Understanding the Need for Skilled Nursing Care
Before initiating the admissions process, it is vital to confirm that skilled nursing care is the appropriate level of care needed. Skilled nursing facilities (SNFs) offer 24-hour medical supervision, which is different from the custodial care provided in assisted living communities.
Determining Eligibility
Eligibility for a nursing home is determined by a comprehensive assessment of the individual's needs. The criteria generally include:
- Physical Abilities and Functional Decline: An inability to perform most Activities of Daily Living (ADLs) such as bathing, dressing, and eating without significant assistance.
- Medical Needs: The requirement for frequent medical services like intravenous injections, wound care, or catheter management.
- Cognitive Status: Significant cognitive decline, such as that associated with dementia, which makes independent living unsafe.
- Behavioral Issues: Unsafe behaviors like wandering, aggression, or impulse control issues that cannot be managed in a less restrictive setting.
The Admissions Process: A Step-by-Step Walkthrough
The process of admitting a loved one into a nursing home follows a structured path. While procedures can vary by state and facility, the following steps are universal.
Step 1: Secure a Physician's Medical Order
Admittance to a nursing home requires a medical professional to certify that the individual needs skilled nursing care. This is often the primary care physician or a hospital doctor if the patient is being discharged. The medical order will confirm the long-term skilled care requirement and include orders for medication and treatment.
Step 2: Research and Select a Facility
Once the medical need is established, the search for a suitable facility begins. Considerations should include location, cost, specializations (e.g., memory care), and overall quality. Resources for your search include:
- Eldercare Locator: A public service that connects families with local resources.
- Medicare's Care Compare tool: Allows you to find and compare certified nursing homes in your area and view quality ratings.
- Area Agency on Aging (AAA): Local nonprofit agencies offering information and support for seniors.
Step 3: Complete Financial Assessment and Paperwork
Nursing home care can be expensive, so a financial plan is essential. Facilities require full financial disclosure to determine how care will be paid for. Common payment methods include:
- Private Pay: Using personal savings, investments, or long-term care insurance.
- Medicare: Covers short-term, skilled nursing care for up to 100 days under specific conditions, typically following a qualifying hospital stay.
- Medicaid: A federal and state program for those with low income and limited resources. Eligibility and application processes vary by state.
- Veterans' Benefits: The VA offers benefits for eligible veterans and their families to cover nursing home costs.
Step 4: Gather All Required Documents
The admissions team will require a significant amount of documentation. Creating a folder with all necessary records can streamline the process. Documents typically needed include:
- Physician's order for admission and treatment
- Medical history, physical exam results, and recent test results (e.g., TB test)
- Proof of insurance (Medicare, Medicaid, private)
- Relevant legal documents, such as Power of Attorney (POA) or guardianship papers
- Advance directives like a Living Will or Do Not Resuscitate (DNR) order
- Social security card and other personal identification
Nursing Home vs. Assisted Living Comparison
To highlight the distinction, here is a comparison of key features for nursing homes and assisted living facilities.
| Feature | Nursing Home | Assisted Living |
|---|---|---|
| Care Level | 24/7 skilled medical care and supervision | Assistance with daily living (ADLs) |
| Medical Staff | Registered Nurses (RNs) and Licensed Practical Nurses (LPNs) available 24/7 | Caregivers provide non-medical care; nurses may be on-site but not 24/7 |
| Residency | Long-term or short-term stays, often for chronic conditions or rehabilitation | Long-term residency |
| Cost | Generally higher due to medical care | Lower than nursing homes |
| Independence | Less independence for residents with high medical needs | Promotes independence with support |
Addressing Special Circumstances
Emergency Admissions
In cases of sudden illness or injury, an expedited emergency admission may be possible. Hospital social workers are crucial in this situation, helping to coordinate the transfer directly from the hospital. While the process is faster, all the same documentation and assessments are still required, just on an accelerated timeline.
Dealing with a Refusal to Move
If the individual is unwilling to move, the situation becomes more delicate. Unless a court has appointed a legal guardian, a doctor cannot force someone into a nursing home. Family intervention, with the support of a social worker or geriatric care manager, is often necessary. Emphasize the benefits of specialized care and explain the safety concerns honestly.
Legal Authority: Power of Attorney and Guardianship
If the individual lacks the capacity to make their own decisions, a legally appointed agent must act on their behalf. A Medical Power of Attorney (POA) or court-appointed guardianship is required for making medical decisions and consenting to admission.
Conclusion
Admitting a loved one into a nursing home is a significant and complex undertaking. Following a structured approach—starting with a thorough medical assessment and proceeding through facility selection, financial planning, and document preparation—can make the process more manageable. Leaning on professional resources, like social workers and elder law attorneys, is essential for a smooth transition. For further guidance on selecting a facility, the National Institute on Aging provides a helpful guide on choosing a long-term care facility.
