You Do Have Residential
Eldercare Options:
A Nursing Home

If your elder needs more care than you can safely and affordably provide at home, and if he or she isn't independent enough to be able to live in an assisted living residence, a  nursing home is often your best available choice.

We've all heard and seen the horrifying stories on the news  about nursing home abuse. Of course, it does happen.

What we don't hear, because they don't make gripping evening news stories, are the stories about nursing homes that do their best to provide good care.  

If your elder needs supervision around the clock, can't get out of bed, or really needs more medical care than you can give at home, a skilled nursing facility is almost always the best answer.  

Most nursing homes offer more than skilled nursing care. Today they have social workers and activities directors to keep residents involved and active.  In addition to the doctors who are regularly there, many have psychologists, podiatrists, dentists, opticians and hearing specialists, and hair dressers who visit residents.  

New regulations and oversight have encouraged nursing homes to reduce the use of drugs and restraints. Patient plans of care now encourage independence and individuality to whatever extent possible. You'll see most residents up and dressed in their own clothing, if they are able. Rooms are decorated with personal belongings.

There is certainly no such thing as perfection, and nursing homes aren't perfect. Problems with having enough good help will continue to plague nursing homes for the foreseeable future, particularly as the older population grows and the need for services increases. For this reason, it is extremely important that you do your homework before you choose a nursing facility, and that you are an involved visitor and advocate for your loved one throughout his or her stay.

Who Pays for Nursing Home Care?

Nursing home care is expensive. Costs are now ranging upward from about $40,000 per year on the low end to sometimes more than double that amount. Many people are surprised to discover that Medicare and private health insurance pay  nothing toward the cost of long-term nursing home care.  

Good long-term care insurance policies cover nursing home care up to whatever the daily benefit amount might be. Unfortunately, most seniors don't have long-term care insurance policies. 

You may have heard that, "Medicare will pay for up to 100 days in a nursing home."  This is sometimes true. However, the care that Medicare covers is for rehabilitation after a hospital stay, not for long-term "custodial" care, and there is no guarantee that Medicare will cover any specific length of time.  Most residents of a nursing home are there for custodial care, not  rehabilitation. They aren't eligible for Medicare coverage.

For those residents who don't have long-term care insurance, or sometimes VA benefits, the remaining alternatives are to pay privately out of personal funds, or apply for Medicaid assistance.

Every state has specific and strict financial eligibility rules that must be followed in order to qualify for Medicaid assistance. In essence, an elderly person who is not married must spend almost all of his or her assets and have a limited monthly income. A married individual who is leaving a spouse 
at home is able to keep substantially more assets, but not necessarily everything. If your elder has too much income or too many assets to qualify for Medicaid, it's very important that you get advice from a legal expert before you attempt to make any financial arrangements in order to qualify.  

There is a lot of well-meaning but inaccurate information floating around about Medicaid. If you make the wrong financial decision it can rarely be reversed, and there may well be stiff penalties as a consequence. If you have questions contact your local state Medicaid office for specific information applicable to your state and circumstances. Then, if you feel that you might need to make some important financial decisions, consult with an elder law attorney in your local area for advice before you do anything else.

If there's a probability that your elder will need Medicaid assistance within a year of entering a nursing home, be looking now for a facility that accepts Medicaid, even though you won't be applying immediately. Plan on paying privately for at least several months. The better facilities almost always have long waiting lists for Medicaid, and patients who are already in residence usually get priority. It's always easier to move in as a private pay patient, and then apply for Medicaid when financially eligible.

Choosing a Nursing Home

The most important thing to remember when choosing a nursing home for a loved one is that your elder still needs you.  Although you may not be giving direct physical care, your presence is all important.  Therefore, location, location and location are the first things to consider.

If you can drop in easily at any time, even if only for a few moments, you will be able to monitor the care your loved one is receiving, and step in, or "advocate", before little problems become big concerns. You'll have a chance to get acquainted with the various staff members who work on different shifts, who you might not ever see if you could only visit on weekends. Your presence will do more to insure that your loved one receives good care than any number of state inspectors.

Pay a visit to the Medicare website. Here you'll find valuable information about all of the nursing homes in the U.S. that accept public funding (Medicare and Medicaid), and how they have scored on their most recent inspections. You can also get information about the kind of patients they tend to have, and some information about their staff.  Other important information on this site is the ownership of all nursing homes, so you can see whether they are publicly or privately held.