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Nursing Homes

A nursing home, also known as a skilled nursing facility, provides 24-hour medical, nursing and other services to frail elderly individuals and persons of all ages with disabilities. These facilities are licensed by the New York State Department of Health (DOH). A nursing home offers a protective, therapeutic environment for those who need rehabilitative care or can no longer live independently because of chronic physical or mental conditions that require 24-hour a day care.

Nursing homes are the most intensive and, therefore, often the most expensive level of long term care aimed at serving people who need high-intensity nursing care and supervision.

What are patient assessments and why are they important?

Before being admitted into a nursing home, the prospective resident must undergo a screening process to determine if a lower level of care would be more suitable for him/her. The screening process begins with a health care professional completing a patient review instrument (PRI). The PRI is used to assess the applicant’s ability to complete “activities of daily living” such as walking, bathing and using the toilet, as well as clinical conditions and the need for specialized services. This health assessment helps to identify physical, medical, social and psychological issues the applicant faces.

If the person is in the hospital and is being transferred directly to a nursing home, hospital social services or discharge planning staff will assist in completing the PRI and the screening process to determine whether nursing home placement is appropriate. If the person is at home or in a community-based program, a certified home health agency should be contacted to complete the PRI. Under these circumstances, a home visit is usually necessary. It is important to give the evaluator honest, accurate and complete information during this visit.

If the individual is a Medicaid beneficiary and is enrolled in a Medicaid managed care plan (see more information on managed care below), the plan will be involved in the administration of the assessment process.

Once accepted for nursing home placement, the person will also undergo a much more extensive assessment process within the nursing home using a form called the minimum data set (MDS). The MDS comprehensively reviews the person’s history and needs. It is a key part of the resident’s overall assessment and is used to develop and maintain an individualized care plan.

Services Available

A nursing home offers a full array of personal, dietary, therapeutic, medical, rehabilitative, social, spiritual, recreational, housekeeping and nursing services. Residents are involved in decisions about their care and receive services based on their individual needs. While many residents need care for extended periods due to chronic illness, a growing number of other patients enter a nursing home for a short stay for restorative therapy services. This may be after surgery or an accident, or to recuperate from a serious illness before returning home.

Living Arrangements: Living arrangements will vary depending upon the facility. Semi-private or private rooms are available with private or shared baths.

Payment

Often, a resident enters a nursing home and initially pays with his or her own money. When that money is mostly exhausted (also known as “spend-down”), the individual can apply to Medicaid for coverage. Spend-down laws allow the non-institutionalized spouse to keep a house, a car and a reasonable amount of assets. Spouses no longer need to “impoverish” themselves by spending down all their money in order to obtain Medicaid funding. Since these laws are complicated and subject to change, LeadingAge New York suggests discussing them with the admitting facility or the local department of social services. The local department of social services can also advise the individual with regard to the requirement, if any, to enroll in a Medicaid managed care plan.

Questions

When deciding on a nursing home for services, consider asking the following questions:

• Is the nursing home well maintained, pleasing and cheerful?

• Does the staff seem friendly, caring and accommodating to residents and visitors?

• Do the residents appear comfortable, well-groomed and involved in meaningful activities?

• Does the facility conduct resident and staff satisfaction surveys and if so, is this information available for review?

• What are the findings from the most recent state inspection, and can I discuss them with a representative from the facility?

• Are amenities such as private rooms, cable service for individual televisions, and private telephones available? At what cost?

• What activity programs and special events are held at the facility or off-site?

• What religious/spiritual programs are offered?

• How many physicians are on staff? Do you have a choice between the facility’s staff physician and your personal physician?

• Does the facility have staff providing occupational, physical and speech therapy?

• Should hospitalization become necessary, which hospital does the facility use?

• How many residents are under the care of one nurse aide on the day shift? What staff coverage is available on evenings, nights and weekends?

• Who coordinates admissions? How are the rooms assigned? Is there an orientation for new residents?

• Is there a family council to provide input into the kinds of programs and problems the facility may have? How often does the residents’ council meet?

• What may residents bring with them? Is there room for a favorite chair, photographs and wall hangings?