Nursing homes
Nursing homes are facilities that are designed to meet the needs of people convalescing from illness. In addition, they are intended to provide long termnursing supervision and meet the needs of people with long-term medical problems. Today nursing homes serve individuals with more severe health problems than they did in the past. They are required to provide medical care, room, and board to individuals of all ages on a long or short-term basis. Oftentimes,patients recovering from an illness or major surgery go to a nursing facility before they return to their homes.
A nursing home is not a hospital and does not give the acute care that is provided in a hospital setting. The goal of the nursing homes is to provide careand treatment so that the patient's highest level of physical and mental well being are restored or maintained. Besides medical services, nursing homes provide dental services, personal care assistance, rehabilitation services, social activities, mental health care, dietary services, medication administration and exercise programs.
There are many different kinds of nursing facilities where various levels ofcare are available. * A Skilled Nursing Facility (SNF) has registered and licensed vocational nurses and can provide continuous (24-hour) nursing supervision. These facilities, commonly referred to as "nursing homes" or "convalescent hospitals" care for the people who are in need of short or long-term assistance. They provide support for people who need help with everyday activitiessuch as bathing, dressing, eating, and walking. * An Intermediate Care Facility (ICF) is required to provide only 8 hours of nursing supervision every day. They are therefore less extensive than skilled nursing care and generallyserves people who are ambulatory and need less supervision and care. Licensednurses are not always immediately available in an ICF. * A Skilled Nursing Facility for special disabilities is a place that provides security or a "protective" environment for persons with mental disabilities. For the protectionof the individual and of the others in the facility, these places will have locked areas where the patients reside. Some facilities have a designated number of beds for the care of long term mental patients.
The government regulates nursing homes, which receive federal money. Some states have additional regulations for nursing homes. All state governments require that nursing homes be licensed. These licensing requirements establish acceptable practices for care and other services. State inspectors visit the home at least once a year to ensure their compliance with the set standards andtheir qualifications to receive Medicare and Medicaid reimbursement.
Although nursing home care can vary widely, it is expensive. The basic chargefor a double bed room can be in the range of 20,000 to 50,000 a year. The medication costs and the physician visits are not included in the basic charge.Any special treatments such as any rehabilitation therapy, physical therapyetc. add to the basic cost. There are also extra charges for services such aslaundry, haircuts, and so on. Most nursing homes are certified to participate in both the federal Medicare and Medicaid programs.
Some of the nursing homes patients are private-pay residents who can afford to cover the entire cost themselves. Three out of four patients who need longterm care in nursing homes are dependent upon government assistance through Medicare or Medicaid. Other sources of financial aid might be available from private health insurance. Eligibility for Medicaid is contingent upon the amount of a patient and spouse's income, personal assets, and real property. Financial assets accumulated by a person may be exhausted during prolonged care in a skilled nursing facility. Although federal and state laws exist and are intended to limit discrimination, Medicaid beneficiaries often do face discrimination in admissions to nursing homes and the services they receive.
Some nursing homes are sponsored by various religious, charitable, fraternaland other groups and are operated as nonprofit corporations. Some are even run by government agencies at the local, state, and federal levels. Many nursing homes are run as businesses operating for profit. They are owned by individuals or corporations. Some are even part of a chain.
The person in charge of the day-to-day management of the nursing home is called the director or the administrator. The governing body sets the policies and the rules of the nursing home. It is the legal entity that is licensed by the state and is finally responsible for the smooth operation of the nursing home. A person in a nursing home must be under the care of a physician. It isthe physician's obligation to evaluate the patient's needs and to prescribe aprogram of medical care that is appropriate for the person's health and wellbeing. A nursing home cannot initiate any form of medical treatment, therapy, or even a special diet without first consulting the person's physician.
Before a person is admitted to a nursing home, a complete physical examination should be completed. The results of the examination will determine whetherthe patient needs skilled nursing care or intermediate care. The duration ofthe treatment, the need for nursing home and the patent's rehabilitation potential are all decided by the physician after the physical examination is completed.
If the need for a nursing home in the future can be foreseen, it is a good idea to plan ahead and maybe place oneself on a waiting list. Many nursing homes have long waiting lists and the chances of getting placed in the home of one's choice is enhanced if the placement is made on a waiting list prior to the actual time of need.
When visiting a nursing home, the following factors should be carefully considered and evaluated. * Administration: Find out if the home has the requiredcurrent license from the state, or the letter of approval from a licensing agency. Check to see if the home is certified in the Medicare and Medicaid programs. Ensure that there is a written statement of the patient's rights and that every patient gets a copy of the same. Walk around and see if the staff shows genuine interest and affection. Do the patients seem well cared for and content? * Medical Services: Find out if a physician is available at all times, either on staff or on call. Does the home have arrangements with a nearby hospital for quick transfer of patients in case of an emergency. Are pharmaceutical services provided by a qualified pharmacist? Does the home have an arrangement with a dental service to provide patients with dental care? Is thereat least one registered nurse or licensed practical nurse on duty day and night? Are nurse call buttons located at each patient's bed and in the toilet and bathing facilities? * Location: It would be convenient for friends and relatives if the home were in a place that is easily accessible for them. The home should also be appealing to the patient and should be reasonably close to ahospital in case an emergency arises. * Size: A large nursing facility may have more activities, but a smaller home might be more personal. That is an individual's personal choice. The quality of the services and activities offered should be considered. * Financing: is one of the most important issues to deal with. It is important to get a clear understanding from the facility as to what services Medicare or Medicaid covers. In addition, it is important tofind out what are the extra costs in addition to the daily room rate. Some homes provide only the bare minimum by way of services. Any professional services beyond nursing care may be charged extra, including television and toiletries. * Bed-hold: Inquire whether the facility will hold a bed, just in case the patient has to transferred to a hospital. Medicaid pays for 7 days of bed-hold. Medicare and private-pay patients will have to pay for each day that the bed is held. Sometimes, if extended stay at the hospital is needed, an agreement can be made with the nursing home regarding the room rates. * Grievanceprocedure: Find out if there is a council through which a patient's grievances can be resolved. * Volunteers: Find out if volunteers from the community at large are involved with the home. This will extend the amount of patient services available and help to reduce the isolation and loneliness that many patients inevitably feel. * Food: check the food being served. Inquire about the quality of the food from the other patients. Find out if they supply food for special diets, and if food is available at times other than meal times. *General physical considerations: Walk around the facility and get a general feel for the place. Does it seem clean and orderly? Are the toilets and bathing facilities easy for handicapped patients to use? Does the home appear welllighted and free of unpleasant odors? Are rooms well ventilated and kept at acomfortable temperature? * Safety: Make notes on the safety of the place. Ensure that there are wheel chair ramps where necessary. Ascertain whether there are grab bars in toilet and bathing facilities, and handrails on both sidesof the hallways. Check to see that there are portable fire extinguishers, emergency exit doors that are unobstructed and easily accessible and smoke detectors and fire alarms on every floor. * Rehabilitation Therapy, Social Service, and patient activities: Find out if there are full time programs of physical therapy for patients who need it. Find out if there are special services available to aid patients and their families. Inquire if the nursing home hasa varied program of recreational, cultural, and intellectual activities for patients, and if some activities are offered to patients who are confined to their rooms.
There are three basic ways to pay for long-term care in a nursing home: Medicare, Medicaid, or private pay (out of pocket or by using long term care insurance. Medicare is the federal program offered to those who need a skilled level of care after a 3-day hospital stay. Skilled care is best described as thetype of care that is needed after a hip fracture or a stroke - therapy on adaily basis. Medicare pays 100% for the first 20 days of stay in a nursing home. Beginning on day 21 through day 100, there is a co-pay required by Medicare. Most seniors have a Medicare supplement policy that will pay in conjunction with Medicare. Once Medicare stops paying for care, most supplements willnot continue to pay.
Once Medicare is exhausted, the only other options available are Medicaid andpaying out of pocket. Medicaid is available for those individuals that are low income or have limited resources. It is the state welfare program and haslimitations as to the amount of assets that the individual can own and the amount of income that one receives each month before they become eligible. Besides paying out of one's own pocket, one can purchase long-term insurance. Theinsurance must be purchased before needing long-term care. The eligibility is based on one's health at the time of purchase. Therefore, if one is alreadyill, they will probably not be insurable.
When visiting a nursing facility, ask oneself, "What are my needs or the needs of my loved ones?" List those needs and generate questions that will meet those needs. Make the first visit unannounced, and do a walkthrough just to get a feel for the place. If one is satisfied with what one saw, then a secondvisit should be scheduled, this time with an appointment with the Director ofAdmissions. Ensure that one has information about the occupancy rate of thefacility, the staff turnover rate, the type of rating the facility received in its last survey and what its deficiencies were. Ask questions about the type of activities the facility provides and the therapies available.
Once a nursing home has been selected, the home's contract or financial agreement should be thoroughly reviewed. Since the agreement constitutes a legal contract, it is advisable to have a lawyer review the agreement before signingit. The admission papers should include the following items: * the agreementstating the terms and conditions, the daily room rate, the services coveredby it and so on. * A list of optional services and the charges for them. * Acopy of the patient's Bill of Rights * A statement about eligibility for Medicaid * A statement that the nursing home is or is not Medicare or Medicaid certified.
It is important that someone other than the patient have legal and medical powers of Attorney for the patient. This will allow someone else to legally make the decision for the patient and act on their behalf, should they ever become incompetent. It is important for the family members or friends to know theappeals process and how to challenge a nursing home decision regarding coverage limitations. It also pays rich dividends to be educated about the familymembers diagnosis / disease and to be aware of complications, treatment options and later stages.
Finally, it is important to realize that a nursing home will not be like home. Be prepared to make the transition as smooth as possible. Such a change mayaffect the whole family and there will be a period of disruption before onegets used to the new living arrangements. The resident can be helped to be more comfortable by taking along familiar items such as family photos, sentimental items, and so forth. The frequency of visits to the resident is a decision of personal choice, but it is important for friends and relatives to keep in mind that their presence greatly helps the patient. Visits by family and friends offer reassurance to the resident that someone still cares. This, in turn keeps the residents morale up and they usually receive better care from the staff.