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Nursing Home Admissions

Washington D.C. Nursing Home Admissions Attorneys

Choosing the Right Nursing Home

Although it is difficult to think about, there may come a time when you or a loved one will need to enter a nursing home. Sometimes the decision is made in a time of crisis, such as when a loved one must be transferred from a hospital into a nursing home. Do you know you and your family's priorities for a nursing home? Have you figured out how you will finance the nursing home care? There are many issues to think about in order to ensure the best fit for your family.

An experienced Elder Law attorney can guide you through the process of selecting a nursing home, financing nursing home care, and a variety of other long-term care issues. Contact the Elder & Disability Law Center for a consultation regarding nursing home admissions and residents' rights.

Items to Consider When Choosing a Nursing Home

The following list is useful for determining what really matters to you and your family when you are choosing a nursing home:

  • Location of the nursing home (proximity to your home, other services, etc.)
  • Size of facility
  • Facility's ratings
  • Cost
  • Individualized care
  • Quality of care
  • Interior design
  • Grounds
  • Friendliness of staff
  • Variety of services provided
  • Activities offered and how residents spend their time daily
  • Wait list for admission
  • The possibility of Hospice

A Geriatric Care Manager Can Be a Useful Tool

While you and your family can go through the process of choosing a nursing home yourselves, you may find it more helpful, and less time-consuming, to use a Geriatric Care Manager (GCM) to help with your search. A GCM can help you and your family sort out what really matters to you when it comes to choosing a nursing home. GCM's are professionals who help families determine the best plan of action for their loved one's long-term care. A GCM can be vital in helping you narrow down your choice of nursing home and assisting you through the application process.

Before visiting a nursing home, the GCM should perform a resident assessment to evaluate your family member and to determine the level of care they require. There are many types of senior living facilities. Your loved one may not need to be in a nursing home right away. You and the GCM can work together to make sure the proper type of care is sought for the loved one. In addition to consulting with the GCM, you may also want to consult the prospective resident's physician for his/her thoughts on the type of care that is needed.

The Financial Aspect of Entering a Nursing Home

After that, look at how you will be financing the care, and whether or not you will need a nursing home that is Medicare or Medicaid certified. A nursing home's basic monthly charge will usually cover room and meals, housekeeping, linens, general nursing care, medical records services, recreation, personal care, and similar services that are provided equally to all residents. Extra charges in most nursing homes include:

  • Physician's services, including the work of specialists like dentists, ophthalmologists, podiatrists, etc.
  • Drugs and medications
  • Physical therapy
  • Diagnostic services, such as laboratory work, x-rays, electrocardiograms, etc.
  • Personal services, such as telephone calls, personal laundry, beauticians and barbers. Medicare and Medicaid may cover some of these extra charges. Private pay residents may be billed either once for the length of the resident's stay, as a flat charge each month, or each time a service or material is provided

The cost depends on the amount and type of care that is required. In 2007, in the D.C. Metropolitan area, the average cost for nursing home care ranged from $90,000-$160,000 per year.

Once you have narrowed down your choices, schedule a visit so that you and your family can personally observe the conditions of the nursing home. Take a nursing home checklist with you to take notes on what you see to help you determine if it is the best nursing home for your needs. Your GCM can also come to the nursing home with you to assist in your selection.

After visiting and touring the facility to make your own assessment, it may be a good idea to visit again, without an appointment, to observe if the facility operates any differently when the staff is not expecting guests. You may also want to look at the federal government's nursing home comparison at www.medicare.gov to compare the ratings of various nursing homes in your area.

Once you have selected a nursing home, you will need to apply for admission. There are many issues to consider as you navigate nursing home procedures. The GCM and an experienced Elder Law lawyer can help you determine which options are best for your family.

The Application Process

In order to apply to a nursing home, you will need to obtain the applications for the nursing homes that interest you. If you are hospitalized and need to transfer to a nursing home, the hospital social worker or discharge planner can help you. One of the first things you need to consider is whether you will pay for your nursing home care yourself or whether you will be utilizing Medicaid. A nursing home can ask you on its application how you plan to pay for the nursing home care. However, the nursing home cannot ask for financial information to show that you are not eligible for Medicaid.

Ask the nursing home for a copy of their admission policies so that you know the procedures and if particular applicants have preference. For example, applicants for short-term rehabilitation or applicants who already have a spouse in the nursing home may be given higher priority on the waiting list. Also, applicants paying via Medicaid may have lower priority than those who private pay, particularly if the nursing home has a set number of Medicaid beds. An ideal plan would be to privately pay a minimum of three months of your nursing home care, and possibly up to a year, to ensure that you can obtain admission to the nursing home of your choice, and also to assist with techniques for your Medicaid eligibility plan.

Once your application is received by the nursing home, your name may be placed on a waiting list. You, your representative or your GCM can periodically ask the nursing home where you are on the waiting list.

All Nursing Home Contracts Are Negotiable

Once you are admitted to a nursing home, you will sign an admissions contract. This may be an emotional time, however, it is important to remember that you are signing a legal and binding contract. You want the contract to ensure that you or your loved one will receive the best care possible. Because of these concerns, it is a good idea to have an Elder Law attorney review the contract with you. In addition, if there are problems with the contract or simply details that you want dealt with before signing the contract, an attorney can act as an advocate for you with the nursing home.

Before you sign the contract, ask the nursing home about any language that you find confusing. Make sure you understand your discharge rights, confidentiality rights, and grievance rights. If you make any changes to the language of the contract, make sure that both you and a representative of the nursing home initial the change.

The prospective resident is the only person who should be signing the nursing home contract, unless the court has appointed a legal guardian for him/her or he/she has a durable power of attorney. A family member or a friend should only sign the contract if he/she voluntarily agrees to be liable for the nursing home expenses. Be sure that no one is labeled the "responsible party" or "guarantor" unless he/she plans to be liable for the nursing home expenses.

Although deciding to enter a nursing home or placing a loved one in a nursing home is difficult, it is important to remember that you must insist on a high quality of care. The responsibility for advocating for quality care for your loved one continues even after the admissions process is complete.

An experienced Elder Law attorney can help you through the admissions process and, if necessary, advocate for the best nursing home care for you or your loved one. Contact the Elder & Disability Law Center for a consultation.