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Table of contents
Section 1: Getting started . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Before you get started . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
If you have Medicare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
If you have Medicaid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Section 2: Where to get help . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Administration for Community Living (ACL) . . . . . . . . . . . . . . . . . . . . . . . . 7
Long-Term Care Ombudsman . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
Centers for Independent Living (CILs) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
Centers for Medicare & Medicaid Services (CMS) . . . . . . . . . . . . . . . . . . . . . 8
Beneficiary and Family Centered Care Quality Improvement
Organizations (BFCC-QIOs) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Medicaid Offices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
State Survey Agencies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
Section 3: Choosing the type of care you need . . . . . . . . . . . . . . . . . . . . . . . . . 11
Alternative long-term care choices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Section 4: Steps to choosing a nursing home . . . . . . . . . . . . . . . . . . . . . . . . . . 17
Step 1: Find nursing homes in your area. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
Step 2: Compare the quality of the nursing homes youre considering. . . . 18
Step 3: Visit the nursing homes youre interested in or have someone
visit for you. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
Nursing home checklist . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
Step 4: Choose the nursing home that meets your needs. . . . . . . . . . . . . . . 33
Section5: Paying for nursing home &otherhealthcarecosts . . . . . . . . . . . 37
Personal resources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38
Help from your state (Medicaid) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38
Long-term care insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
Medicare health & prescription drug coverage . . . . . . . . . . . . . . . . . . . . . . . 41
Section 6: Living in the nursing home . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
Care plans . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
Reporting & resolving problems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46
Your resident rights & protections . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47
Section 7: Definitions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53
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Section 1:
Getting started
People go to nursing homes for different reasons, including if
theyre sick, hurt, had surgery and need to get better, or have
chronic care needs or disabilities that require on-going nursing
care. Your Guide to Choosing a Nursing Home or Other
Long-Term Care can help you make informed decisions about
nursing home care, whether youre planning ahead or need to
make an unexpected decision.
Section 2:
Words in blue
are defined on
pages 5356.
Medicaid offices
Medicaid offices are state agencies that are in charge of the
states Medicaid Program. Your local Medicaid office can give
you information about Medicaid eligibility and covered benefits,
including coverage for institutional (nursing home) and homeand community-based long-term care services. This information
may also be available from other entities in the state, including
the state health insurance exchange and providers like hospitals
or federally qualified health centers. Visit Medicaid.gov to get
the phone number for your local Medicaid office.
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Words in blue
are defined on
pages 5356.
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Section 3:
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Words in blue
are defined on
pages 5356.
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If you qualify for hospice care and choose to get the hospice
benefit, hospice services may include physical care, counseling,
drugs, equipment, and supplies for the terminal illness and
related condition(s). As part of hospice care, youll have a
specially trained team of professionals and caregivers to provide
care, including taking care of your physical, emotional, social,
and spiritual needs.
The hospice benefit allows you and your family to stay together
in the comfort of your home unless you need care in an inpatient
facility. Some long-term care facilities and nursing homes offer
hospice services from outside providers. If the hospice team
determines that you need inpatient care, they will make the
arrangements for your stay. Many nursing homes and residential
care facilities also have contracts with hospice providers.
Words in blue
are defined on
pages 5356.
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Words in blue
are defined on
pages 5356.
Respite care: Some nursing homes, residential care facilities, and hospice
care facilities provide respite care. You may also get respite care in your
home. Respite care is short-term assistance so your primary caregiver
can rest. Medicare covers inpatient respite care for up to 5 days if youre
getting covered hospice care services. Medicare covers room and board
for inpatient respite care and during short-term hospital stays. Ifyoure
eligible, Medicaid will pay for some of these services at home that arent
covered by Medicare.
For more information on Medicares coverage of respite care and who
qualifies, visit Medicare.gov.
Programs of All-inclusive Care for the Elderly (PACE): PACE is a
Medicare and Medicaid program offered in many states that allows people
who otherwise need a nursing home-level of care to stay in the community.
To qualify for PACE, you must meet these conditions:
Youre 55 or older.
You live in the service area of a PACE organization.
Your state certifies that you need a nursing home-level of care.
At the time you join, youre able to live safely in the community with the
help of PACE services.
To find out if youre eligible and if theres a PACE site near you, visit
pace4you.org or Medicaid.gov, or you can call your local Medicaid office.
Seepage 38.
Home- and community-based waiver programs: If youre already
eligible for Medicaid (or, in some states, would be specifically eligible
for Medicaid coverage for nursing home services), you may be able to
get help with the costs of some home- and community-based services,
like homemaker services, personal care, and respite care. States have
home- and community-based waiver programs to help people keep their
independence while getting the care they need outside of an inpatient
facility.
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Section 4:
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Words in blue
are defined on
pages 5356.
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Staffing
Is there enough staff to give me the care I need?
Will I have the same staff people take care of me day to day or do they
change?
Does the nursing home post information about the number of nursing
staff, including Certified Nursing Assistants (CNAs)? Are they willing
to show me if I ask to see it? (Note: Nursing homes are required to post
this information.)
How many residents is a CNA assigned to work with during each shift
(day and night) and during meals?
What type of therapy is available at this facility? Are therapy staff
available?
Is there a social worker available? Can I meet him or her?
(Note: Nursing homes must provide medically related social services,
but if the nursing home has less than 120 beds, it doesnt have to have a
full-time social worker on staff.)
Religious & cultural preference
Does the nursing home offer the religious or cultural support I need?
Ifnot, what type of arrangements will they provide to meet my needs?
Do they provide special diet options that my faith practice may
require?
Food & dining
Does the nursing home have food service that I would be happy with?
Does the nursing home provide a pleasant dining experience?
Does the staff help residents eat and drink at mealtimes if help is
needed?
What types of meals does the nursing home serve? (Note: Ask the
nursing home if you can see a menu.)
Can I get food and drinks I like at any time? What if I dont like the
food thats served?
Do residents have a choice of food items at each meal? Are there
options and substitutes available if I dont like a particular meal?
Can the nursing home provide for my dietary needs?
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Hospitals
Does the nursing home have an arrangement with a nearby hospital
for emergencies?
Can my doctor care for me at that hospital?
Licensing
Are the nursing home and current administrator licensed in my
state?
Note: This means nursing homes have met certain standards set by
a state or local government agency.
Certification (certified)
Is the nursing home Medicare- and/or Medicaid-certified?
Note: Certified means the nursing home meets Medicare and/or
Medicaid regulations and the nursing home has passed and
continues to pass an inspection survey done by the State Survey
Agency. If theyre certified, make sure they havent recently lost
their certification or are about to lose their certification. Also, some
nursing homes may only have a certain distinct part of their
building certified for Medicare or Medicaid residents.
Services
What services does the nursing home provide? Does the nursing
home have the services I need?
Charges & fees
Will the nursing home tell me in writing about their services,
charges, and fees before I move into the home?
Note: Medicare- and/or Medicaid-certified nursing homes must
tell you this information in writing. Get a copy of the fee schedule
to find out which services are available, which are included in your
monthly fee, and which services cost extra. Then, compare nursing
home costs.
Is there a basic fee for room, meals, and personal care?
Are there extra charges for other services, like beauty shop services?
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Basic information
Yes
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Notes
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When you have all the information about the nursing homes
youre interested in, talk with people who understand your
personal and health care needs. This might include your family,
friends, doctor, clergy, spiritual advisor, hospital discharge
planner, or social worker.
What if more than one nursing home meets my needs?
If you find more than one nursing home you like with a bed
available, use the information you got to compare them. Trust
your senses. If you dont like what you saw on a visit (for example,
if the facility wasnt clean or you werent comfortable talking with
the nursing home staff), you may want to choose another nursing
home. If you felt that the residents were treated well, the facility
was clean, and the staff was helpful, you might feel better about
choosing that nursing home.
What if Im helping someone make a decision?
If youre helping someone, keep the person youre helping
involved in making the decision as much as possible. Peoplewho
are involved from the beginning are better prepared when they
move into a nursing home. If the person youre helping isnt
alert or able to communicate well, keep his or her values and
preferences in mind.
What if I dont like a nursing home?
If you visit a nursing home that you dont like, look at other
options, if available. Quality care is important. If youre in a
hospital, talk to the hospital discharge planner or your doctor
before you decide not to go to a nursing home that has an
available bed. They may be able to help you find a more suitable
nursing home or arrange for other care, like short-term home
care, until a bed is available at another nursing home you choose.
However, you may be responsible for paying the bill for any
additional days you stay in the hospital.
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Words in blue
are defined on
pages 5356.
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Section5:
Personal resources
You can use your personal money and savings to pay for nursing home
care. Some insurance companies let you use your life insurance policy
to pay for long-term care. Ask your insurance agent how this works.
Important: Be sure to get help before using either of these options.
There are important issues you need to understand.
Words in blue
are defined on
pages 5356.
Medicaid is a joint federal and state program that helps with medical
costs for some people with limited income and resources. Mosthealth
care costs are covered if you qualify for both Medicare and Medicaid.
Most, but not all, nursing homes accept Medicaid payment. Evenif
you pay out-of-pocket or with long-term care insurance, you
eventually may spend down your assets while youre at the nursing
home, so its good to know whether the home will accept Medicaid.
Check with the nursing home to see if they accept people with
Medicaid. Medicaid programs vary state to state. Most often, eligibility
is based on your income and personal resources. Many states have
higher Medicaid income limits for nursing home residents. You may
be eligible for Medicaid coverage in a nursing home even if you havent
qualified for other Medicaid services in the past.
Sometimes you wont be eligible for Medicaid until youve spent
some of your personal resources on health care. Generally, even if
youre eligible for Medicaid, all of your income (except for a monthly
personal needs allowance and amounts considered necessary to
support your spouse and family living in the community) will go to
pay your nursing home expenses and Medicaid will cover the rest.
Toget more information on Medicaid eligibility in your state, call
your local Medicaid office. Seepage 9.
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This type of private insurance policy can help pay for many types
of long-term care, including both skilled and nonskilled care.
Long-term care insurance can vary widely. Somepolicies may
cover only nursing home care, while others may include coverage
for a whole range of services, like adult day care, assisted living,
medical equipment, and informal home care.
If you have long-term care insurance, check your policy or call
the insurance company to find out if the care you need is covered.
If youre shopping for long-term care insurance, find out which
types of long-term care services and facilities the different policies
cover. Also, check to see if your coverage could be limited because
of a pre-existing condition. Make sure you buy from a reliable
company thats licensed in your state.
Federal employees, members of the uniformed services, retirees,
their spouses, and other qualified relatives may be able to buy
long-term care insurance at discounted group rates. Formore
information about long-term care insurance for federal
employees, visit opm.gov/insure/ltc.
Medicare
Medicare is the federal health insurance program for people
who are 65 or older, certain younger people with disabilities, and
people with End-Stage Renal Disease (permanent kidney failure
requiring dialysis or a transplant, sometimes called ESRD).
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Section 6:
The nursing home staff will get your health information and review
your health condition to prepare your care plan. You (if youre able),
your family (with your permission), or someone acting on your
behalf has the right to take part in planning your care with the
nursing home staff.
Your care plan is very important. A good care plan can help make
sure that youre getting the care you need, help the nursing home
understand your personal goals and wishes, and help make your stay
better. Your health assessment (a review of your health condition)
starts the day youre admitted. A comprehensive assessment must be
completed within 14 days of admission. You should expect to get a
health assessment at least every 90 days after your first review and
possibly more often if your medical status changes.
The nursing home staff will assess your condition regularly to see
if your health status has changed. Theyll adjust your care plan as
needed. Nursing homes are required to submit this information
to the federal government. This information is used for quality
measures, nursing home payment, and state inspections.
Depending on your needs, your care plan may include:
What kind of personal or health care services you need
What type of staff should give you these services
How often you need the services
What kind of equipment or supplies you need (like a wheelchair
orfeeding tube)
What kind of diet you need (if you need a special one) and your
food preferences
Your health and personal goals
How your care plan will help you reach your goals
Information on whether you plan to return to the community, and
if so, a plan to help you meet that goal
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Words in blue
are defined on
pages 5356.
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Section 7:
Definitions
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Definitions
Hospice: A
special way of caring for people who are terminally
ill. Hospice care involves a team-oriented approach that addresses
the medical, physical, social, emotional, and spiritual needs of the
patient. Hospice also provides support to the patients family or
caregiver.
Long-term care: S ervices that include medical and non-medical
care provided to people who are unable to perform basic activities
of daily living like dressing or bathing. Long-term supports and
services can be provided at home, in the community, in assisted
living, or in nursing homes. Individuals may need long-term
supports and services at any age. Medicare and most health
insurance plans dont pay for long-term care.
Long-Term Care Ombudsman: An independent advocate
(supporter) for nursing home and assisted living facility residents
who works to solve problems between residents and nursing
homes or assisted living facilities. They may be able to provide
information about home health agencies in their area.
Medicaid: A
joint federal and state program that helps with
medical costs for some people with limited income and resources.
Medicaid programs vary from state to state, but most health care
costs are covered if you qualify for both Medicare and Medicaid.
Medicare: The federal health insurance program for people who
are 65 or older, certain younger people with disabilities, and
people with End-Stage Renal Disease (permanent kidney failure
requiring dialysis or a transplant, sometimes called ESRD).
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Definitions
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Definitions
Programs of All-Inclusive Care for the Elderly (PACE): A
special type of health plan that provides all the care and services
covered by Medicare and Medicaid as well as additional medically
necessary care and services based on your needs as determined
by an interdisciplinary team. PACE serves frail older adults
who need nursing home services but are capable of living in the
community. PACE combines medical, social, and long-term care
services and prescription drug coverage.
Respite care: Temporary care provided in a nursing home,
hospice inpatient facility, or hospital so that a family member or
friend who is the patients caregiver can rest or take some time off.
State Health Insurance Assistance Program (SHIP): A state
program that gets money from the federal government to give free
local health insurance counseling to people with Medicare.
Skilled nursing facility (SNF): A
nursing facility with the staff
and equipment to give skilled nursing care and, in most cases,
skilled rehabilitative services and other related health services.
Skilled nursing facility (SNF) care: S killed nursing care and
rehabilitation services provided on a continuous, daily basis, in a
skilled nursing facility.
State Survey Agency: A state agency that oversees health care
facilities that participate in the Medicare and/or Medicaid
programs. The State Survey Agency inspects health care facilities
and investigates complaints to ensure that health and safety
standards are met.
TTY: A
TTY (teletypewriter) is a communication device used
by people who are deaf, hard-of-hearing, or have severe speech
impairment. People who dont have a TTY can communicate with
a TTY user through a message relay center (MRC). An MRC has
TTY operators available to send and interpret TTY messages.
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Notes