Step 1: Medical and Functional Assessment
Before a person can be admitted to a nursing home, a formal assessment of their medical condition and daily needs is required. This step determines if they meet the state's criteria for a nursing home level of care.
The Physician's Role
Your loved one's physician is the first and most critical point of contact. The doctor will need to provide a formal order for admission to a skilled nursing facility, much like a prescription. This order confirms that the patient requires a higher level of care than can be provided at home or in an assisted living setting. If your loved one is currently in a hospital, the hospital's social worker and discharge planner will handle this evaluation.
Activities of Daily Living (ADLs) and Instrumental ADLs (IADLs)
To determine the level of care needed, healthcare professionals assess a person's ability to perform routine tasks, known as ADLs and IADLs.
ADLs (Basic self-care):
- Bathing
- Dressing
- Eating
- Toileting
- Continence
- Transferring (moving from bed to chair)
IADLs (Complex life skills):
- Managing finances
- Managing medications
- Using the telephone
- Shopping for groceries
- Housekeeping
- Preparing meals
Formal assessment tools, like the Katz Index or the Functional Independence Measure (FIM), are often used to document the level of assistance required.
Step 2: Legal and Financial Preparation
Once the medical need is established, legal and financial matters must be addressed. This ensures the ability to manage the person's affairs and pay for the high cost of care.
Legal Documentation
- Power of Attorney (POA): If your loved one is still able to make decisions, they can appoint an agent through a Durable Power of Attorney (DPOA) to handle their finances and a Healthcare Power of Attorney (HCPOA) to make medical decisions if they become incapacitated.
- Guardianship: If the person is already deemed incompetent and no POA is in place, you may need to petition the court for legal guardianship, a more complex and lengthy process.
- Advanced Directives: A living will or other advanced directives detailing end-of-life care wishes should be prepared and provided to the facility.
Financial Assessment and Funding Options
Before admission, the facility will require a financial assessment to determine the payment method. Costs can be covered in several ways:
- Private Pay: Using personal savings, investments, or long-term care insurance.
- Medicaid: A joint federal and state program for low-income individuals. Eligibility is based on strict income and asset limits. Many families use a "spend-down" strategy, paying privately until they qualify.
- Medicare: Covers up to 100 days of skilled nursing care per benefit period following a qualifying hospital stay of at least three consecutive days. It does not cover long-term custodial care.
- Veteran's Benefits: Certain VA benefits, such as Aid and Attendance, can help cover nursing home costs for eligible veterans and their spouses.
| Feature | Medicare | Medicaid | Private Pay |
|---|---|---|---|
| Coverage | Short-term skilled nursing care (up to 100 days) | Long-term custodial care for eligible low-income individuals | Long-term custodial care, no time limit |
| Eligibility | Age 65+ or certain disabilities; 3-day hospital stay requirement | Low-income and asset limits | Financial resources, regardless of income |
| Facility Choice | Must be a Medicare-certified facility | Must be a Medicaid-certified facility | Wider choice of facilities |
| Application | Through Social Security | Through state health and human services | Directly with the facility |
Step 3: Researching and Selecting a Facility
With legal and financial matters in motion, the next step is finding the right nursing home for your loved one. This requires careful research and visits.
Research Tools and Resources
- Medicare.gov Nursing Home Compare: This website is a valuable tool for comparing Medicare-certified facilities based on health inspections, staffing, and quality measures. You can access it at Medicare.gov Nursing Home Compare.
- Area Agency on Aging (AAA): Your local AAA can provide information on local resources, long-term care ombudsmen, and help with navigating the system, especially in emergencies.
- Professional Referrals: Social workers and elder law attorneys can offer valuable recommendations and guidance.
Touring and Evaluating Facilities
Once you have a list of potential homes, schedule visits. During your tour, consider asking about:
- Staffing: What are the staff-to-resident ratios? How is staff trained, particularly for residents with specialized needs like dementia?
- Care Plans: How are resident care plans developed and communicated with families?
- Activities and Amenities: What social, cultural, and recreational activities are offered? Are there outdoor spaces?
- Food: Can you see a menu? Is there variety and are special dietary needs accommodated?
- Atmosphere: Does the facility feel clean, safe, and welcoming? Talk to residents and their families if possible.
Step 4: The Admissions Process
After selecting a facility, you will begin the formal admissions process, which involves completing extensive paperwork.
Gathering Documents
Prepare a folder with the following essential documents:
- Medical Information: Physician's order, recent medical history, physical examination results, list of medications and dosages, and vaccine records (e.g., flu, pneumonia, COVID-19).
- State-Required Forms: Each state has specific forms, such as a Preadmission Screening and Resident Review (PASRR), that certify the individual's need for nursing home care.
- Legal Documents: Power of Attorney forms, advanced directives, and guardianship papers, if applicable.
- Financial Documents: Insurance cards (Medicare, Medicaid, supplemental), financial paperwork to prove ability to pay, and bank statements.
Finalizing Paperwork
On or before the admission day, you or the designated POA will sign the admission paperwork. Carefully review all documents, including the resident's rights, billing information, and any arbitration agreements, which can often be declined.
Step 5: Transitioning to the Nursing Home
The final stage is the physical move. This can be an emotional and challenging time for the individual and family.
- Packing: Pack personal items that will make the space feel like home, such as family photos, a favorite blanket, or small mementos. Ensure all belongings are labeled.
- Communication: Maintain open and consistent communication with the nursing home staff. Establish a rapport with the nurses, social workers, and other caregivers who will be involved in your loved one's care.
- Support: Provide emotional support during the adjustment period. Regular visits and communication are crucial to help your loved one feel comfortable and secure in their new environment.
Conclusion
Navigating the journey to nursing home placement is a structured process involving medical, legal, and financial planning. By following these steps and being prepared with the necessary documentation, families can make the transition as seamless and stress-free as possible. It is a decision rooted in providing the best possible care for your loved one when their needs exceed what can be managed at home.
