Nursing Homes

Conversely, more than 60 percent of adults haven't planned ahead for retirement. Of those who have, nearly half didn't factor in long-term care. Of those who did, around 40 percent did nothing about it.

For many seniors, financial assets will dictate which type of senior housing to select.

Average Costs

The average rate for a private room in a nursing home is approximately $200 a day, nearly $74,000 a year. This is more than double the cost of a single bedroom unit in assisted living quarters.

How are long-term care facilities paid for?

• 36 percent of long-term care spending is covered by private pay providers.
• 17 percent of long-term care spending is paid for by Medicare.
• 47 percent of long-term care spending is paid for by Medicaid.

When to Consider a Nursing Home

Assisted living or adult day care may be sufficient to meet the needs of the senior who needs moderate care and support. A nursing home or skilled nursing facility may be necessary if someone:

• needs access to 24-hour nursing care,
• may endanger themselves, including by wandering, without supervision,
• needs substantial or comprehensive help with activities of daily living (ADL),
• needs more help than the current caregiver can possibly give,
• should not live alone.

Choosing a Long-Term Care Facility

Consider what is important to the senior, such as social, religious, and recreation preferences. When you evaluate a convalescent home, consider strongly if you would feel reassured leaving your loved one there.

• Location: Consider locations accessible to both family and friends.
• Referrals: Ask doctors, social workers, local hospital discharge planners, and religious or welfare organizations.
• Ombudsman: Each state has a long-term care Ombudsman. These representatives are equipped to answer many questions about long-term care facilities. The Ombudsman is also useful for solving problems once the patient resides in a facility. To locate the Ombudsman, call 1-800-677-1116 or visit eldercare.gov.
• Veterans: Retired military may be able to get help through the Department of Veterans Affairs programs. Find out more information at www.va.gov, by calling 1-877-222-8387, or contacting the VA medical center nearest you.

Questions to Ask

• Phone Inquiries: Make a list of possible facilities and call each one. Ask questions about:
  • Openings
  • Waiting lists
  • Costs
  • Payment methods
  • Occupancy statistics
  • Services

Inquire about the nursing home's connection with Medicare and Medicaid. If the senior has Alzheimer’s or dementia-related disease, find out what special services are available.

• Visit: Schedule appointments to meet with both the director of nursing and the director of social services. Educate yourself about:
  • Certifications
  • Handicap access
  • Staff involvement with current residents
  • Volunteers

Note the residents' appearance. Be aware of the odor of the nursing home, is it poor or overtly fragranced? Find out how often the staff doctor visits and/or about coordination with the senior's personal physician.

• Accreditations: If the facility is a member of the Joint Committee on Accreditation of Healthcare Organizations, ask to see the JCCAHO review of the home. Evaluate other accreditations, including for Medicare and Medicaid.
• Repeat Visit: Arrive at the nursing home unannounced and on another day of the week or time of day. This will also allow you to meet other nursing home staff members and further review the facilities conditions. Are your first impressions the same?
• Financial Contract: Once you or your relative have decided on a facility, be sure to understand their contracts and payment plans. Consider if you need a lawyer to review the documents before signing.

Fees and Financing

Learn as much as you can about the nursing home's fee structure and payment alternatives.

• Are fees competitive? Have fees increased significantly in the past few years?
• What are the billing, payment and credit policies?
• Are there variable costs for various levels or categories of services?
• What services are covered in the quoted fee and what services are extra?
• What governmental financing options are available (Medicare, Medicaid, Medicare Supplemental Insurance, Supplemental Security Income)?
• When may a contract be terminated? What is the refund policy?

Medicaid and Medicare

Be sure that the senior applies for coverage as soon as they are eligible, approval delays of up to 90 days are common.

For information on Medicare and Medicaid see LoveToKnow's Medicare and Medicaid sections. For additional information on coverage and how to apply for these programs see: Medicare.gov

Related Senior Housing Links

• Senior Housing
• Elder Care
• Assisted Living
• Home Health Care
• Senior Services