long-term nursing home care, but there are many rules about qualifying. It is important to check with Medicare, Medicaid and any private insurance company to find out the rules.

When thinking about costs, keep in mind that there can be extra out-of-pocket charges for some supplies, personal care like hair appointments, laundry and services that are outside routine care.

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