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Selecting a Nursing Home

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Deciding upon nursing home placement is never easy. Families of individuals with a diagnosis of Alzheimer's disease and/or a related dementia have a particularly difficult task because often the diagnosed individual can not participate in the decision. This leaves it up to the family to decide when and where to move their loved one.

Moving a family member brings many decisions and, ultimately, they are personal decisions. Professionals and friends can help with information and discussing options, but the family knows the diagnosed individual and their circumstances in a way that others can not. Sometimes circumstances leave the family little choice (a sudden hospitalization and few openings at local homes), but for families coping with Alzheimer's disease or a related dementia on a day to day basis there is often time to plan for long-term care, and it is in the patient's and family's best interest to plan ahead

Considerations for planning for long-term care include, but are not limited to, the cost of care, type (or level) of care needed, the location of the home and the family's comfort level with the facility. A checklist of specific considerations is included in this nursing home packet to assist with decision making once the choices have been narrowed.

Cost

The cost of nursing homes vary, dependent on the home and the type of care being provided. The average cost nationally is $42,000 per year, and in Northern Virginia it is often higher. This cost is paid privately by the diagnosed individual, state Medicaid programs and to a much smaller extent by Medicare and other insurance plans.

Medicare: Medicare covers short-term skilled care up to 100 days. Only the first 20 days are covered at 100% and from day 21 to day 100 the patient's copayment is $95 per day (1997). To meet the criteria for Medicare the patient must have a three day hospitalization and be in need of skilled care. Admission must be within 30 days of hospitalization and the patient must be in need of services for which he/she was treated in the hospital.

Medicaid: Medicaid is a state/federal program that does pay the cost of nursing home care for eligible individuals. The patient must meet income and resource requirements, although for spousal couples there are provisions under the law to provide some protection for the well spouse. The Medicaid programs are administered on a local level and applications are made through the county social services departments. The Alzheimer's Association, Northern Virginia Chapter has a list of these departments.

Often patients will enter nursing homes as a private pay patient, but once their resources are "spent down" they may apply for Medicaid. Homes often ask detailed financial questions on the admissions application to ascertain how long the patient can pay privately before needing to apply for Medicaid.

Other Insurance: Long-term care insurance and a very few health insurance policies will pay for nursing home care. Families need to check carefully any plans they have as to the requirements to make use of the benefits offered.

Type of Care

Nursing homes usually distinguish between skilled care and custodial (or intermediate) care. Skilled care is covered, short-term by Medicare and sometimes by other insurance. Examples of care which could be considered skilled care are, physical therapy after a joint replacement or a stroke, nursing services such as IV therapy, dressing changes for a stage 3 wound or new tube feedings. Custodial care, which is not usually covered by insurance, other than Medicaid, encompasses much of the care provided in nursing homes. It usually includes assistance with most activities of daily living such as assistance with eating, dressing, bathing, medication management, and walking.

Most patients with Alzheimer's disease or a related dementia require custodial care. Some homes have designated Alzheimer's or dementia units to meet the special needs of those with cognitive impairment. Currently most homes self-define their dementia unit and what is included can vary considerably from home to home. Many have precautions for those who may wander, special training for staff in dealing with difficult behaviors, activities geared for those with memory loss and other environmental considerations. Families will want to ask the home what makes their dementia unit specialized. Additionally, not all patients with dementia necessarily require a specialized unit. Caregivers know the patient best and their particular needs. It is essential to visit all homes under consideration in order to make an informed choice. Families may want to visit more than once, at different times, to observe the routine of the home.

Location and other considerations

A location convenient to the family is an important consideration. Sometimes due to availability or for financial reasons it is not possible to find a home which is close to the family. If a home is convenient it does allow frequent visits which can be of comfort to the family and allows them more opportunity to monitor the care being provided. Forming relationships with the staff and working together will benefit everyone.

Families who have a physician with whom they would like to continue, should check with him/her to see if they provide care in any nursing homes and which ones. If your MD does not practice in nursing homes, the homes have a list of physicians who regularly visit there. The family may want to go over this list with their current MD for recommendations.

Finally, families will want to consider their comfort (gut feeling) and the patient's comfort with the home and staff.


In the Northern Virginia Chapter Service Area, for more information about Selecting a Nursing Home, please contact the Chapter's telephone Helpline at 703-359-4440 or 800-207-8679. Outside Northern Virginia, please contact your local Chapter.

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Last updated: March 1, 1999

Please return to https://www.alz-nova.org or
call 800-207-8679 or 703-359-4440
for more information about services in Northern Virginia.

© 1997 - 2000 Alzheimer's Association, Northern Virginia Chapter. All rights reserved.

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