Plan
Ahead
Have the conversation about long-term care before the need
arises. By planning ahead, you can find the quality of care
and quality of life that you desire in a long-term care facility
for yourself, loved one or other person. Planning ahead will
also make the transition easier because many important decisions
will already have been made or at least discussed.
Tips
for planning ahead include:
- Research
your options based on the needs of the patient.
- Get
financial records in order and understand your financial
options.
- Have
an open and honest discussion with your loved one about
their desires when the time comes to enter a skilled nursing
facility.
- Involve
the patient in the discussion and selection process, and
enlist the help of eldercare professionals about special
healthcare needs and quality of life matters.
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 Finding
A Nursing Facility
Today's nursing facilities (often referred to as nursing homes,
extended care services, or health care centers) serve the
young and old alike, both those who expect to recover fully
as well as those in need of extended long-term care services.
The goal of care in a nursing facility is to help individuals
meet their daily physical, social, medical, and psychological
needs and to return home whenever possible.
Services
Four basic types of services are offered by nursing facilities:
- Medical
Care – Residents in nursing facilities are under
the care of physicians, who visit regularly and are responsible
for the residents' overall plan of care. Physicians certify
the need for nursing care and may serve as a resource for
information about long-term care facilities in the community.
- Nursing
and Rehabilitative Care – All nursing facilities
require the professional skills of a registered or licensed
practical nurse. Nursing services include assessment, treatments,
injections, coordination of care, and medication administration.
Rehabilitative services such as post-hospital stroke, heart,
or orthopedic care are available in addition to related
services such as respiratory therapy, physical therapy,
occupational therapy, or speech therapy.
- Personal
Care – Personal care is provided to residents
who need help with various activities such as walking, getting
in and out of bed, bathing, dressing, and eating.
- Residential
Care – Residential care services include general
supervision, provided within a safe and secure environment,
along with a variety of with a variety of programs to meet
the social and spiritual needs of residents.
After you know the type of services needed, obtain the names
of facilities in your area. Talk with administrative personnel
and make an appointment to tour the facility. Try to visit
each facility at several different times of the day. Be sure
to ask questions about what you are seeing, hearing, or feeling
about the facility.
Ask what
types of group activities are offered and how individual residents'
needs and preferences are identified. Residents should have
the opportunity to be involved in activities that provide
mental, physical, and social stimulation.
Take some
time to talk with the residents and their families. Ask them
about their life in the facility. Also, try to plan a visit
to the facility during mealtimes so you can observe food presentation
and interaction in the dining room.
During
your visit, talk to the caregivers; many of these talented
professionals are registered or licensed practical nurses
and certified nursing assistants who have devoted their careers
to caring for the elderly and the disabled. People providing
services to people is what long-term care is all about.
Survey
and Inspection Reports
In Kentucky, the Cabinet for Health Services is responsible
for conducting facility inspections every year. The survey
results are available at the facility (and on the Internet
at www.medicare.gov).
Review this report of the facility's performance. A staff
representative can answer your questions and provide additional
information about this complex document.
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Questions
To Think About
The following questions may guide you in evaluating nursing
facilities throughout your selection process. Remember, each
resident has different needs, preferences, and desires that
should be taken into account in the selection of a facility.
Location
Visitors are important! Is the facility conveniently
located for frequent visits from family and friends?
Ambience
Is the atmosphere welcoming and attractive?
Staff
Observe staff interactions with the residents.
Do caregivers show respect and a positive attitude toward
residents and others?
Activities
Look over the activity calendar for the week or
month and ask about the programs available. How are residents
encouraged to participate?
 Religion
Are religious services held on the premises? What
individualized arrangements can be made for residents to
worship?
Rooms
Ask
to visit a typical room.
-
Does the living space suit the needs of the resident?
- How
are roommates selected?
- How
are private items stored or secured?
- What
is the policy for residents having a private telephone?
- What
is the policy for decorating rooms with personal items?
Dining
Observe
mealtime at the facility.
Ask to have the dining procedures explained to you.
- How
is the menu managed weekly and monthly?
- What
arrangements will be made if residents are unable to eat
in the dining room?
- What
is the practice for special dining or menu requests?
- Are
snacks provided?
- Are
private dining areas available when family and friends
are visiting?
Care
Planning
- Are
residents and families encouraged to participate in developing
their care plan?
-
Does the facility provide services for terminally ill
residents and their families?
-
What special programs (Alzheimer's, AIDS, subacute care)
does the facility offer?
Medical
- Are
other medical professionals (dentists, podiatrists, optometrists)
available?
-
Does the facility have an arrangement with a nearby hospital?
- Will
a bed be available after hospitalization?
-
How are prescription drugs ordered?
-
Are therapy programs provided (physical, occupational,
speech pathologist)?
Costs
Are
all the services the resident requires covered in the basic
charge?
Request a list of specific services not covered in the basic
rate. (Some facilities have schedules covering therapies,
beautician services, barbers, specialty foods, personal
laundry, etc.)
Patient Rights/Autonomy
- What
are the patient's rights and responsibilities?
-
Does the facility have a Resident Council?
- Does
the facility have a Family Council in which you can participate?
Licensure
and Certification
Ask to see the latest inspection report and ask a
facility representative to answer any questions you may
have.
- If
needed by the resident, is the facility certified to provide
Medicare and/or Medicaid coverage?
- Does
the facility have a formal quality assurance program?
Your Role
If you are helping to select a long-term care facility for
a loved one, are you:
- Involving
this person in the process?
-
Prepared to ease the resident's transition to the nursing
facility by being with them on admission day and staying
several hours to get them settled?
-
Ready to visit the resident frequently and encourage friends
to make similar visits?
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Paying
for long-term care
long-term care is a costly proposition for which few people
are fully prepared. Yearly costs for a nursing facility today
can exceed $50,000 per year. Many people mistakenly believe
that Medicare will cover the cost of long-term care, but Medicare
only pays for approximately nine percent of nursing facility
costs. Rather, Medicaid picks up nearly three-fourths of the
cost. long-term care insurance accounts for a very small percentage
of nursing facility payments. As these figures show, long-term care financing is a serious matter requiring serious
planning.
Medicare
– Medicare is a federal health insurance program for
people over 65 and certain disabled people under 65. Medicare
covers only those nursing facility services rendered to
help a beneficiary recover from an acute illness or injury.
Medicare is administered by The Centers for Medicare and
Medicaid Services (CMS). Coverage for long-term care services
under Medicare is very limited. For more information about
Medicare visit their web site at www.medicare.gov.
Medicaid
– Medicaid is a cooperative federal-state program
designed to provide assistance to low income people. It
has become the major funding source for long-term care,
covering nearly 75 percent of nursing facility bills. Medicaid
is administered by the states under broad federal guidelines.
Medicaid will pay for nursing facility care for those who
meet a state-determined poverty level, provided the nursing
facility is Medicaid “certified.” For information
on the Kentucky requirements to qualify for Medicaid, contact
the Department of Medicaid Services at 502-564-4321, or
visit their web site at: http://chs.state.ky.us/dms.
long-term care Insurance – Because many Americans
fail to plan for their long-term care needs, tens of thousands
of Americans are impoverished each year by the costs of
long-term care. Recently enacted health insurance legislation
has helped make private long-term care insurance a more
viable option to paying for long-term care costs, while
preserving personal savings. long-term care insurance can
protect personal assess and inheritance for the family,
provide greater choice in the selection of a long-term care
setting, and generally provide for financial security. The
National Association of Insurance Commissioners publishes
a Shopper’s Guide to long-term care Insurance
brochure that provides information you should know when
evaluating long-term care insurance policies. For a free
copy of the brochure, contact the Kentucky Department of
Insurance at 1-800-595-6053, or visit their web site at
http://www.doi.state.ky.us/kentucky.
long-term care facilities strive to be like a community where the residents
can feel comfortable, find familiar faces, and build relationships
just like they would in their homes. Many people have a mistaken
impression of these services, so it is important that you
gain as much knowledge about them as possible. It’s
best to plan ahead and have the conversation about long-term care. By doing so, you can ensure that your loved one will
be provided with the highest quality of care and quality of
life.
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Additional
Resources
The following web sites provide information on long-term care
and other aging issues.
The
American Health Care Association’s Consumer Web Site
This site provides information to consumers including links
to many of the sites mentioned in this article
Administration
on Aging
This site links to associations, conferences, consultants,
managed care companies, nursing facilities, and assisted
living corporations. News sources and publications are also
found here.
Elder
Care Web
This site is a comprehensive place to link to research and
information about eldercare.
Nursing
Home Compare
From the Centers for Medicare and Medicaid Services, a tool
to provide detailed information about the past performance
of every Medicare and Medicaid certified nursing home in
the country.
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