Your Step-by-Step Guide to Nursing Home Admission
1. The Initial Medical Assessment and Physician’s Order
Before a nursing home can admit a new resident, a physician or other qualified medical professional must formally evaluate the individual and certify that they require a nursing home level of care. This is a critical first step. The assessment determines if the person's needs—related to physical abilities, medical issues, cognitive status, or behavioral history—cannot be managed in a less-intensive setting, such as a private home with support or assisted living.
This evaluation often measures the individual's ability to perform Activities of Daily Living (ADLs), including bathing, dressing, and eating, as well as Instrumental Activities of Daily Living (IADLs), such as managing finances or preparing meals. The physician will then issue a formal order for admission, which is a required document for the application.
2. The Pre-Admission Screening and Annual Resident Review (PASARR)
For any facility that participates in Medicare and/or Medicaid, a federal law requires a Pre-Admission Screening and Annual Resident Review (PASARR) before admission. This screening determines if the potential resident has a mental illness, intellectual disability, or a related condition. The purpose is to ensure that a nursing home is the most appropriate setting for their needs and that they don't require specialized services best delivered elsewhere. A positive initial screen leads to a more in-depth evaluation.
3. Financial Evaluation and Planning
The cost of nursing home care is a major consideration. Prospective facilities will conduct a financial assessment to understand how the care will be funded. This involves determining the person's assets and income to see if they will be private pay or require financial assistance through public programs like Medicare or Medicaid.
Navigating Payment Options
- Private Pay: Individuals use their own funds, savings, investments, or long-term care insurance to cover costs.
- Medicare: This federal health insurance for seniors over 65 covers short-term, skilled nursing care (up to 100 days under specific conditions), not long-term custodial care.
- Medicaid: This is a state and federal program that can cover long-term nursing home care for low-income individuals who meet strict financial eligibility requirements. Each state has its own rules for qualification.
Medicare vs. Medicaid: At a Glance
| Feature | Medicare | Medicaid |
|---|---|---|
| Coverage | Short-term, skilled nursing care after a qualifying hospital stay. | Long-term custodial care for financially eligible individuals. |
| Eligibility | Age 65+ or certain disabilities; no income or asset limits. | Based on strict income and asset limits, which vary by state. |
| Duration | Limited to a maximum of 100 days per benefit period. | Continuous coverage as long as eligibility is maintained. |
| Primary Purpose | Rehabilitation and recovery. | Long-term care needs. |
4. Compiling the Required Paperwork
Once medical and financial assessments are underway, a significant amount of paperwork must be gathered. Having these documents organized in advance can prevent delays. Key paperwork includes:
- Physician's orders for admission and treatment
- Medical history and physical results
- Complete list of medications and dosages
- Health insurance cards (Medicare, Medicaid, private insurance)
- Social Security card
- Power of Attorney documents (for health care and finances)
- Advanced directives, such as a living will or DNR order
- Proof of recent health screenings or vaccines (e.g., tuberculosis test)
- Dietary requirements or restrictions
5. The Application and Admission Day
After selecting a facility, a formal application is submitted. Many facilities have waitlists, though emergency placement is often available for urgent cases. The admission day is the final step, involving signing admissions paperwork with a staff member. It’s important to review all documents carefully with the patient or their legal representative.
- Select a Facility: Choose a nursing home that meets the resident's needs, considering location, services, and reputation.
- Submit Application: Complete the facility's application, providing all necessary medical and financial information.
- Wait for Acceptance: The facility will review the application and determine if a bed is available. For waitlisted applicants, it's a matter of waiting for a vacancy.
- Confirm Admission: Upon acceptance, coordinate the move-in date and time with the facility.
- Complete Final Paperwork: On admission day, sign final agreements, consents, and policies. A staff member will guide you.
- Settle In: Help the resident get comfortable, decorate their room, and meet staff and new neighbors.
Conclusion
Securing a spot in a nursing home is a multi-faceted endeavor that involves careful medical and financial evaluation, extensive paperwork, and coordination with the chosen facility. While it can feel overwhelming, approaching the process systematically can help reduce anxiety and ensure a smooth transition. For more detailed information on Medicare coverage, visit Medicare's official website.
