Nursing Home

When should you consider a nursing home?

Begin to consider nursing home facilities for your loved one if they:

• Need help with activities of daily living (ADLs).
• Are experiencing more common accidents at home.
• Need more frequent visits to medical providers.
• Are showing signs of memory loss and aggression.
• Are having trouble keeping their house safe, clean, and maintained.
• Cannot manage their finances and have trouble paying their bills.
• Have trouble eating, have lost their appetite, or are making unhealthy food choices for their conditions.
• Get lost while driving or have bad judgment when behind the wheel.
• Need specialized care like rehabilitation or some sort of regular therapy. These include physical, occupational, and speech therapy, plus others.

It may be a good time to consider nursing home options for your loved one if you:

• Are having serious physical issues caring for them.
• Are feeling excessively burned out or overwhelmed caring for them.
• Feel in danger or ill equipped to provide care.
• Feel that caring for them may hurt your relationship with each other, or with other important people in your life.
• Find it hard to balance work or caring for your children with caregiving your loved one.
• Think it may be financially beneficial to look into nursing home care.

What services do nursing homes offer?

While services may differ based on the nursing home, most will offer:

• Housing and meals.
• Medication administration and tracking.
• 24-hour nurse supervision by registered nurses or licensed practical nurses.
• Help with ADLs, such as transferring, personal hygiene, dressing, bathing, eating assistance, and toileting.
• Hospice care.
• Emergency care.
• Exercise programs.
• Social activities and events.

Other services that some nursing homes may provide are:

• Skilled care like rehab, physical therapy, and other forms of therapy.
• On-site pharmacy, dental care, x-ray lab, and other lab services.
• Mental health and pastoral counseling.
• Intravenous (IV) drug therapy.
• Renal (kidney) dialysis.
• Special units for people with Alzheimer’s and dementia.
• If your loved one requires specific needs like any of the above, ask nursing homes if they provide those services.

How much does a nursing home cost?

The cost of nursing homes differs by state. Based on research from Genworth Financial, the national median costs in 2021 were:

• $263 per day (monthly: $7,989 & yearly: $95,867) for a shared room
• $299 per day (monthly: $9,086 & yearly: $109,026) for a private room.

According to Genworth, the median costs of nursing homes are estimated to rise in 2022 to around:

• $271 per day (monthly: $8,228 &  yearly: $98,743) for a shared room
• $308 per day (monthly: $9,358 & yearly: $112,296) for a private room.

A full breakdown of average costs by state can be found on SeniorLiving.com.

How do you pay for a nursing home?

Medicaid

Medicaid is the most common way Americans pay for nursing home care. Medicaid may cover 100% of the cost of a Medicaid approved nursing home facility if your loved one qualifies. This is based on their income and financial assets and if they fall into the range required by your state’s Medicaid program. They may have to pay a co-payment based on your state’s financial requirements. To learn more, continue reading on Policy Genius.

Medicare

Medicare pays for short-term stays at nursing homes (called convalescent care) for people who are recovering from surgery or an episode of illness. This is not for long-term care. To receive this form of care a person must have:

• Spent 3 days or more in the hospital.
• Been discharged from the hospital within 30 days.
• Require special services like rehabilitation or therapy.
• To learn more about what Medicare will cover and if you qualify, review Medicare’s Skilled Nursing Facility (SNF) care page.

Under these circumstances, Medicare will pay the full cost of up to 20 days of nursing home care and will cover part of the next 80 days.

• Your loved one is responsible to pay a daily co-payment of $170.50 after the first 20 days unless they are on a Medicare Supplemental Insurance plan. When that’s the case, there is no co-payment for those 80 days.
• Medicare does not pay for nursing home care after 100 days.

There is an exception to the above rules for Medicare PACE Programs.

• PACE (Programs of All-inclusive Care for the Elderly): are state-run initiatives that offer medical and personal care services at home. PACE is for individuals that need nursing home level care but prefer to receive it at home or in the community.
  • Not all states offer PACE. To see if your state offers PACE go visit Medicare’s PACE locator.
  • Medicare and Medicaid beneficiaries may be eligible for PACE if they are:
    • Over 55 years old.
    • Require skilled nursing care.
    • Meet Medicare or Medicaid requirements.
    • Live in a state that offers PACE.

Veteran Affairs

• VA Nursing Homes: The VA has their own nursing home system at the state level. These care for war-time veterans, non-wartime veterans, and the spouses of both groups.
  • Eligibility: Every state has their own requirements to qualify for care at a VA nursing home.
    • Most require the veteran or their spouse be at least 70% disabled.
    • Many VA nursing homes have waiting lists.
    • To learn more about your options, call your local VA nursing home.
• Aid and Attendance Benefit (also called Improved Pension): Is a program designed for only war-time veterans (and their survivors) who have limited financial assets and income.
  • They also need help from another person to manage their ADLs.
  • Veterans can use the Aid and Attendance Benefit to pay for the cost of a nursing home or assisted living facility.
  • To learn more, including if you are eligible for the Aid and Attendance Benefit program, continuing reading on VA.gov.
• You cannot enroll in both the Aid and Attendance Benefit program and a VA nursing home at the same time.

Long-Term Care Insurance

Although many people cannot afford long term care insurance, it typically starts paying out to the beneficiary when a qualifying medical need requires skilled care.

• The amount paid from the LTC insurance may go towards care ranging from a nursing home to home health aide, etc.
• One thing to keep in mind about LTC insurance is that the monthly premium will rise as the beneficiary ages and their condition worsens.

How to find a nearby nursing home facility

Go to Medicare’s Nursing Home Compare to find nursing home facilities near you.

How to choose a nursing home

There are a few aspects to consider when choosing a nursing home:

• How the needs of your loved one match up with the services the facility offers.
• The location and if it is near family or friends, if this is important for your loved one.
• If the nursing home size and surroundings fit your loved one’s preferences.
• The facilities of the home include:
  • Safe and quiet outdoor space for walking or sitting in nature.
  • Social areas for activities and events.
  • Comfortable dining areas.
  • Handicap access.
  • A quiet space to meet with family and friends. One that is not your loved one’s room.
• How the staff interacts with residents and each other.
• The way residents interact with each other and the perception they give off.

It is always wise to visit at least a few nursing homes a few times to get a feel for the differences between them. Think about aspects your loved one likes and doesn’t like so you can make the best decision together.

Questions to ask during your nursing home visit

Here’s a list of possible questions to ask, and things to watch for, when visiting nursing homes:

Certifications/Financials:

• Is the facility certified for Medicare and Medicaid, and is that up to date?
• Is the nursing home administrator’s license up to date?
• Is it a for-profit or non-profit organization?
• Is the management of the organization willing to speak with family members when needed?
• Do the monthly costs seem reasonable relative to other nursing homes in the area?
• Are all services included in the monthly costs?
• Is the contract clear and informative?
• Is the nursing home willing to hold the room of your loved one if they have to spend some time in the hospital?
• Does the nursing home staff perform a resident assessment during admission to the facility and regularly after that?
• Does the nursing home have insurance?
• Is there a waiting list? If so, how long is it?

Residents:

• Are the residents dressed properly for the current weather indoors and outdoors?
• Are residents taking part in different activities?
• Are the residents enjoying themselves and interacting with staff?
• Does the food they are eating look appetizing and healthy?
• Are there a diverse group of residents living there?

Facility:

• Do the rooms offer privacy to the residents?
• Are there any powerful odors?
• Are there safety features inside and outside the rooms including grab bars, handrails, stability mats in the shower and emergency call buttons?
• Does the nursing home have security features in case of emergency or if a resident wanders away?
• Are most of the services and offerings handicap accessible?
• Are pets allowed to live in the facility or visit their owners in the facility?
• Are there plants, good lighting and pleasing furniture to create a comfortable setting?
• Is the dining room comfortable, clean and large enough?
• Are residents allowed to have personal belongings, like pictures, bedding items, or electronics, such as a TV, radio, or computer?

Staff:

• Do the nursing home staff refer to the residents by name?
• Does the ratio of staff and nurses to residents seem reasonable?
• How long have most of the staff worked in the home?
• How long have the directors of each program worked there?
• Is there a diverse group of staff in the home?
• Are there social workers on staff or regularly at the nursing home?
• Does the staff happily help residents who can’t feed themselves?

Offerings:

• Are the visiting hours flexible and do they have activities that include family members?
• Does the nursing home make accommodations for residents to take part in religious gatherings?
• Is there an ongoing event or activity schedule that varies weekly with a lot of options?
• Do they guarantee 24/7 medical help and emergency services?
• Does the nursing staff seem capable and have the resources they need?
• Can the resident and his or her family take part in developing the resident’s care plan?
• Are there on site pharmaceutical services? If not, who provides them?
• Does the nursing home offer rehabilitation and therapy services internally? If not, do they have a partnership close by? Are these costs extra?
• Do they offer special meals for health or religious reasons? Do they post a weekly menu that has variety?

What is the difference between a skilled nursing facility and nursing home?

Short-term: A skilled nursing facility (SNF) offers care designed for short-term rehabilitation or therapy. The goal is that a person can leave the hospital and have short-term care before returning to their home or moving to a long-term-care facility. Skilled nursing facilities hire registered nurses who provide specialized care like that of a hospital and work under a physician’s supervision.

Long-term: Nursing homes employ licensed registered nurses who work under a physician’s direction and supervise licensed practical/vocational nurses and nurses aides. The goal is to create a safe, comfortable long-term residence for people needing help with their activities of daily living and managing chronic illnesses.

Why is there confusion about these types of facilities? Some providers have both nursing home care and skilled nursing care. These are usually in separate wings of the same facility to allow a resident to easily move from one type of care to another.