Seeking nursing home placement can be very difficult for the family and the individual who is going to be placed. Important questions one should ask when speaking with the admissions director include what type of payer sources the facility accepts. In Carroll, Douglas, and Haralson counties, most nursing facilities accept Medicare, Medicaid, Private Insurance, and private pay. In order to be eligible for nursing home Medicare benefits the recipient of Medicare must have a three-day qualifying stay in the hospital. This means the individual must be admitted to the hospital for a three-night stay, this does not include being held in observation. During the three days stay the attending physician will determine if the patient requires further assistance. The hospital social worker will send referrals to nursing homes within a 50-mile radius of the patient’s address. The family has the opportunity to schedule visits to the nursing facility for a tour and ask questions. In most facilities, the admissions director, or social service director will provide a tour and answer questions.
Upon this visit, one should inquire if the facility is skilled nursing. Skilled nursing offers rehabilitation services such as physical, occupational, and speech therapy. Then ask who is the R.N./L.P.N./C.N.A patient ratio, how many deficiency free surveys the skilled nursing facility has had in the past five years? If the facility had deficiencies what were they and how were the corrected.
Does the skilled nursing facility offer activities, what type of dietary services are offered. One should also inquire about bath schedule, wound care, podiatrist, psychological and dental services.
By the end of the tour, you should have gained enough insight into the skilled nursing facility to feel comfortable enough to have your loved one placed. Speak with the admissions director about the payer source, if your loved one has Medicare ensure it is traditional Medicare which will cover 20 days at 100% on the 21st day there will be a co-pay.
If the patient has a co-insurance such as AARP this will cover the co-pay in most cases. If the patient has Medicaid and requires a skilled nursing stay over 30 days the business office will assist in changing the Community Medicaid to nursing home Medicaid to cover room and board, medications, meals, and assistance with ADL’s. If the patient has private insurance the admissions director or business office manager can contact the insurance company and verify benefits and will be able to give an estimate of the out of pocket expense.
If short-term rehabilitation turns into long-term care the business office manager should assist in completing a Medicaid application. He or she will give a list of items needed to process the application which includes checking and savings bank statements for three months, life insurance policies, and other sources of income.
Asking the right questions during the tour can be imperative, you are placing your loved one into the hands of skilled caregivers and want to ensure the best possible care.