One of the things many families face as our loved ones age is finding a suitable nursing home to care for an elderly relative. Nursing homes and assisted living facilities vary in the types of patients they accept, the services they offer, and the care they deliver. While some nursing homes may initially appear to offer the services you want and the staff may say everything you want to hear, it still prudent to look for objective measures of quality of care.
When looking for nursing home, we advise you stay away from ones with:
• High turnover rates: If nursing home residents and staff are happy, they will stay. When staffs are not happy with their job or the conditions of their employ, they will either leave or take it out on those in their care. You do not want either. High turnover rates are a bad sign.
• A low Medicare star rating: Medicare.gov assigns star ratings to nursing homes based on a variety of factors. All you need to do is enter your zip code to compare the ratings of nursing homes based on health inspections, staffing quality measures, and overall rating.
• A number of serious violations: Not all violations are of the same level of severity. When looking for a nursing home take the time to find out how many reported violations it has and the basis for each violation. Nursing homes cited for severe violations should be avoided.
• Heavy restrictions on the independence of residents: When you admit a loved one to a nursing home, you do not want one that puts heavy restrictions on his or her independence. You want to provide a safe place where your loved one will still be able to have a certain level of freedom, maintain decision-making responsibilities, and feel at home.
Most importantly, you want to avoid any nursing home that leaves you feeling uneasy or uncomfortable. Meet with the nursing home administrator of prospective nursing homes and ask about their restraint policies, the ratio of personal care staff to residents, how often doctors visit and the social calendar for residents. Do residents appear well groomed and dressed? Choosing a nursing home is not a minor decision. You need to trust your instincts. The future health and well-being of your loved one depends largely on the choices you make.
Choosing the Right Nursing Home Based on Your Loved One’s Needs
When looking for the right nursing home, you will want to choose one based on your loved one’s specific needs. The right nursing home will treat your loved one with dignity and respect and provide the high-quality care and services he or she needs to maintain health and security. In addition to nursing homes, many areas have a number of community services designed to assist with the personal care and provide activities for the elderly. Home health care, subsidized senior housing, residential care facilities, and Continuing Care Retirement Communities (CCRC) are among the options to consider before placing your loved one in a nursing home.
Common Resident Complaints in Nursing Homes
There are many complaints among nursing home residents. Many of these are valid, while others indicate a perceived lack of quality care in the eyes of residents and family members. Common complaints include:
• Slow responses to calls. When residents seek help using in-house calling systems, the response time can vary. Staff members have extremely high workloads, and may not respond as quickly as patients demand. This can lead to significant numbers of complaints, as patients do not feel as if their needs are being addressed in a timely fashion.
• Poor food quality. Long the bane of every healthcare facility, complaints about food, both in quality and in variety, have risen in recent years. While it impossible to cater to every taste while providing healthy, nutritious meal options, nursing homes need to take a proactive approach in addressing food quality issues.
• Staffing issues. With some facilities facing serious staffing shortages and high workloads among existing staff, patients in these nursing homes often feel as if their needs are not being met. Complaints arise regarding patient lifting equipment, under-trained staff members, and a host of related issues surrounding care delivery and staff responsiveness.
• A lack of social interaction. Many elderly patients grow to feel isolated from the world around them. Dwindling family visits are often the cause for this isolated feeling, and patients come to expect that staff members replace family in social interactions. Unfortunately, staff members do not have the time and may not have the training for this role.
• Disruptions in sleep. Care never stops in nursing homes; these facilities provide around-the-clock care for residents. Interruptions in sleep, such as when staff members stop in to take vital signs or to deliver medication, are common. Residents often complain about loud neighbors and even the conversations between workers during nighttime hours.
Handling Common Complaints: Reducing Liability Exposures
Forward-thinking nursing homes and skilled care facilities understand that they are not only healthcare providers but also customer service-oriented operations. To address complaints and to improve service, many of these facilities have adopted unique approaches. Regular review of policies and procedures is typically the first step in reducing complaints. Many facilities will seek the input of patients and family members, usually through some form of survey instrument. With this information, the facility can then create initiatives to address common complaints. As mentioned earlier, food-related complaints are very common in any healthcare facility. To address this, facilities often create long-term food rotation schedules, such as four-week rotations. These facilities may also seek higher-quality food vendors and enhance presentation of food items to head off any potential complaints. Staff training and retraining is an important part of risk management, just as is nursing home insurance. By making sure staff members are equipped with the knowledge and skill needed to provide expert care, complaints tend to plummet. With these practices, nursing homes can continue to provide care for the many patients who rely on their service. Being responsive to emerging complaints is a powerful risk management tool, helping to improve the quality of care and the life of so many elderly citizens.
Choosing and Evaluating a Nursing Home
Can there be a more difficult job than finding a nursing home for a parent or spouse? No one wants to live in a nursing home. They serve as institutions of last resort when it’s impossible to provide the necessary care in any other setting. And, typically, the search takes place under the gun when a hospital or rehabilitation center is threatening discharge or it’s no longer possible for the loved one to live at home. Finally, in most cases, finding the right nursing home is a once-in-a-lifetime task, one you’re taking on without the experience of having done it before.
That said, there are a few rules of thumb that can help you:
• Location. No single factor is more important to quality of care and quality of life of a nursing home resident than visits by family members. The quality of care is often better if the facility staff knows that someone who cares is watching and involved. Visits can be the high point of the day or week for the nursing home resident. So, make it as easy as possible for family members and friends to visit.
• Get references. Ask the facility to provide the names of family members of residents so you can ask them about the care provided in the facility and the staff’s responsiveness when the resident or relatives raise concerns.
• Check certifying agency reports. Medicare’s Nursing Home Compare is a free site that allows consumers to compare the quality of the nursing homes they’re considering, using Five-Star Quality Ratings, health inspection results, nursing home staff data, quality measures, and fire safety inspection results.
• Talk to the nursing home administrator or nursing staff about how care plans are developed for residents and how they respond to concerns expressed by family members. Make sure you are comfortable with the response. It is better that you meet with and ask questions of the people responsible for care and not just the person marketing the facility.
• Tour the nursing home. Try not to be impressed by a fancy lobby or depressed by an older, more rundown facility. What matters most is the quality of care and the interactions between staff and residents. See what you pick up about how well residents are attended to and whether they are treated with respect. Also, investigate the quality of the food service. Eating is both a necessity and a pleasure that continues even when we’re unable to enjoy much else. It is also advisable to try and get a tour of the facility that is not prearranged. While this is not always possible, it does give you the opportunity of seeing an unrehearsed atmosphere.
How Much Does a Nursing Home Cost?
Nursing home care is likely more expensive than you think, which means you need to do your homework to find the best deal. The average total cost for a nursing home is higher than you might think – way higher. According to industry data, the average cost of a nursing home residence, is $8,121 a month for a private room, and $7,148 a month for a semi-private room. Both figures represent total costs for nursing home care monthly, including room, board, fees, and ancillary expenses charged by nursing home (also called a skilled nursing facility.) The factors that matter when calculating the total cost of a nursing home stay rarely vary. The top of that list includes the quality and location of the nursing home residence, how long the stay will be the nursing home care recipient, and the number and quality of specific senior home care services required by the recipient and his or her family. Those extra charges could be for a wide menu of services, including physical therapy, memory care, prescription drug purchase and/or delivery, special meals based on dietary needs, and other critical services a nursing home resident may need. That’s why an all-inclusive nursing home care rate is advisable for seniors and their families. It gives you a total cost estimate and you may get discounts on key services for paying for an all-inclusive senior care center plan. It’s also worth noting that nursing home care on all levels outpaces the U.S. rate of inflation, by an average of 3%-to-6% annual cost growth rate for nursing homes versus the current U.S. inflation rate of 1.8% through July 2019. Put that calculating factor into play and the expected cost of annual nursing home care for a semi-private room rises to $120,008 and the cost of a private room soars to $134,896 in 2028.
With the costs of nursing home care so high – even for a semi-private room – Utah seniors and their families may want to set their sights lower and pay a more affordable rate of senior home care or assisted living care even if that means foregoing the nursing home care experience.
There are two ways of looking at the costs of nursing home care versus assisted living.
• First, you’re getting more comprehensive care, including 24-hour medical services, from a nursing home.
• Second, you’re paying significantly less for assisted-living care, which costs approximately 50% less (depending on where you live) compared to nursing home care. If you’re a senior with a family able to pitch in for care needs, the price difference is hard to ignore, as most Americans can hardly afford $8,000 or even $6,000 a month for full-time nursing home care.
Home-based senior care has a quality of life advantage built into the equation, like most seniors, if health allows, would rather stay in the comfort and safety of their own home than have to live in a nursing home or even spend time at an assisted care center. Base costs for home care do come in much lower than a nursing home or even assisted-living care, but there are plenty of add-ons and caveats that can add to the cost of home-based senior care.
Is Nursing Home Care Tax Deductible?
The short answer is yes, nursing home care and most professional senior care costs can be tax-deductible as legitimate medical expenses. You can deduct the full cost of nursing home care if you or your spouse or dependent resides in a nursing home care for medical/health care reasons. In that scenario, you can deduct the whole cost of nursing home care, including room, board, and meals. The IRS is prickly about seniors opting for nursing home care for non-medical reasons and doesn’t allow for deductions for seniors who reside in a nursing home for personal reasons (i.e., they like the environment and the facility, and are there for reasons other than health issues.) That “medical versus personal” area is a gray one in the eyes of the IRS, so it’s best to work with a trusted accountant or tax specialist to make sure you’re making the correct call when listing a nursing home expense as a deduction on your taxes.
Choosing the Right Nursing Home
Now that you’re more aware of the cost of a nursing home, what are the best action steps to take to choose the right one for yourself or a loved one?
If you or a family member has a close relationship with their physicians or has spent time in a hospital and care clinic, take advantage of that proximity to knowledge and ask a doctor, nurse or clinician for their “top votes” for nursing home care centers near you.
What matters to you in a nursing home selection process is a big issue and needs to be prioritized. If it’s the location to family, quality of the facility (i.e. cleanliness or access to regular medical care), good meals, or access to favored religious services, that matter, then say so upfront when you’re visiting home and vetting it.
Ask your friends, neighbors, and co-workers if they have any tips or inside knowledge on local nursing homes. Social media, the Better Business Bureau, and even local law enforcement or community centers are a good place to go fishing for solid nursing home information.
Visit the Center and Ask Other Families and Residents Staying There
Besides asking for references, which should be a staple when you’re vetting a nursing home, ask residents and their families what they like and don’t like about the facility. Anyone who spends regular time at a nursing home should be a great source of information and red flags concerning that facility. So make sure to ask around when you’re on site.
Medicaid is one of the most common ways to pay for a nursing home when you have no money available. Even if you have had too much money to qualify for Medicaid in the past, you may find that you are eligible for Medicaid nursing home care because the income limits are higher for this purpose. The specific income requirements will depend on your state. As it is a separate program, Medicare does not pay for long-term nursing home care, although in some cases, the insurance will cover a short-term stay (under 100 days) in a nursing home. Another option is to seek assistance from your state’s agency in the National Association of Area Agencies on Aging. This government program helps seniors access the local financial assistance services available to them.
Can I Be Kicked Out of My Assisted Living Community or Nursing Home if I Can’t Pay?
Once you find an assisted living community or nursing home you can afford in the present, it is important to ensure you can afford to stay there in the future if your resources run out. Always ask to see the care company’s policy in writing, so you know what will happen if your money runs out. In most cases, the bottom line is that yes, the care home can evict a resident who can no longer afford to pay. The requirements to kick a resident out for failure to pay vary from state to state. Generally, assisted living and nursing homes must notify you and your family at least 30 days before discharge, and also create a report summarizing your current mental and physical health status and your post-discharge plan of care.
If your money runs out and your family is not able to step in and cover costs, your options will depend on your state and whether you are residing in an assisted living or nursing home. At a nursing home, federal law entitles you to the right to file a hardship waiver with your state’s Department of Health and Human Services. A hardship waiver must document how the move would endanger your health or your access to shelter and food. While a federal hardship waiver does not apply to assisted living facilities, you can still reach out to government agencies, such as your Area Agency on Aging or your local long-term care ombudsman, which every state is required to have under the Federal Older Americans Act. Your ombudsman may be able to negotiate with the facility, secure financial aid to pay for your care or find you a new home. Finally, a lawyer may take your case and help you.
Elder Law Attorney
8833 S. Redwood Road, Suite C
West Jordan, Utah
84088 United States
Telephone: (801) 676-5506