A Consumer's Guide to Nursing Facilities
Assessing Your Needs
Survey and Inspection Reports
Your state's health department inspects every facility annually. The survey results are available at the facility and you may review the report of the facility's performance. A staff representative can answer your questions and provide additional information about this complex document.
In addition, many nursing facilities participate in voluntary quality assurance programs. One example is the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) Long Term Care Program. This accreditation program evaluates facilities' operations based on a monitoring system to measure the facility's performance.
Financial Considerations
There are several ways to finance nursing facility care. While many individuals pay for nursing facility services with their own funds, purchasing long term care insurance is an excellent way to prepare for these expenses and some employers provide long term care insurance coverage as an employee benefit (see AHCA's pamphlet "What Consumers Need to Know about Long Term Care Insurance"). Medicare, a government health care insurance program for those 65 and over, will cover the first 20 days of nursing facility care and will partially pay for the next 80 days for a total benefit not to exceed 100 days. A three-day hospital stay is required to qualify for this benefit. Another way to finance long term care is with Medicaid. Medicaid is a health care program for those individuals without the ability to pay for health care themselves.
The cost of nursing facility care can vary. Cost is determined by the level of care needed, the setting where the care is provided, and the geographic location. Finances should be discussed openly and in detail with the facility's admissions staff who will be able to offer you guidance on payment details for Medicaid, Medicare, insurance matters, and paying privately. To ease the process, your financial records should be well-organized because government programs, like Medicaid, require financial records looking back several years. Payment agreements should be in writing, and you should have a copy of the final arrangements.
It is important to note that facilities cannot require residents to waive their rights to Medicare or Medicaid coverage. Furthermore, nursing facilities cannot require a third party guarantee of payment as a condition of admission.
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