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How to choose a nursing home

Skilled nursing facility - nursing home; Long-term care - nursing home; Short-term care - nursing home

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At some point, you or a loved one may need the services of a nursing home. A nursing home, also called a skilled nursing facility, provides around-the-clock medical care to people recovering from an illness or injury and to those who can no longer care for themselves.

When choosing a nursing home, you want to be sure you find a place that meets your needs and provides quality care. Here are things to consider when deciding.

Information

At a nursing home, skilled staff and health care providers offer around-the-clock care. Nursing homes can provide a number of different services:

• Routine medical care
• 24-hour supervision
• Nursing care
• Doctor visits
• Help with everyday activities, such as bathing and grooming
• Physical, occupational, and speech therapy
• All meals

Nursing homes provide both short-term and long-term care, depending on the needs of the resident.

• You may need short-term care during recovery from a serious illness or injury following a hospitalization. Once you recover, you can go home.
• You may need long-term daily care if you have an ongoing mental or physical condition and can no longer care for yourself.

The type of care you need will be a factor in what facility you choose, as well as how you pay for that care.

THINGS TO CONSIDER WHEN CHOOSING A FACILITY

When you start looking for a nursing home:

• Work with your social worker or discharge planner from the hospital and ask about the kind of care needed. Ask what facilities they recommend.
• You can also ask your health care providers, friends, and family, for recommendations.
• Make a list of all the nursing homes in or near your area that meet your or your loved one's needs.

It's important to do a bit of homework - not all facilities provide the same quality care. Start by looking up facilities on Medicare.gov Nursing Home Compare -- www.medicare.gov/nursinghomecompare/search.html. This allows you to see and compare Medicare- and Medicaid-certified nursing homes based on certain quality measures:

• Health inspections
• Fire safety inspections
• Staffing
• Quality of resident care
• Penalties (if any)

If you can't find a nursing home listed in the website, check to see if it is Medicare/Medicaid certified. Facilities with this certification must meet certain quality standards. If a facility is not certified, you should probably take it off your list.

Once you've chosen a few facilities to check out, call each facility and check:

• If they are taking new patients. Can you get a single room, or will you need to share a room? Single rooms may cost more.
• The level of care offered. If needed, ask if they offer specialized care, such as stroke rehabilitation or care for dementia patients.
• Whether they accept Medicare and Medicaid.

Once you have a list of facilities that meet your needs, make an appointment to visit each one or ask someone you trust to make the visits. Here are some things to consider during your visit.

• If possible, the nursing home should be close by so that family members can visit regularly. It's also easier to keep an eye on the level of care being given.
• What is the security like for the building? Ask about visiting hours and any restrictions on visits.
• Talk with the staff and observe how they treat residents. Are the interactions friendly, polite, and respectful? Do they call residents by their name?
• Is there a licensed nursing staff available 24-hours a day? Is a registered nurse available at least 8 hours every day? What happens if a doctor is needed?
• Is there someone on staff to help with social service needs?
• Do the residents appear clean, well-groomed, and comfortably dressed?
• Is the environment well-lit, clean, attractive, and at a comfortable temperature? Are there strong unpleasant smells? Is it very noisy in the dining and common areas?
• Ask about how staff members are hired - are there background checks? Are staff members assigned to specific residents? What is the ratio of staff to residents?
• Ask about the food and meal schedule. Are there choices for meals? Can they accommodate special diets? Ask if the staff helps residents with eating if needed. Do they make sure the residents are drinking enough fluids? How is this measured?
• What are the rooms like? Can a resident bring in personal belongings or furniture? How secure are personal belongings?
• Are there activities available for residents?

Medicare.gov offers a helpful Nursing Home Checklist you may want to take with you as you check out different facilities: www.medicare.gov/NursingHomeCompare/checklist.pdf.

Try to visit again at a different time of day and week. This can help you get a fuller picture of each facility.

PAYING FOR NURSING HOME CARE

Nursing home care is expensive, and most health insurance won't cover the full cost. Often people cover the cost using a combination of self-payment, Medicare, and Medicaid.

• If you have Medicare, it may pay for short-term care in a nursing home after a 3-day hospitalization. It does not cover long-term care.
• Medicaid does pay for nursing home care, and many people in nursing homes are on Medicaid. However, you have to be eligible based on your income. Often people start by paying out of pocket. Once they spend down their savings they can apply for Medicaid - even if they've never been on it before. However, spouses are protected against losing their home to pay for a partner's nursing home care.
• Long-term care insurance, if you have it, may pay for short- or long-term care. There are many different types of long-term insurance; some only pay for nursing home care and others pay for a range of services. You may not be able to get this type of insurance if you have a pre-existing condition.

It's a good idea to get legal advice when considering how to pay for nursing care - especially before spending all of your savings. Your local Area Agency on Aging may be able to direct you to legal resources. You can also visit LongTermCare.gov for more information.

References

Centers for Medicare and Medicaid Services website. Nursing home toolkit: nursing homes - A guide for Medicaid beneficiaries' families and helpers. www.cms.gov/Medicare-Medicaid-Coordination/Fraud-Prevention/Medicaid-Integrity-Education/Downloads/nursinghome-beneficiary-booklet.pdf. Updated November 2015. Accessed August 8, 2022.

Centers for Medicare and Medicaid Services website. Your guide to choosing a nursing home or other long-term services and supports. www.medicare.gov/Pubs/pdf/02174-Nursing-Home-Other-Long-Term-Services.pdf. Updated October 2019. Accessed August 8, 2022.

Medicare.gov website. Nursing home compare. www.medicare.gov/nursinghomecompare/search.html. Accessed August 8, 2022.

National Institute on Aging website. Choosing a nursing home. www.nia.nih.gov/health/how-choose-nursing-home. Updated May 1, 2017. Accessed August 8, 2022.

National Institute on Aging website. Residential facilities, assisted living, and nursing homes. www.nia.nih.gov/health/residential-facilities-assisted-living-and-nursing-homes. Updated May 1, 2017. Accessed August 8, 2022.

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Review Date: 4/17/2022  

Reviewed By: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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