What Qualifies a Person for a Nursing Home?
September 15, 2023 / Nursing Home
As your loved ones begin to age, there are a number of concerns you may begin thinking about, especially when it comes to keeping them safe and comfortable. Nursing homes are one of the most well known long term care options, designed specifically for seniors who have serious health concerns or need an advanced level of supervision and care. Since nursing homes are designed for this specialized care, there are certain criteria an individual must meet to be admitted to a nursing home. The team at Senior Care AZ, a senior placement agency in Arizona, is breaking down these criteria: the requirements to be admitted to a nursing home, a checklist for seniors considering it, and how individuals can pay for nursing homes.
What Is a Nursing Home?
A nursing home is a skilled residential facility that provides a high level of care for aging adults who are dealing with serious or chronic medical conditions. Residents in a nursing home generally receive 24 hour supervision and care, and they will reside in a hospital-like setting where they may share a room and bathroom with another resident. Nursing homes provide assistance with activities of daily living, such as dressing, grooming, and using the restroom. They also provide three meals a day, medication management, and an advanced level of medical and nursing care. Nursing homes can also offer palliative care, mobility assistance, nutritional services, and different therapies to residents who may need these services. Some nursing homes are structured like rehabilitation facilities, where residents will live in the short-term while they are recovering from an injury, surgery, or a stay in the hospital. Other facilities are designed to be long-term care options for seniors who will not go back to living independently.
Nursing Home Requirements
Nursing homes are intended to serve seniors who have serious or chronic health conditions and require 24/7 supervision and an advanced level of medical and nursing care. In order to be admitted to a nursing home, a senior must meet the criteria for admission from their state of residence, and if any medical conditions are affecting the decision to be admitted, these conditions must be documented by a medical doctor.
State Nursing Home Admission Requirements
The requirements for admission to a nursing home vary state by state, although the Centers for Medicare and Medicaid Services do set some general guidelines that states must follow. In general, the admission requirements will involve an assessment of an individual’s physical and cognitive health. Contacting your local Medicaid county office will provide the most up to date information on admission requirements in your state.
Medicaid and Medicare Qualifications
In some cases, Medicaid or Medicare may reimburse seniors or their families for their nursing home costs if they qualify. To meet these qualifications, individuals must meet certain medical and financial criteria. Similar to the admission requirements, these criteria vary from state to state. Contacting your local Medicaid office will provide the most up-to-date financial requirements for Medicaid or Medicare coverage.
Assessment of Health Care Needs
In order to verify that a senior meets all the necessary qualifications for nursing home admission, they must go through an assessment of their health care needs with a physician. The physician will work to get a holistic picture of their current medical, physical, and cognitive health state. They will also take note of any previous conditions, chronic conditions, or other medical concerns. If your loved one is currently in the hospital and considering the transition to a nursing home, a doctor on staff at the hospital will likely complete this assessment. If your loved one is not in the hospital, you can make an appointment with their primary care physician to complete the assessment.
Nursing Home Checklist
There are certain documents it is necessary to collect prior to beginning the admissions process for a nursing home. These documents include:
- A Physician’s Order for Admission: After a doctor completes the assessment of health care needs, they will likely write an order for admission, which is similar to writing a prescription. This order states that a doctor has reviewed the individual’s medical state and determined they are qualified for nursing-home level care.
- Physician’s Order for Medication and Treatment: Upon admission to a nursing home, seniors will have new doctors and nurses to care for them. In order to ensure continuity of care, their previous primary care physician will write them an order for medication and treatment, providing background and information on their care.
- Medical History and Physical Examination: Similar to the order for medication and treatment, the primary care physician will provide a report on the medical history and latest physical examination.
- State Required Form: As mentioned, each state has required qualifications for nursing home admission. This form can be obtained at a nursing home where a senior is considering admission, and a doctor can fill out this form with the necessary information.
- Health Care Tests: Nursing homes will be required to provide flu shots, pneumonia vaccines, and TB tests within a few days of admission, but if an individual has had these tests or immunizations recently, they will need to provide proof.
- Completed Admissions Paperwork: While necessary information varies greatly between facilities, it is often necessary to fill out this information at a facility with a faculty member. When filling out this paperwork, you will often need the resident’s social security card, Medicare or Medicaid card, insurance card, and their consent to be treated. This can come from the patient themselves or their Power of Attorney.
How to Pay For Nursing Homes
The most common ways that seniors and their families pay for skilled nursing facilities are through government health programs such as Medicare and Medicaid, as well as other types of long-term care and health insurance, private pay options, retirement funds, and social security benefits.
Does Medicare Pay for Nursing Homes?
Most skilled nursing facilities offer both long-term care and short-term care options, which are structured more like rehabilitation facilities. Medicare provides coverage to individuals who are 65 and older and will generally cover short-term rehab stays in a skilled nursing facility but will not cover the costs of a long-term stay in a skilled nursing facility.
Does Medicaid Pay for Nursing Homes?
Medicaid is a state and federal program that covers medical costs for individuals with limited income or resources. Medicaid generally covers the costs of a long-term care facility if a senior qualifies based on their income and financial assets. Eligibility requirements for Medicaid to cover the costs of skilled nursing facility care vary on a state by state basis, so working within the guidelines for your state of residence will be necessary to determine benefits. Most skilled nursing facilities accept Medicaid, but some do not, so it is important to check with the facility prior to admission.