Do you have your own room in a nursing home?

According to a study cited by the Commonwealth Fund, older adults overwhelmingly prefer single rooms over shared ones by a 20-to-1 margin. But the question remains: Do you have your own room in a nursing home? The answer is not always straightforward and depends on several critical factors.

Quick Summary

The ability to secure a private room in a nursing home is determined by a combination of funding sources, medical requirements, and facility availability. While private rooms often come with a higher cost, there are specific circumstances and payment methods that can make them attainable for residents.

Key Points

• Room Availability Varies: The chance of having your own room depends on the specific nursing home and its room inventory.

• Funding is Crucial: Private-pay residents have the best chance at securing a private room, while Medicaid typically only covers shared rooms unless medically necessary.

• Medical Needs are an Exception: Conditions requiring medical isolation or causing severe behavioral issues may qualify a resident for a private room under Medicaid coverage.

• Higher Cost for Private Rooms: Private rooms are significantly more expensive than shared rooms, requiring a different financial approach.

• Consider Privacy vs. Companionship: A private room offers maximum privacy, while a shared room can provide companionship but may also lead to conflicts.

• Advocacy is Key: Families and residents must be proactive, researching facilities and documenting any medical needs to improve the chances of getting a private room.

Private vs. Shared Rooms: An Overview

When considering a nursing home, the living arrangements are a primary concern for many individuals and their families. While most people prefer the privacy and independence of their own room, the reality is that many facilities operate with a mix of private and shared accommodations. The type of room a resident receives can be influenced by their health status, financial resources, and the policies of the specific nursing home.

The Impact of Funding on Your Room Choice

One of the most significant factors determining room type is how care is being paid for. Financial arrangements play a crucial role in the room assignment process, creating different pathways for private and shared rooms.

Private Pay Residents: Those who are paying for their care out-of-pocket, without government assistance, generally have the most flexibility. They can specifically request a private room and, as long as one is available and they can afford the higher rate, their request will typically be granted. For private-pay residents, the room selection process is more like a consumer choice, with facilities often marketing private rooms as a premium option.

Medicaid Residents: For individuals whose care is funded by Medicaid, the options are more limited. Medicaid is designed to cover the cost of a semi-private (shared) room. While it is possible to obtain a private room, it is not a standard benefit. A private room for a Medicaid recipient usually requires one of the following conditions:

• Medical Necessity: A physician must deem a private room medically necessary. This could be due to conditions requiring isolation for infection control or if a resident's behaviors or medical needs would be disruptive or unsafe for a roommate.
• Availability Exception: In some states, if a shared room is not available at the time of admission and only private rooms are open, Medicaid may temporarily cover the private room until a shared option becomes free.

Medicare Residents: Medicare's coverage for skilled nursing facility stays is typically short-term and is also tied to specific conditions. For the limited time Medicare pays for coverage (up to 100 days), it generally covers a semi-private room, and additional costs for a private room are usually the patient's responsibility.

Comparing Private and Shared Room Options

To make an informed decision, it's essential to weigh the advantages and disadvantages of each room type. The ideal choice is often a balance of personal preference, financial capacity, and health needs.

Comparison: Private vs. Shared Rooms

Feature	Private Room	Shared Room
Cost	Significantly higher.	Less expensive, often covered by Medicaid.
Privacy	Maximum privacy and control over personal space.	Limited privacy, shared living and sleeping areas.
Personalization	Freedom to decorate and arrange as desired.	Restricted personalization due to shared space.
Companionship	No built-in roommate; can lead to social isolation for some.	Built-in companion may offer social interaction.
Sleep Quality	Generally better due to fewer disturbances.	Can be affected by roommate's habits (noise, lights).
Health & Safety	Reduced risk of infection transmission.	Higher risk of contagious illness spread.
Family Visits	More comfortable and private for family visits.	Visits may feel less intimate with a roommate present.

How to Increase Your Chances of Getting a Private Room

If a private room is a priority, there are steps you can take to improve your chances of securing one:

1. Research Facilities Thoroughly: Start by identifying nursing homes in your area that offer private rooms and have a good reputation. Inquire about their specific policies and the availability of private accommodations.
2. Plan Ahead Financially: If you are privately paying, ensure your finances are in order. If relying on government benefits, investigate if your state allows for family supplementation, where a family member pays the difference for an upgraded room.
3. Discuss Medical Needs: If there is a medical reason for a private room, have the resident's physician provide written documentation of the medical necessity. This is the primary pathway for Medicaid to cover a private room.
4. Visit and Ask Questions: During facility tours, ask direct questions about room options, costs, and the process for residents to request a room change. Observing the atmosphere and resident-staff interactions is also crucial. For a comprehensive guide on what to look for, consult resources like the National Institute on Aging's guide on choosing a long-term care facility.
5. Be Prepared for a Waitlist: Private rooms, particularly in desirable facilities, are often in high demand. If a private room is not immediately available, you may need to join a waitlist.

The Final Decision

Ultimately, the choice between a private and shared room is a personal one. For some, the companionship of a roommate can be a welcome buffer against loneliness. For others, the peace and privacy of a private room are non-negotiable. Weighing the financial implications against the emotional and physical needs of the resident is a vital step in ensuring the best possible quality of life in their new home. Understanding the rules, exploring all options, and being a vocal advocate for the resident's preferences can make a significant difference in the outcome. For more detailed information on making this critical decision, see How To Choose a Nursing Home or Other Long-Term Care Facility.

Frequently Asked Questions

Does Medicaid pay for a private room in a nursing home?

Generally, no. Medicaid typically only covers a semi-private (shared) room. An exception is made if a private room is deemed medically necessary by a physician for reasons like infection control or a resident's specific behavioral needs.

Can I pay extra for a private room if Medicaid is covering my care?

This depends on state laws. Some states allow for 'family supplementation,' where a family member can pay the difference between the shared and private room cost. However, not all states permit this, so it's essential to check your state's specific Medicaid rules.

What is considered a medical necessity for a private room?

Medical necessity can include needing isolation for a communicable disease, having a compromised immune system, or exhibiting behavior that could harm or significantly disturb a roommate.

What happens if a private room is the only one available?

In some states, if a facility only has private rooms available at the time of admission, Medicaid may cover the cost temporarily until a shared room opens up. This is not the case everywhere and is an exception to the rule.

Are private rooms always better than shared rooms?

Not necessarily. While private rooms offer more privacy and a lower risk of infection, shared rooms can provide valuable companionship and help combat loneliness. The best option depends on the individual resident's personality and needs.

How can I request a room change for myself or a loved one?

You should speak with the facility's administrator or social worker to submit a formal request for a room change. Documenting the reason, whether it's a conflict with a roommate or a medical issue, is crucial. If safety is a concern, the request is often prioritized.

Does a private room guarantee peace and quiet?

While a private room significantly increases quiet time and reduces disturbances, it does not guarantee total silence. Nursing homes are communal living environments with staff checks and other activities that may create noise. However, it eliminates roommate-related disturbances.