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Skilled Nursing As A Long Term Care Option – Know the Medicare Policy

A nursing home, also known as a skilled nursing facility, is a place for people who no longer need to be in a hospital but are unable to care for themselves at home and require some medical assistance. Most nursing homes have skilled nurses on hand 24 hours a day. A doctor can help patients decide if a nursing home is the best choice for their situation. Some nursing homes are set up like hospitals. The staff provides medical care as well as physical, speech and occupational therapy. There is most likely a nurses’ station on each floor. As a rule, rooms are shared by two residents but most have options for private rooms. Many residents and their families hang photos or other personal memorabilia to create a more home-like atmosphere. Other nursing homes are designed to be more like homes and the day-to-day routines are less structured. Staff and residents seek to create a neighborhood feel. Kitchens are sometimes open to residents and staff is encouraged to develop strong relationships with the residents.

Some nursing homes have visiting doctors who see their patients on site. Other nursing homes provide transportation for residents to visit their doctor’s office. Nursing homes sometimes have separate areas called Special Care Units for people with conditions such as Alzheimer’s and other dementias. When considering a nursing home for yourself or a loved one, it is important for families to think about any special needs that are present or may be anticipated in the future. Look. What choices are in your area? Is there a place close to family and friends? What’s important to you—nursing care, meals, a religious connection, hospice care, or Special Care Units for dementia care?
Ask. Talk with friends, relatives, social workers and religious groups to find out what places they suggest. Ask doctors which nursing homes they feel provide good care. Call. Get in touch with each place on your list. Ask questions about how many people live there and what it costs. Inquire about waiting lists. Visit. Make plans to meet with the facility director and the nursing director.

Important things to look for:
Medicare and Medicaid certification
Handicap access
Strong odors (either bad or good)
Food choice options
Residents who look well cared for
Staff to patient ratio

Talk. Don’t be afraid to ask questions. Ask how long the director and department heads such as nursing, food and social services have worked at the facility. If key staff members change frequently, there may a problem. Visit again. Make a second visit without calling ahead. Try another day of the week or time of day so you will meet other staff members and see other activities. Stop by at mealtime and observe if residents seem to be enjoying their food. Understand. Once you choose, carefully read the contract. Check with your State Ombudsman for help if the contract is not fully understood.

Do Nursing Homes Have to Meet Standards?
The Centers for Medicare and Medicaid Services (CMS) requires each State to inspect any nursing home that receives money from the government. Homes that do not pass inspection cannot be certified. Ask to see the current inspection report and certification of homes you are considering. A good website to check for certification policies is Medicare.gov.

Payment Options for Nursing Home Care
Medicare. Many people mistakenly believe Medicare will pay for long term stays in a nursing home, but it does not. For example, Medicare will only cover all or portions of the first 100 days in a skilled nursing home for someone who needs special care or rehabilitation after leaving the hospital. State/Federal Medicaid programs may pay for long term nursing home care, but there are many stipulations for qualifying. It is important to check with Medicare, Medicaid, and any private insurance company to find out the current rules.

In order for Medicare to pay for care in a skilled nursing facility the patient must have been in the hospital for three consecutive days. Then, no later than thirty days after discharge from the hospital, be admitted to a Medicare certified nursing facility. If these criteria are met, then days 1 through 20 in a skilled nursing facility are paid 100% by Medicare.  For days 21 through 100, Medicare pays all except your co pay which is currently $137.00 per day. The rate changes yearly and in 2008 was $128.00 per day. From days 101 and beyond, regardless of your condition, you are responsible for all of the facility costs. Medicaid. This State/Federal program provides health benefits to some people with low incomes and lack of resources to pay. According to Medicare.gov, if your income and resources are limited, you may be able to get help to pay for skilled nursing and other health care costs. If you qualify for both Medicare and Medicaid, most health care costs are covered. You may also qualify for the Medicaid nursing home benefit or the Programs of All-inclusive Care for the Elderly. Call your State Medical Assistance (Medicaid) Office for more information.

Once you have met the requirements of your state’s Medicaid program, keep in mind it can take up to 90 days to be approved. Private pay. Some people pay for long term care with their own savings for as long as possible. When that is no longer feasible, they may be eligible for Medicaid benefits. If you think you may need to apply for Medicaid in the future, ask the facility to make sure they accept that type of funding and if they are Medicare/Medicaid certified. Long-term care insurance. Some people buy private long term care insurance. It can pay part of the costs for a nursing home or other long term care such as an assisted living residence. Long term care insurance is sold by many different companies and benefits vary widely. Look carefully at several policies before making a choice.

800Seniors.com is a leading referral system in the Elderly Healthcare industry. We are located on 5400 Atlantis Court, Moorpark, California 93021. 800Seniors.com provides the perfect match between seniors searching for health care provisions such as Home Care, Home Health, Skilled Nursing Los Angeles, Hospice Care, Medical Supplies, as well as a variety of Assisted Living and Care Homes nationwide. Take the confusion and hassle out of the search. For more information call 1-800-768-8221, visit http://800seniors.com or fax us your details at (805)517-1623.

About The Author: Gloria Ha’o Schneider is an expert in senior citizen and baby boomer issues. Her topics revolve around Senior Living and Healthcare to provide the latest information to this demographic as well as their families and loved ones.

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