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Nursing Home Checklist

Choosing the right facility — Page 2

nursing home checklist to Page 1

— Long-Term Custodial Care —

Contrary to the belief of most seniors, Medicare pays nothing for long-term care. It doesn't matter if the care is provided at home, in an assisted living facility, or in a nursing home.

Perhaps the confusion arises because Medicare can temporarily pay for nursing home care for recovering patients, as described in the section above. But, after they've recovered, Medicare's benefits stop even though the patient may remain in the nursing home as a permanent long-term resident.

Medicaid currently pays nearly half of all nursing home expenses. However, Medicaid reduces a senior's options to just one — a Medicaid nursing home with at least one roommate (no privacy). If local homes are full, the senior goes wherever a bed is available, even if it is hours away from family and friends. While no one really knows how this affects people with advanced Alzheimers or senility, it can be devastating for an elderly person who is very frail but still mentally alert.

9 out of 10 nursing homes that accept private-pay patients also participate in the Medicaid program. If your loved one is not on Medicaid when they move into one of these homes, they cannot be discharged later if they run out of money and have to go on Medicaid. But, the nursing home can move them, without anyone's permission, into a lower-cost room, including a ward-type room with several roommates, or into a special Medicaid section of the facility.

To help avoid that possibility, we recommend that you look over your loved one's finances with the goal of stretching their available funds to last as long as possible. That may mean they won't be able to afford the most luxurious facility. But, the good news is that nursing home care is not as expensive as it seems at first. Instead, to an extent that varies from one person to another, it simply involves a shift of expenses from one living arrangement into another.

After an elderly person's capabilities have declined to the point where they need to move into an nursing home, the move is almost always permanent. When their former home is sold, or its lease terminated, most of the expenses they had been paying for it can then be used to help pay their nursing home expenses. And, the money resulting from the sale of their home can be used, for example, to purchase a CD or annuity that pays monthly interest to boost income.

Also, since nursing home fees include all meals, your loved one will no longer have to buy groceries, thereby freeing up even more money. To help you evaluate your loved one's financial situation, we've included a worksheet, Finding the Funds for Long-Term Nursing Home Care.

The worksheet assumes that no assets are being spent down; in other words, they will remain intact with only the interest/dividend income they produce being used to supplement your loved one's income. But, if they are short of the funds needed for nursing home care, some or all of their assets will have to be spent down. That is, the principal value of an asset will have to be converted into a stream of monthly income payments. When doing so, several factors need to be kept in mind. Among them ...

  • Your loved one's income needs will increase from month-to-month due to inflation. The cost of nursing home care has been increasing 4.5% per year, faster than inflation in general.

  • You need to decide how many years the income should last (the longer the period, the lower the income). Some people might use the remaining life expectancy to calculate monthly payouts, but that would be a mistake. By definition, life expectancy is an average for all people; therefore, half of us will live longer than our life expectancy.

    Instead, you want to be as certain as possible, without overdoing it, that your loved one won't outlive their income. To accomplish that, we recommend you select a payout period based on a 90% probability that they won't . The following pull-down menus, based on the current age of your loved one, show our recommended payout periods for ages 65 through 90.

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  • Work with a trusted financial advisor to assist you in converting each financial asset into a stream of monthly payments.

Step Two: Determine your loved one's needs

The types of care available can vary widely from one nursing home to another. To be certain that a facility can provide the care necessary for your loved one, first determine what your loved one's needs truly are (they may be different than you think). We've included 3 excellent checklists in our section, Getting started — What kind of help does your loved one need?

When you compare nursing homes, some factors matter more than others. No perfect home exists. Finding one that meets your needs is Goal Number 1. But don't underestimate Goal Number 2, that is, getting them to accept your loved one. When you tour a home and interview its staff, be thorough, clear and professional. Show them that you're part of the solution and will work closely with them to achieve the best care possible for the new member of their community.

Be ready to:

  • Explain the type of care your loved one needs. Ask the facility to describe how it will meet those needs, for example, assistance with dressing, taking medications, incontinence, or general supervision. A nursing home should provide enough care and support to meet your loved one's needs while encouraging and allowing them to remain as independent as possible. And, don't forget that your loved one may need more care as time passes; ask questions that don't apply now, but may in the future.

  • Visit several facilities; services and fees will vary greatly. Our checklist will help you compare facilities and organize your impressions of different homes.

Step Three: Select a location and narrow down your choices

To help you find the best nursing home for your loved one, you could use the ElderCarelink service which has established a nationwide network of carefully screened facilities. ElderCarelink provides this referral service free of charge.

Within minutes of completing their brief Needs Survey, you will receive a detailed email report listing nursing homes in your area that match your specific requirements. Last year, over 100,000 families utilized this service in their search for high-quality senior care. Click here to use the ElderCarelink service.

After making your preliminary choices using ElderCarelink, you can narrow them down by using Medicare's free reports. Each year, the Centers for Medicare & Medicaid Services (CMS), the federal agency that administers both programs, inspects each nursing home that it certifies and includes the results in free reports available online. Reading the reports for the facilities on your list before you visit might alert you to possible problems or special areas of interest. To find the CMS's latest reports, go to Medicare's Nursing Home Compare.

If your loved one needs short-term recovery care, Medicare could have a few nasty surprises in store for you:

  • Medicare saves money by getting patients out of the hospital and into a skilled nursing facility as quickly as possible. But, Medicare won't pay for the cost of transportation between the hospital and skilled nursing facility. Instead, the patient has to pay for it out of their own pocket, even if an ambulance is used. Consequently, we recommend you select a skilled nursing facility near your loved one's home and, at the same time, as close as reasonably possible to the hospital where they were confined — the shorter the distance between the hospital and the skilled nursing facility, the lower the transportation cost.

    But, don't let the transportation cost be the sole deciding factor for your choice of a skilled nursing facility. We recommend that you select the one that, while being relatively nearby, will provide the best possible medical care for your loved one.

  • Do your homework when selecting a skilled nursing facility. If you don't, and you decide later to move your loved one into a better facility to complete their recovery, Medicare won't pay for the second one, regardless of the reason for the move.

    Tip: Your loved one doesn't have to go to the skilled nursing facility where their hospital wants to send them; take a few days to find the best one. To learn how, especially if the hospital is pressuring you to discharge your loved one, go to our article, Hospitals — What should you know when your loved one is a Medicare patient?

On the other hand, if your loved one needs long-term custodial care and is still mentally alert, we strongly recommend that you include them in the selection process. After all, it is their future home you are selecting. Remember, it is your role as a caregiver to help them maintain as much control over their lives as feasible, not take it away; this includes allowing them to make their own decisions whenever possible.

Step Four: Go

Make an appointment for each home you want to tour. Ask to see more than the public areas. Visit several residents' rooms. Ask if both you and your loved one can join the residents for lunch or dinner. And, if possible, stroll through the facility on your own. This will allow you to experience it without an official interpretation. Talk to the residents; ask them what they like most — and what they feel could be improved.

Take a deep breath and clear your mind. You're ready. (Take a blank checklist with you for each visit.)

 
Nursing Home Checklist

Nursing Home Checklist

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