How the Nursing Home Admission Process Works
When our loved one is at home and it becomes obvious that professional care in a nursing home is the best long term option, we don't have the advantage of a hospital social worker or discharge planner to set things in motion. There are many available articles and checklists about how to choose a nursing home, including right here on on this site. There is very little information available about the actual process of having a loved one assessed and admitted to a nursing home after the selection has been made.
For a senior with medical needs that require 24-hour nursing care the process of applying for admission to a nursing home is relatively straightforward. In general, the process is as follows:
The patient will need to have seen his or her physician no more than 30 days before applying for admission to a nursing home. The physician must agree that nursing home placement is appropriate, and will usually have to provide the nursing home with the documents listed below. The nursing home you choose will tell you exactly what they want from the doctor.
Sometimes the nursing home will also want to send a nurse to assess your elder at home before they make an admission decision. This is hit and miss, depending on the facility.
1. A "History and Physical". This is a written summary, signed by the physician, that provides a general description of the patient (height, weight, age, etc.), a description of his primary medical problems, and a list of any "secondary" diagnoses;
2. A copy of the most recent laboratory reports (bloodwork, scans, eeg, ekg, etc.);
3. A list of all the medications the patient is taking and how they are to be administered. This list must be signed by the physician;
4. A copy of any nursing notes, therapy reports, or other information that would be helpful to the nursing home;
5. A written "order" signed by the physician for admission to a nursing home for long-term care.
The admission director or administrator of the nursing home will often assist with the coordination of this process.
For those seniors with limited assets, locating a nursing home which will accept a person as a "Medicaid pending" patient may be difficult. "Medicaid pending" is the situation where the patient cannot apply for Medicaid until he is in a nursing home, and he does not have the funds to pay the nursing home while awaiting Medicaid. Many nursing homes will not accept Medicaid pending patients because this essentially means they will be providing either free or very low-cost care for several months until Medicaid is approved. If, for some reason, the patient does not qualify for Medicaid after moving into the nursing home, then the nursing home has a non-paying patient they cannot easily evict. Many nursing homes try to avoid this scenario at all costs.
If your loved one can pay the nursing home privately while he is applying for Medicaid he will have a larger selection of facilities. It usually takes approximately three to four months to complete the Medicaid approval process.
If there is a spouse who will be remaining at home, it is often important to make arrangements for the stay-at-home spouse to have enough income to live on after nursing home expenses are paid. If this is your situation, it is almost always a good investment to have a consultation with an elder law attorney who can give advice on managing income, assets and property to the best advantage of the stay-at-home-spouse. Do this before your loved one moves to a nursing home, or as soon as possible after the move.
The National Academy of Elder Law Attorneys maintains a search and referral service if you don't know an elder law attorney in your vicinity.