What is the process for putting someone in a nursing home?

According to the Centers for Disease Control and Prevention, approximately 1.3 million people in the U.S. reside in certified nursing homes. Understanding what is the process for putting someone in a nursing home is crucial for families facing this significant transition, requiring careful planning and informed decisions.

Quick Summary

The process for putting someone in a nursing home involves a series of coordinated steps, beginning with a medical assessment to confirm eligibility and concluding with the move-in. It requires researching facilities, securing financial arrangements, and preparing crucial legal and personal documentation to ensure a smooth transition.

Key Points

• Medical Assessment First: A physician's order is mandatory, certifying the need for a nursing facility level of care before admission can proceed.

• Research and Visit Facilities: Use tools like Medicare's Care Compare and conduct in-person tours to evaluate and compare multiple facilities based on quality, services, and atmosphere.

• Secure Financial Arrangements: Understand and prepare for the significant costs of care by exploring payment options such as private pay, Medicare (for short-term), Medicaid, and Veterans' benefits.

• Organize Important Paperwork: Gather and complete all necessary medical, legal (e.g., Power of Attorney), and financial documents required by the facility during admission.

• Plan for a Smooth Transition: Ease the move-in process by personalizing the resident's new space and maintaining open communication with both your loved one and the nursing home staff.

Understanding the Need for Nursing Home Care

Making the decision to place a loved one in a nursing home is often difficult, prompted by a significant change in their health or care needs. This step is typically necessary when an individual requires 24/7 skilled nursing care that cannot be safely or adequately provided at home or in an assisted living facility.

Assessing Health and Daily Living Needs

Before starting the formal process, a thorough evaluation of the individual's needs is essential. This assessment helps determine if a nursing home is the most appropriate level of care. Key areas to evaluate include:

• Activities of Daily Living (ADLs): The ability to perform basic tasks such as bathing, dressing, eating, and toileting. A significant decline in ADL independence is a major indicator.
• Instrumental Activities of Daily Living (IADLs): The capacity to manage more complex tasks like managing finances, handling medications, and navigating transportation.
• Medical Needs: The presence of chronic health conditions, cognitive impairment (such as dementia), and the need for medical procedures like wound care, injections, or frequent vital sign monitoring. A physician's evaluation is a critical part of this stage.

The Step-by-Step Admission Process

Once the need for skilled nursing care is confirmed, the following steps guide families through the admission process.

Step 1: Medical Evaluation and Physician's Order

Formal admission begins with a medical certification. A physician must evaluate the individual and issue an order confirming that they require a "nursing facility level of care." This is a mandatory requirement for admission and is often completed by the hospital's discharge planner or the person's primary care doctor.

Step 2: Researching and Selecting a Facility

Finding the right nursing home is a critical and time-consuming step. The ideal facility offers high-quality care, a comfortable environment, and services that match the resident's specific needs. Families should:

• Use online resources like the official Medicare Care Compare tool to find and compare certified nursing homes in their area. Ratings and inspection results are key indicators of quality.
• Visit multiple facilities. During visits, observe the staff-to-resident ratio, cleanliness, resident engagement, and the overall atmosphere.
• Ask detailed questions about staffing, care plans, meal options, activities, and communication protocols.
• Consider the location in relation to family members to ensure frequent visits.

Step 3: Handling the Financial Aspects

Nursing home care is expensive, and understanding payment options is crucial. This step involves a financial assessment and securing payment sources.

• Private Pay: Using personal savings, long-term care insurance, or selling assets.
• Medicare: Covers up to 100 days of skilled nursing care following a qualifying hospital stay, not long-term custodial care.
• Medicaid: A joint federal and state program covering long-term care for individuals with low income and limited assets. The application process is complex and often requires assistance from an elder law attorney.
• Veteran's Benefits: Certain VA benefits, like the Aid & Attendance pension, can help cover costs for eligible veterans and their surviving spouses.

Step 4: Completing the Admissions Paperwork

This phase involves submitting all necessary documentation to the chosen facility. A comprehensive packet includes:

• Medical Records: A physician's order, medical history, physical examination results, and medication lists.
• Legal Documents: Power of attorney for healthcare and finances, a living will, and any advance directives.
• Financial Information: Proof of payment source, whether it's insurance details or Medicaid application documents.
• Personal Information: Identification, Social Security card, and contact information for the care team and emergency contacts.

Step 5: Planning the Transition and Move-in Day

Easing the transition for the new resident is paramount. This includes planning for the move and helping them adjust.

• Personalize the Space: Bring familiar items like photos, a favorite blanket, or a comfortable chair to make their room feel more like home.
• Prepare for Emotional Adjustment: Both the family and the resident may experience a range of emotions. Maintain open communication and regular visits to provide reassurance.
• Meet the Staff: Get to know the nurses, aides, and social workers who will be providing daily care. Building a relationship with them fosters trust and better care coordination.

Comparison Table: Nursing Home vs. Assisted Living

Feature	Nursing Home	Assisted Living
Level of Care	24/7 medical and skilled nursing care; for residents with complex health needs.	Assistance with daily living activities; for residents who can maintain some independence.
Typical Resident	Individuals with chronic illness, mobility issues, advanced dementia, or needing extensive rehab.	Independent seniors who need help with tasks like bathing, dressing, or medication management.
Medical Staffing	Requires registered nurses (RNs) and licensed practical nurses (LPNs) on duty 24/7.	Staff generally consists of personal care aides and is not required to have 24/7 skilled nursing.
Cost	Generally more expensive, often covered by Medicaid after private funds are exhausted.	Less expensive than nursing home care, typically paid for privately or with long-term care insurance.
Environment	More clinical, with a strong focus on medical care and rehabilitation.	More residential and social, with a focus on community and structured activities.

Key Legal and Financial Considerations

This move has significant legal and financial implications. Consulting with an elder law attorney is highly recommended to navigate these complexities.

Power of Attorney and Advance Directives

If the individual is no longer able to make their own decisions, a designated Power of Attorney (POA) for both healthcare and finances will be essential. This legal document grants a trusted person the authority to make critical decisions on their behalf.

Paying for Care: Options and Resources

For those who may not have enough savings, it's vital to explore all funding avenues. Medicaid planning, in particular, requires expert guidance to navigate asset limits and eligibility rules. Resources like your local Area Agency on Aging (AAA) can also provide invaluable support and information.

Conclusion

The process for putting someone in a nursing home is a multi-faceted journey that involves medical, financial, and emotional considerations. By following a structured approach—from the initial needs assessment to the final transition—families can make informed decisions that honor their loved one's health and well-being. Proactive research, open communication, and seeking professional guidance are the keys to ensuring a smooth and supportive transition. For more information, visit the National Institute on Aging website.

Frequently Asked Questions

What qualifies someone for nursing home admission?

A person qualifies for nursing home admission when a physician certifies they need a 'nursing facility level of care,' meaning they require 24/7 skilled nursing care for chronic conditions or assistance with daily living activities that cannot be safely managed elsewhere.

Does Medicare pay for putting someone in a nursing home?

Medicare will not pay for long-term custodial care in a nursing home. However, it may cover up to 100 days of skilled nursing care following a qualifying hospital stay, provided specific criteria are met.

Which legal documents are needed for the nursing home process?

Essential legal documents include a healthcare Power of Attorney, financial Power of Attorney, a living will, and any other advance directives. These ensure that a designated person can make decisions on the resident's behalf if needed.

How do I start the process of finding a nursing home?

You can start by having a medical assessment performed by a physician. Then, use online tools like Medicare's Care Compare and consult with your local Area Agency on Aging to research and identify potential facilities.

How long does the nursing home admission process take?

The duration of the process varies greatly. It can be expedited in an emergency but may take weeks or months if there's a waiting list or a complex Medicaid application is required.

Can I use Medicaid to pay for a nursing home?

Yes, Medicaid is the primary payer for long-term care in the U.S. for those with limited income and assets. The process requires a detailed financial review and asset spend-down to qualify.

What should I look for when touring a nursing home?

When touring, observe the staff-to-resident interaction, cleanliness of the facility, the residents' overall mood, and the variety of activities offered. Ask about staff training, turnover rates, and communication policies.