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Selecting a Nursing Home or Long-Term Care Facility
Please use the questions below as a guide in selecting a nursing home or another long-term care facility for you or a loved one. It’s also a good idea to ask the home for a copy of its latest inspection and whether a volunteer ombudsman visits regularly. An ombudsman will advocate for your loved one and other residents. And remember, if you have a complaint about a home, or suspect an elderly or disabled person who lives there is being abused or neglected, call the Elderly Abuse and Neglect Hotline, 1-800-392-0210.
Do all facilities provide the same services and care?
What questions should I ask to choose an appropriate facility?
What should I look for when signing a long-term care facility contract?
What happens if I run out of money?
What is the cost of facility care?
Do all facilities take Medicare and/or Medicaid reimbursement for care?
What are my rights as a long-term care facility resident?
Do all facilities provide the same services and care
No, there are four levels of care provided by these facilities:
* A Residential Care Facility I (RCFI) provides shelter, board and protective oversight; this may mean it keeps and distributes medications and provides care during short-term illnesses or recuperation.
* A Residential Care Facility II (RCFII) provides additional services, including supervision of diets and assistance with personal care.
* An Intermediate Care Facility (ICF) provides board, personal care, basic health and nursing care services under the direction of a licensed physician and daily supervision of a licensed nurse.
* A Skilled Nursing Facility (SNF) provides board, skilled nursing care and treatment services commonly performed by or under the supervision of a registered professional nurse. Individuals living in an SNF require twenty-four hour care and other specialized nursing services.
What questions should I ask to choose an appropriate facility?
* Can the facility meet my or my loved one’s needs?
* Does it have a current state license?
* Does it accept Medicare and/or Medicaid?
* What problems were identified during the last survey or inspection? (A copy of the home’s last inspection should be posted or available in the home.)
* Are the residents treated with dignity?
* Is the home clean and odor free?
* Is there an ombudsman who visits regularly?
* Talk to residents and family members. What comments do they have?
Try to visit several homes or facilities, more than once if possible, and at different times. You’ll be able to see how staff interacts with residents at meal times and during afternoon or evening hours.
For a more complete checklist, contact your local Area Agency on Aging or the Missouri Long-Term Care Ombudsman Program at 1-800-309-3282 .
What should I look for when signing a long-term care facility contract?
Residents have rights secured by both state and federal laws (these rights are listed at the end of these questions). The admission agreement is also very important in defining a resident’s rights and obligations.
Carefully read the admission agreement and ask questions when you don’t understand something. The agreement must specify items and services included in the daily rate, and items and services not included.
It should also state how the facility handles emergency situations and when a resident may be transferred.
Each facility also has a “bed-hold policy” that specifies how residents can secure their bed, or a bed in the facility, if they have to go to the hospital.
The agreement must not require family members to be responsible for their loved one’s bills if their loved ones receive Medicaid.
What happens if I run out of money?
Many people enter a skilled nursing or an intermediate care facility as private pay residents and turn to Medicaid when their money runs out. If the home is Medicaid-certified, it must continue to care for a resident who eventually requires Medicaid if a Medicaid bed is available. To ensure continued coverage, request a Medicaid-certified bed upon admission. If there is a suspected diagnosis of mental illness, mental retardation, or related disorder, a special screening process may be required.
Placement in a Medicaid bed allows a person to take advantage of the “division of assets” program. The program helps ensure residents’ spouses who live in the community are not impoverished because of their loved one’s facility bills. A person can apply for Medicaid at his or her local Division of Family Services office.
In some instances, residents are eligible for a cash grant to help cover the costs of their care. The grant, funded by Missouri tax dollars, is available to eligible low-income persons through application at their local Division of Family Services office.
What is the cost of facility care?
Nationwide, the cost is around is $64,000 per year for a skilled nursing home. The average cost in a residential care facility is around $24,000. When selecting a facility, find out which services are included in the basic daily charge and which are not covered. Ask whether a deposit is required and the procedure for return of the deposit. (Medicaid residents do not have to give a deposit).
Do all facilities accept Medicare and/or Medicaid reimbursement for care?
Many skilled nursing and intermediate care facilities accept Medicare and/or Medicaid reimbursement, but residential care facilities do not. However, residential care facility residents may be eligible for state assistance through the Supplemental Nursing Care grant. In addition residential care facilities may participate in the Medicaid Personal Care Program. The Personal Care Program offers Medicaid-eligible residents assistance with activities of daily living. This program provides residential care residents an alternative to nursing facility care.
What are my rights as a long-term care facility resident?
Missourians who live in a long-term care facility licensed by the state are guaranteed certain rights under the Missouri Omnibus Nursing Home Act of 1979 and the federal Omnibus Budget Reconciliation Act of 1987. The rights are:
* You will be informed (at the time of admission to the facility and periodically during your stay) orally and in writing of your rights and responsibilities as a resident.
* You will be informed of the services available and related charges, including protection of personal funds if held by the facility, and all services not covered in the facility’s daily rate.
* You may purchase or rent goods or services not included in the facility rate from a provider of your choice.
* You will receive notice before room or roommate changes are made.
* You may examine results of facility inspections including plans of correction.
* You have the right to receive service with reasonable accommodation of your individual needs and preferences except when your health and safety or that of other residents would be endangered.
* You have the right to not have your life regulated beyond what is necessary in providing resident services.
* You have the right to retain your personal possessions as space permits.
* You have the right to be informed of all aspects of your care, to choose your own personal physician, to participate in planning your care and treatment, including any changes in care and treatment. You have the right to refuse treatment and to be informed of the consequences of such refusal.
* You shall be encouraged and assisted throughout your stay to exercise your rights. You have the right to voice complaints and recommend changes regarding personal care, behavior of other residents, conditions in the facility, or other unmet needs or expectations and to expect prompt efforts will be made to address complaints.
* You have a right to privacy for visits with your spouse and may share a room with your spouse if you are both residents and both agree to the cohabitation.
* You have the right to privacy and respect regarding accommodations, personal care, medical treatment, written and telephone communications and visits with other individuals.
* All information related to your medical, personal, social, or financial affairs will be kept confidential.
* You may be discharged or transferred only for medical reasons, for your own welfare or that of others, or for nonpayment. Pre-transfer and pre-discharge notices must be made at least 30 days in advance. Written notices must go to the resident, family member or legal representative or long-term care ombudsman if there is no family and include reasons for the action, the right to appeal and information on how to contact the State Long-Term Care Ombudsman. The facility must assist you in arranging other accommodations.
* You have the right to participate in resident councils and your family has the right to meet together in the facility with families of other residents.
* You may associate and communicate privately with persons of your choice. You may have free access to an ombudsman, your individual physician, or any representative of the state or federal government.
* You have the right to have appropriate activities for your participation and may engage in social, religious and community activities of your choice.
* You have the right to be free from physical or mental abuse, corporal punishment, involuntary seclusion and any physical or chemical restraints imposed for purposes of discipline or for convenience of the staff. Restraints may not be used except under the direction of a physician and only to treat your medical symptoms.
Nursing Home checklist
Checklists can help you evaluate the nursing homes that you call or visit. Use a new checklist for each home you call or visit. Then, compare the scores. This will help you select a nursing home that is a good choice for you or your relative.
Nursing Home Name: _________________________________________
Date Visited: __________________________
Address: ______________________________________________
1. Basic Information
1. Is the facility Medicare certified?:____(yes) _____(no)
2. Is the facility Medicaid certified?:____(yes) _____(no)
3. Is this a skilled nursing facility?:____(yes) _____(no)
4. Is the facility accepting new patients?:____(yes) _____(no)
5. Is there a waiting period for admission?:____(yes) _____(no)
6. Is a skilled bed available to you?:____(yes) _____(no)
Useful Tips
* Generally, skilled nursing care is available only for a short period of time after a hospitalization. Custodial care is for a much longer period of time. If a facility offers both types of care, learn if residents may transfer between levels of care within the nursing home without having to move from their old room or from the nursing home.
* Nursing homes that only take Medicaid residents might offer longer term but less intensive levels of care. Nursing Homes that don’t accept Medicaid payment may make a resident move when Medicare or the resident’s own money runs out.
* An occupancy rate is the total number of residents currently living in a nursing home divided by the home’s total number of beds. Occupancy rates vary by area, depending on the overall number of available nursing home beds.
2. Nursing Home Information:
1. Is the home and the current administrator licensed?:____(yes) _____(no)
2. Does the home conduct background checks on all staff?:____(yes) _____(no)
3. Does the home have special services units?:____(yes) _____(no)
4. Does the home have abuse prevention training?:____(yes) _____(no)
Useful Tips
* LICENSURE: The nursing home and its administrator should be licensed by the State to operate.
* BACKGROUND CHECKS: Do the nursing home’s procedures to screen potential employees for a history of abuse meet your State’s requirements? Your State’s Ombudsman program might be able to help you with this information.
* SPECIAL SERVICES: Some nursing homes have special service units like rehabilitation, Alzheimer’s, and hospice. Learn if there are separate waiting periods or facility guidelines for when residents would be moved on or off the special unit.
* STAFF TRAINING: Do the nursing home’s training programs educate employees about how to recognize resident abuse and neglect, how to deal with aggressive or difficult residents, and how to deal with the stress of caring for so many needs? Are there clear procedures to identify events or trends that might lead to abuse and neglect, and on how to investigate, report, and resolve your complaints?
* LOSS PREVENTION: Are there policies or procedures to safeguard resident possessions?
For Sections III through VI, give the nursing home a grade from one to five. One is worst, five is best.
3. Quality of Life:
Worst Best
1. Residents can make choices about their daily routine. Examples are when to go to bed or get up, when to bathe, or when to eat.
1 2 3 4 5
2. The interaction between staff and patient is warm and respectful.
1 2 3 4 5
3. The home is easy to visit for friends and family.
1 2 3 4 5
4. The nursing home meets your cultural, religious, or language needs.
1 2 3 4 5
5. The nursing home smells and looks clean and has good lighting.
1 2 3 4 5
6. The home maintains comfortable temperatures.
1 2 3 4 5
7. The resident rooms have personal articles and furniture.
1 2 3 4 5
8. The public and resident rooms have comfortable furniture.
1 2 3 4 5
9. The nursing home and its dining room are generally quiet.
1 2 3 4 5
10. Residents may choose from a variety of activities that they like.
1 2 3 4 5
11. The nursing home has outside volunteer groups.
1 2 3 4 5
12. The nursing home has outdoor areas for resident use and helps residents to get outside.
1 2 3 4 5
TOTAL: _____________
(Best Possible Score: 60)
4. Quality of Care:
Worst Best
1. The facility corrected any Quality of Care deficiencies that were in the State inspection report.
1 2 3 4 5
2. Residents may continue to see their personal physician.
1 2 3 4 5
3. Residents are clean, appropriately dressed, and well groomed.
1 2 3 4 5
4. Nursing Home staff respond quickly to requests for help.
1 2 3 4 5
5. The administrator and staff seem comfortable with each other and with the residents.
1 2 3 4 5
6. Residents have the same care givers on a daily basis.
1 2 3 4 5
7. There are enough staff at night and on week-ends or holidays to care for each resident.
1 2 3 4 5
8. The home has an arrangement for emergency situations with a nearby hospital.
1 2 3 4 5
9. The family and residents councils are independent from the nursing home’s management.
1 2 3 4 5
10. Care plan meetings are held at times that are easy for residents and their family members to attend.
1 2 3 4 5
TOTAL: _____________
(Best Possible Score: 50)
Useful Tips
* Good care plans are essential to good care. They should be put together by a team of providers and family and updated as often as necessary.
5. Nutrition and Hydration (Diet and Fluids):
Worst Best
1. The home corrected any deficiencies in these areas that were on the recent state inspection report.
1 2 3 4 5
2. There are enough staff to assist each resident who requires help with eating.
1 2 3 4 5
3. The food smells and looks good and is served at proper temperatures.
1 2 3 4 5
4. Residents are offered choices of food at mealtimes.
1 2 3 4 5
5. Residents’ weight is routinely monitored.
1 2 3 4 5
6. There are water pitchers and glasses on tables in the rooms.
1 2 3 4 5
7. Staff help residents drink if they are not able to do so on their own.
1 2 3 4 5
8. Nutritious snacks are available during the day and evening.
1 2 3 4 5
9. The environment in the dining room encourages residents to relax, socialize, and enjoy their food.
1 2 3 4 5
TOTAL: _____________
(Best Possible Score: 45)
Useful Tips
* Ask the professional staff how the medicine a resident takes can affect what they eat and how often they may want something to drink.
* Visit at mealtime. Are residents rushed through meals or do they have time to finish eating and to use the meal as an opportunity to socialize with each other?
* Sometimes the food a home serves is fine, but a resident still won’t eat. Nursing home residents may like some control over their diet. Can they select their meals from a menu or select their mealtime?
* If residents need help eating, do care plans specify what type of assistance they will receive?
6. Safety
Worst Best
1. There are handrails in the hallways and grab bars in the bathrooms.
1 2 3 4 5
2. Exits are clearly marked. 1 2 3 4 5
3. Spills and other accidents are cleaned up quickly.
1 2 3 4 5
4. Hallways are free of clutter and have good lighting.
1 2 3 4 5
5. There are enough staff to help move residents quickly in an emergency.
1 2 3 4 5
6. The nursing home has smoke detectors and sprinklers.
1 2 3 4 5
TOTAL: _____________
(Best Possible Score: 30)
Allen Memorial Home, ALABAMA
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Allen Memorial Home, ALABAMA Ratings |
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| Facility location | |
| Facilities are clean and well-organized | |
| Wheelchairs and other equipment is in working order | |
| Staff is welcoming and caring | |
| Nurses are knowledgeable, helpful and approachable | |
| Physicians are knowledgeable, helpful and approachable | |
| Staff responds quickly to calls | |
| Complains are handled effectively | |
| Activities and Entertainment | |
| Food quality | |
| Availability of special services | |
| Patient councel | |
Athens Convalescent Center Inc, ALABAMA
Athens Convalescent Center Inc, ALABAMA Ratings |
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| Facility location |
 (Excellent) |
| Facilities are clean and well-organized | |
| Wheelchairs and other equipment is in working order | |
| Staff is welcoming and caring | |
| Nurses are knowledgeable, helpful and approachable | |
| Physicians are knowledgeable, helpful and approachable | |
| Staff responds quickly to calls | |
| Complains are handled effectively | |
| Activities and Entertainment | |
| Food quality | |
| Availability of special services | |
| Patient councel | |
Andrew Residence, MINNESOTA
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Andrew Residence, MINNESOTA Ratings |
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| Facility location | |
| Facilities are clean and well-organized | |
| Wheelchairs and other equipment is in working order | |
| Staff is welcoming and caring | |
| Nurses are knowledgeable, helpful and approachable | |
| Physicians are knowledgeable, helpful and approachable | |
| Staff responds quickly to calls | |
| Complains are handled effectively | |
| Activities and Entertainment | |
| Food quality | |
| Availability of special services | |
| Patient councel | |
Auburn Manor, MINNESOTA
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Auburn Manor, MINNESOTA Ratings |
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| Facility location | |
| Facilities are clean and well-organized | |
| Wheelchairs and other equipment is in working order | |
| Staff is welcoming and caring | |
| Nurses are knowledgeable, helpful and approachable | |
| Physicians are knowledgeable, helpful and approachable | |
| Staff responds quickly to calls | |
| Complains are handled effectively | |
| Activities and Entertainment | |
| Food quality | |
| Availability of special services | |
| Patient councel | |
Auburn Home In Waconia, MINNESOTA
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Auburn Home In Waconia, MINNESOTA Ratings |
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| Facility location | |
| Facilities are clean and well-organized | |
| Wheelchairs and other equipment is in working order | |
| Staff is welcoming and caring | |
| Nurses are knowledgeable, helpful and approachable | |
| Physicians are knowledgeable, helpful and approachable | |
| Staff responds quickly to calls | |
| Complains are handled effectively | |
| Activities and Entertainment | |
| Food quality | |
| Availability of special services | |
| Patient councel | |
Adams Health Care Center, MINNESOTA
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Adams Health Care Center, MINNESOTA Ratings |
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| Facility location | |
| Facilities are clean and well-organized | |
| Wheelchairs and other equipment is in working order | |
| Staff is welcoming and caring | |
| Nurses are knowledgeable, helpful and approachable | |
| Physicians are knowledgeable, helpful and approachable | |
| Staff responds quickly to calls | |
| Complains are handled effectively | |
| Activities and Entertainment | |
| Food quality | |
| Availability of special services | |
| Patient councel | |
Augustana Chapel View Care Center, MINNESOTA
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Augustana Chapel View Care Center, MINNESOTA Ratings |
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| Facility location | |
| Facilities are clean and well-organized | |
| Wheelchairs and other equipment is in working order | |
| Staff is welcoming and caring | |
| Nurses are knowledgeable, helpful and approachable | |
| Physicians are knowledgeable, helpful and approachable | |
| Staff responds quickly to calls | |
| Complains are handled effectively | |
| Activities and Entertainment | |
| Food quality | |
| Availability of special services | |
| Patient councel | |