Long-Term Care: Choosing the Right Place : Part 2

by National Institute on Aging

(Page 2 of 2)

Is the person in need of long-term care a military veteran? They might be able to get help through the Department of Veterans Affairs programs. You can check by going to www.va.gov, calling the VA Health Care Benefits number, 1-877-222-8387, or contacting the VA medical center nearest you.

Call. Once you have a list of possible places, get in touch with each one. Ask basic questions about openings and waiting lists, number of residents, costs and methods of payment, and their link to Medicare and Medicaid. Take a few minutes to think about what's important to you or your relative, such as transportation, meals, activities, connection to a certain religion, or special units for Alzheimer's disease.

Visit. Make plans to meet with the director of nursing and director of social services. Medicare offers a nursing home checklist to use when visiting (see Help in Planning). Some of the things to look for include certification for Medicare and Medicaid, handicap access, no strong odors (either bad or good ones), contact between staff and current residents, volunteers, and the appearance of residents. If the nursing home is a member of the Joint Committee on Accreditation of Healthcare Organizations, ask to see that group's review of the home. Ask yourself if you would feel reassured leaving your loved one there.

Visit again. Make a second visit without an appointment, maybe on another day of the week or time of day, so you will meet other staff members. See if your first thoughts are still the same.

Understand. Once you or your relative have made a choice, be sure to understand the facility's contract and payment plan. If you don't understand it, you could have a lawyer look them over before signing.

How to pay

There are several ways to pay for nursing facility care for people over age 65. They are: Medicare, Private pay, Medicaid, Long-term care insurance.

Let's see what happened after Alice left the hospital. She went directly to a skilled nursing facility. It had a rehabilitation unit where she began to receive physical therapy. Medicare covered most of her costs for the first few weeks as she got better. Then she had a stroke which left her unable to move her left arm and leg. While she was in the hospital for the stroke, her doctors decided Alice should probably not return home. She no longer qualified for Medicare to pay for her nursing home care.

Many people believe that Medicare will pay for long stays in a nursing home, but it doesn't. The Federal Medicare program and private "Medigap" (Medicare supplemental) insurance only cover short times of home health or nursing home care. They pay for a short stay in a nursing home for someone who is getting better after leaving the hospital, but still needs nursing care and therapy.

Alice's husband started to pay for her care on his own, but they didn't have a lot of savings. When they had used most of their savings, her husband arranged for her to apply for Medicaid. The good news about Medicaid is that her husband did not have to sell their home for her to qualify for this support.

Many people start paying for long-term care with their own money (private pay). Later they may become eligible for state-run Medicaid. Each state decides who qualifies for this program. Contact your state government to learn more. Keep in mind that applying for Medicaid takes at least 3 months.

Alice's children are now looking into buying long-term care insurance for themselves. They don't want to have the same worries if they need nursing care when they are older.

Long-term care insurance is a private insurance policy you can buy years before you think you might need it. Each policy is different. Your state's insurance commission can tell you more about private long-term care policies. They can also offer tips on how to buy long-term care insurance. These agencies are listed in your telephone book, under "Government."

Help in planning

Planning for long-term care is not easy. People's needs change over time. So do the rules about programs and benefits. What someone qualifies for may change from one year to the next. There is some help. The following resources are online. If you or your relative don't have a computer, there may be one at your local library or senior center.

Care Planner from Medicare is online at www.careplanner.org. It has details about different care options. You can answer questions online about needs and resources to get a list of suggested services, as well as helpful resources.

Medicare has two resources on its website, www.medicare.gov, which may be useful. First, Nursing Home Compare helps you learn more about nursing homes you may be interested in. They also have a Nursing Home Checklist with tips to use when visiting homes. Second, many states have State Health Insurance Counseling and Assistance Programs (SHIPS). These programs can help you choose the health care plan that is right for you and your family.

Making a smooth transition

Moving to a care facility can be a big change for the whole family. Some facilities or community groups have a social worker who can help you prepare for the change. Allow some time to adjust after the move has taken place.

Regular visits by family and friends can make this move easier. This reassures and comforts the person getting used to a new place. Visits are good, too, for keeping an eye on the care that is being given. They also help family to develop a good relationship with the staff caring for their loved one.

About the Author

www.nia.nih.gov
NIA, one of the 27 Institutes and Centers of NIH, leads a broad scientific effort to understand the nature of aging and to extend the healthy, active years of life. In 1974, Congress granted authority to form NIA to provide leadership in aging research, training, health information dissemination, and other programs relevant to aging and older people.