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Choosing a Texas Nursing Home

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Texas skilled nursing homes are certified to provide different levels of care, from custodial to skilled nursing (services that can only be administered by a trained professional). Before deciding which care setting is most appropriate for you or your loved one, talk to your doctor or a social worker and get a realistic assessment of your care needs. Remember that caring for someone who is very sick requires a lot of work.

On any given day, nursing homes are caring for about 1 in 20 Americans over the age of 65. Almost half of all persons turning 65 this year will be admitted to a nursing home for a period of time at least once in their lives.

After 100 days, Medicare no longer pays. If a resident has coverage under Medicare Part B and is eligible for the services provided, he or she will be responsible for 20 percent of the total charges for some of the following services: occupational therapy, speech therapy and physical therapy along with medical supplies.

How is eligibility for Medicare Part A benefits determined?

Planning Ahead

Planning ahead is the best way to ease the stress that accompanies choosing a nursing home and you will have more control over the selection process, more time to gather good information and make certain that everyone in your network is comfortable with the ultimate choice.

Unfortunately, a great many people must select a nursing home with little notice, frequently during a family crisis or right after a serious illness or operation. If you are in this situation, the following should still be helpful. The following steps will help in providing you with information on choosing the nursing home that is right for you or your loved one.

There are also some types of basic information that should help you narrow your list of nursing homes. Consider some of the following factors:

• It is usually a good idea to consider nursing homes that your family and friends can visit easily. In most cases, it is a mistake to select a nursing home that is difficult to visit on a regular basis. Frequent visits are the best way to make sure that you or your relative does well in the nursing home. Visitors are important advocates for chronically ill residents. Frequent visits often make the transition to the nursing home easier for new residents and their families.
• If you have religious or cultural preferences, contact the nursing homes on your list and see if they offer the type of environment that you would prefer.
• If you will be using Medicare or Medicaid, make certain that the nursing homes on your list accept Medicare or Medicaid payment. Often, only a portion of the home is certified for Medicare or Medicaid, so make sure that the home has Medicare or Medicaid "beds" available
• If you belong to a managed care plan that contracts with a particular nursing home or homes in your area, make sure the homes you are considering have contracts with your HMO.
• Make certain that the nursing homes on your list will have space available at the time you might need to be admitted.
• If you require care for special medical conditions, such as Alzheimer's or dementia, make sure that the nursing homes on your list are capable of meeting these special circumstances.

Payment Options

Nursing home care is expensive. A skilled nursing home will cost about $200 or more a day in many parts of the country.

For most people, finding ways to pay for nursing home care is a major concern. There are several ways that nursing home care is paid for:

• Personal Resources: About half of all nursing home residents pay nursing home costs out of their own savings. As personal resources are spent, many people who stay in nursing homes for long periods eventually become eligible for Texas Medicaid.
• Long Term Care Insurance: This is private insurance designed to cover some long-term care costs. For more information, see the section on long-term care insurance in this guide.
• Medicaid: Medicaid is a State and Federal program that will pay most nursing home costs for people with limited income and assets. Medicaid will only pay for nursing home care provided in Medicaid-certified facilities.
• Medicare: Under certain very limited conditions, Medicare will help pay some nursing home costs for Medicare beneficiaries who require skilled nursing or rehabilitation services. To be covered, you must (after a qualifying hospital stay) receive the services from a Medicare-certified skilled nursing home.
• Medicare Supplemental Insurance: This is private insurance (often called Medigap) that pays Medicare's deductibles and co-insurances, and may cover services not covered by Medicare. Most Medigap plans will help pay for skilled nursing care, but only when that care is covered by Medicare. In addition, some people have nursing home costs covered, or partially covered, by managed care plans or employer benefit packages.
   

Visiting Nursing Homes

The nursing home visit is probably the most important step in choosing the right nursing home for you or your loved one. A visit provides you with an opportunity to talk to the nursing home staff, and more importantly, with the people who live and receive care at the nursing home. Before you visit a nursing home for the first time, call ahead to make an appointment for a formal tour of the nursing home. The best time of the day for a first visit is late morning or midday so you can observe mealtimes and scheduled activities. But remember, while a formal tour is a very useful introduction to the home, it is important that you are not overly influenced by the guided tour.

When the tour is over, return to some of the places where the nursing home staff are caring for residents. (Remember to ask permission first, and respect other resident's privacy). Ask to examine the nursing home's most recent state report (inspection). By law, this report must be posted in an area that is accessible to visitors and residents. Ask to speak with the nursing home social worker to help answer any questions you may have.

Admissions

When the final decision is made, contact your nursing home choice on specific instructions regarding official admission to their facility. Make sure you talk to the nursing home administrator and/or social worker to help you through the process.

The nursing home will need a variety of financial, legal, and medical information on your loved one. Make sure you read through all the paperwork carefully before signing. The nursing home must inform you, in writing, about its services and fees before entering the nursing home. Be aware of any extra charges for personal services, such as haircuts and telephones.

* * If you are applying for admission to a nursing facility for care that will be covered by your Medicare or Medicaid coverage, it is unlawful for the facility to require you to pay a cash deposit. The facility may, however, request that a Medicare beneficiary pay coinsurance amounts and other charges for which the beneficiary is liable. You pay those charges as they become due, not before.

A facility may require a cash deposit before admission if your care will not be covered by either Medicare or Medicaid. Resolve any concerns or problems you may have before admission to the nursing home. Remember, you can call your Long Term Care Ombudsman if you need any assistance.

Handling Complaints

It is important that nursing home residents get good, quality care. You can help to make sure your loved one gets that care by visiting often, expressing your concerns whenever they arise, and by being active in the nursing home's family council.

If you are unable to resolve any problems on your own, the following resources can help:

• Your The Texas Long-Term Care Ombudsman (1-800-252-2412) can help solve problems.
• The Texas Nursing Home Advocacy Project (1-800-622-2520) operates a free telephone hotline that gives you information and assistance with nursing home issues.

To access detailed information about the past performance of every Medicare and Medicaid certified nursing home in the country, visit the Nursing Home Compare Database, a service made available by Medicare.Gov

For more information on nursing homes in your area visit the Texas Department of Aging and Disability Services.