5. Finding Nursing Homes can be complicated

Finding the right Nursing Homes in New York City can be tough.

Many Nursing Home communities charge a basic rate that covers all services, with an additional fee for special services. Most assisted living communities charge a month-to-month rate, but there are also long-term options available.

Typically, base rates only cover room and board and a service of daily meals, determined by the assisted living community. Sometimes there are entrance fees, deposits and laundry and housekeeping fees. But because these all vary by community, it’s important to ask each community about their individual costs and services.

According to Genworth.com, the average cost for a one-bedroom assisted living apartment in the U.S. in 2014 was $3,500 per month; an increase of 1.19% over 2013 with a five-year annual growth of 5.71%. Studio and two-bedroom assisted living apartments varied, accordingly.

Some of the things to consider when looking for the right Nursing Home would include:

Understanding the Problem

A nursing home becomes a valuable option when the amount of medical care and nursing attention the older person needs annot be provided at home. Problems such as frequent incontinence, dangerous wandering, inability to sleep at night (a disrupted sleep – awake cycle), or agitation that is harmful can be very difficult to manage. If so, it may be time to consider placement in a nursing home so that the older person can have the care he or she needs.

It is very important to include the older person as much as possible in deciding whether to go to a nursing home or other care setting. If the older person is mentally alert, he or she should be involved in the process every step of the way.

Moving from one’s home to a nursing home is a big life change. Adjusting to the move and becoming comfortable will take time. Both the family care giver and the older person will need patience during the adjustment period. 

Consider the first month in the nursing home as a trial period when you can help ease the transition for the older person. Visiting frequently for short time periods can be more helpful during the adjustment phase than staying for hours at a time.

You can play an important role in assuring that the older person receives good care by being involved during this transition by visiting often, speaking with the staff, and participating in both the care planning sessions and nursing home’s family council. If there is no family council, consider starting one. Talk with the activities director and see if you can help in some of the activities and outings for the residents.

Finding suitable alternative living arrangements is becoming more complex since there are a number of community resources that provide various levels of care. The resources vary from community to community and, with the exception of nursing homes, standard definitions based on services provided are generally lacking. Moreover, terminology and regulation varies from state to state. Funding sources for the different care facilities vary also.

Nursing homes are residential care facilities that provide a range of services. Both federal and state regulations require that a doctor or his or her designee will routinely visit an individual living in a nursing home, assess the resident’s health status, and monitor the plan of care. 

Licensed nursing staff are in the facility 24 hours a day. Some nursing homes provide secure units specifically for persons with dementia. There are several types of nursing home care that you might want to consider, depending on the person’s needs.

Skilled nursing care provides 24-hour licensed nurse coverage and rehabilitation services. These facilities provide care for both short term and long-term stays. An example of a short-term stay would be one following hospitalization to repair a fractured hip which would require a stay of two to four weeks for physical therapy. 

An example of a long-term stay would be care for someone for whom care could no longer be safely provided in the home or for someone who is not expected to recover the ability to care for himself or herself.


Alternatives to Nursing Home Care:

Adult Day Care is used commonly for patients with dementia who need supervision and assistance with their activities of daily living (ADLs) such as toileting, bathing, eating etc., while primary caregivers work.

Assisted living facilities are residential facilities that provide individual rooms, two to three daily meals, and activities for senior citizens who can no longer live alone but do not require 24-hour nursing supervision. These facilities are sometimes referred to as congregate care or congregate living facilities and have grown in number recently. 

Assisted living facilities provide 24-hour on-site support and assistance including help with medicines and personal hygiene. Many assisted living facilities offer a secured Alzheimer’s unit. These facilities are prohibited from providing skilled nursing services and are regulated under a different set of state regulations than those governing a nursing home. If skilled nursing services are required, these services can be provided by a separate home health agency as directed by a doctor or his or her designee. 

There is no doctor involvement in the plan of care for an individual residing in an assisted living facility nor are doctors required to visit, either by state or federal law. An older adult still should receive primary care from their community physician or from a physician who may have an office practice on site at an AL facility.

Board and care homes are generally smaller, more home-like residences for individuals who can no longer live independently. These facilities provide room, board, and assistance with some activities including managing medicines and help with personal hygiene. Fees and services vary from one site to another. The size of the residence determines whether or not it is regulated by a state agency and this varies from state to state.

Sheltered Housing is subsidized through Housing and Urban Development. Programs may be supplemented by social work services and activities coordinators. Personal care assistance, housekeeping services and meals are sometimes offered.

Continuing care retirement communities (CCRCs) usually have all levels of living arrangements, ranging from independent living to nursing home care. The financial requirements for a person to enter a CCRC will vary according to whether health care is included in the total cost or charged only if used. In general, CCRCs are reluctant to accept people directly into the assisted living or nursing home facilities.


Paying for Nursing Homes:

Paying for nursing home care is a major concern for most individuals. If persons enter a nursing home directly from a hospital, Medicare will often pay, but only for a limited time. When persons enter from their own home, they usually pay for the nursing home stay. When personal financial resources are spent, many nursing home residents become eligible for Medicaid. 

Medicaid is regulated by both federal and state laws and provides funding that will pay most nursing home costs for people with limited income and assets. Eligibility for Medicaid varies by state and is provided only to persons in Medicaid-certified facilities. A Medicaid-certified nursing home must continue to provide care for a resident whose personal funds are spent while residing there. 

A nursing home that does not participate in the Medicaid program can discharge the resident. Some nursing homes try to avoid admitting residents who are currently or will soon become Medicaid recipients as they can charge private paying residents a higher fee than they would receive under the Medicaid program.

Medicare, which pays for a number of health care services including hospitalization and limited nursing home stays for episodic illness, will not pay for long-term care in a nursing home. If the older person has long-term care insurance, this can, under certain circumstances, be used to pay nursing homes expenses. 

If you are considering purchasing long-term care insurance for possible future use, be sure to check the costs carefully, read the small print, and review the background and track record of the company involved. It is currently recommended that people consider purchasing long-term care insurance as they approach the age of fifty. Premiums for long-term care insurance increase as one ages and vary in cost with the number of chronic conditions present and type of coverage desired.


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