Understanding the Nursing Home Admission Process
Admitting a loved one into a nursing home is a significant decision, often following a medical crisis or a decline in health that necessitates a higher level of care. The process is not a simple transaction but a multi-step journey that involves medical assessments, financial planning, and extensive paperwork. It can feel overwhelming, but breaking it down into manageable steps makes the path clearer for families and caregivers.
Step 1: Initial Assessment and Determining Medical Necessity
The first and most crucial step is a medical evaluation to determine if a nursing home level of care is truly required. Unlike assisted living, which supports daily activities, a nursing home provides 24/7 skilled medical care and supervision.
- Physician's Order: A doctor, often a hospital physician or the resident's primary care doctor, must officially order admission to a skilled nursing facility, certifying that long-term, skilled care is medically necessary.
- Functional Assessment: The evaluation considers the individual's ability to perform activities of daily living (ADLs) such as bathing, dressing, and eating, as well as instrumental activities of daily living (IADLs) like managing medications.
- Cognitive and Behavioral Evaluation: For individuals with dementia or other cognitive impairments, an assessment of their cognitive state and potential behavioral issues is performed to ensure the facility can provide appropriate care.
Step 2: Financial Planning and Eligibility
Financing nursing home care is a major consideration, as it can be very costly. Understanding the payment options and eligibility requirements is essential before admission.
- Medicare: Medicare generally covers only short-term, post-acute skilled nursing stays for up to 100 days following a qualifying hospital stay. It does not cover long-term custodial care.
- Medicaid: This government program covers long-term nursing home care for individuals with limited income and resources, but strict financial eligibility requirements and “spend-down” rules apply. A facility must be Medicaid-certified to accept this form of payment.
- Private Pay: Using personal savings, retirement funds, or selling assets (like a home) is a common way to pay, especially until a person becomes financially eligible for Medicaid.
- Long-Term Care Insurance: If a policy was purchased before a health crisis, it can help cover costs. However, new policies are rarely sold to those already needing care.
Step 3: Finding and Choosing a Nursing Home
With a medical need and a financial plan in place, the next step is to find the right facility. This requires careful research and due diligence.
- Online Resources: Tools like Medicare's Care Compare offer valuable information on health inspections, staffing, and quality measures for certified facilities.
- Facility Visits: Personal visits are crucial. Observe the atmosphere, cleanliness, and staff-to-resident interactions. Ask to see various areas, not just the lobby.
- Proximity: For a loved one's well-being, choosing a nursing home close to family and friends is often beneficial, as frequent visits can lead to better outcomes.
Step 4: The Admission and Paperwork Process
Once a facility is chosen, the administrative phase of admission begins. Whether coming from a hospital or the community, extensive paperwork is required.
- From the Hospital: A hospital discharge planner is a key resource who coordinates the transfer and ensures all necessary medical records and physician's orders are passed to the nursing home.
- From the Community: Families must work with the resident's primary care physician to gather all medical histories, orders, and recent test results.
- Required Documents: A comprehensive set of documents will be needed, including:
- Physician's order for admission and treatment
- Medical history and physical exam results
- List of current medications and dosages
- Negative tuberculosis (TB) test or chest X-ray
- Power of Attorney (POA) and/or advance directives
- Financial paperwork (insurance cards, Social Security details, etc.)
Comparison of Hospital vs. Community Admission
| Feature | Hospital-to-Nursing-Home Admission | Community-to-Nursing-Home Admission |
|---|---|---|
| Initiator | Hospital discharge planner and medical team | Family, caregiver, or resident with assistance from physician |
| Timeline | Often expedited due to medical necessity | Typically slower, involves more upfront research and planning |
| Assessments | Part of the hospital stay; information transferred internally | Arranged through the resident's primary care doctor |
| Funding Entry | Often begins with Medicare coverage for short-term rehab | Usually starts as private pay, with a transition to Medicaid if assets are depleted |
Step 5: Pre-Admission Screening and Resident Review (PASARR)
Federal law requires that nursing homes perform a PASARR screening for all new residents to check for signs of mental illness or intellectual disabilities. If identified, a more detailed evaluation determines if specialized services outside of a standard nursing home are necessary.
Conclusion
Admitting a loved one to a nursing home is a significant undertaking that requires careful planning and research. By understanding the medical, financial, and procedural steps involved, families can navigate the process more confidently and ensure their loved one receives the highest possible quality of care. Leveraging resources like discharge planners and online comparison tools is key to a smooth transition. Remember to visit facilities in person and speak with staff and residents to get a true sense of the living environment. The best outcomes are achieved through diligence, advocacy, and informed decision-making.
For more detailed information on comparing facilities and their quality ratings, visit the Medicare Care Compare website.
