No one wants to go to a nursing home if they can live safely in their own home. However, if you require health related care and services for your safety, you may need to go to a nursing home. For some this may be temporary while recovering from surgery or an illness, for others it may be a long term stay. In either case, the transition to living in a nursing home may be difficult for you as well as for your family and friends. Finding a nursing home that works best for you is important. Understanding the admission agreement before it is signed is also important.
Before deciding that a nursing home is right for you, check into the possibility of help for your care needs at home or look into an assisted living facility. You may be eligible for Medicaid help to pay for these services through one of the Home and Community Based Service waiver programs, including the Elderly Waiver Program if you are over age 65.
What do I look for in finding a nursing home?
Most people are looking for a nursing home in their home community, that is close to family and friends. They are looking for a nursing home that provides quality care and a pleasant place to live. This includes caring nursing staff and other staff, a comfortable room, good meals, pleasant building and facilities, friendly residents, varied activities, and a welcoming attitude toward your family and friends. Some people may need a nursing home to provide specialty care such as a memory care unit.
A family member, power of attorney agent or guardian may be helping find a nursing home. This information should be shared with them as you look for a nursing home to meet your needs.
What resources are available to check on the quality of a nursing home?
- Check for recommendations of people you know who have family and friends in area nursing homes. Ask about the quality of care and life for their loved ones in the nursing home. Ask what they like about the nursing home and what they don’t like.
- Contact the Iowa Long-Term Care Ombudsman Office for information about nursing homes in your area. They have an excellent Nursing Facility Checklist for helping you evaluate a nursing home. This includes questions to ask the administrator and director of nursing, questions to ask nursing staff, questions to ask residents in the nursing home and their family members, and questions to ask yourself after visiting a nursing home.
- Nursing homes in Iowa are required to be certified by the state. They are regulated by the Iowa Department of Inspections and Appeals (DIA). What is found during an inspection is reported in a “Statement of Deficiencies”. The inspection reports and findings of complaints are available to the public. Nursing homes are required to have a copy of the Statement of Deficiencies on display for the public.
- The complaints and reports can also be viewed by going to the DIA website below https://dia-hfd.iowa.gov/DIA_HFD/Home.do
- You can also check on information reported to the federal government about nursing homes. This is found on Medicare’s Nursing Home Compare website. The list has information about every Medicare and Medicaid certified nursing home throughout the country: https://www.medicare.gov/care-compare/.
What’s next after I have a list of possible nursing homes?
- Visit the nursing home with a family member or friend. Call to set up a visit. Talk with people there. Ask if you can eat a meal at the nursing home and see the rooms and facilities. Are staff members friendly? Are residents relaxed and friendly? Is the facility clean and in good repair? Is there an outdoor area for residents?
- Use the checklist of questions from the Iowa Long-Term Care Ombudsman or Medicare website to check out the nursing home or make your own list of questions. Ask about how the nursing home will handle your care needs. Also ask questions about other things that are important to you, such as: Can I decorate my room? What activities are available including options for religious activities? What is the food like and does it meet my dietary needs? Can I have visitors at any time? Are there meeting rooms for family meals or events? Will I be able to keep my same doctor? Are pets allowed in the nursing home?
- Ask to take home for review a copy of the nursing home admission agreement as well as nursing home policies and rules.
- Before making a final decision on a nursing home, you may also want to drop in for a second visit without an appointment to confirm your first impression.
What should I look for before signing an agreement with the nursing home?
- Is the nursing home Medicare certified? Does it accept Medicare payments? Medicare pays for nursing home care for a limited time in certain situations such as for rehabilitation after surgery.
- Is the nursing home Medicaid certified? Does it accept Medicaid if you don’t have resources to pay your own way or if you run out of money?
- To be admitted to the nursing home, is it required that you be able to pay the cost of nursing home care out of your savings for a certain period of time?
- Is there a room currently available?
- What is the cost for nursing home residence and care? How are costs and fees calculated and billed? Ask for a copy of their fee schedule.
- You should carefully read the nursing home agreement before signing. If you have a family member or power of attorney agent helping you, they need to carefully read the agreement. Ask the nursing home administration staff to answer your questions.
- NOTE: A family member or your power of attorney agent may sign the admission agreement on your behalf. It is important that this signing makes clear that your agent is signing on your behalf and not their own. You, as the resident, and your spouse are legally responsible for the cost of the nursing home care. Your other family members and your power of attorney agent are not liable for the cost unless they sign to accept personal liability. Your power of attorney agent should sign as shown below to make clear they are signing on your behalf:
_____Your Name by ______________________ as Agent
Nursing homes do not have to accept all applications for residents. Civil rights laws provide protections, however, against illegal discrimination.
Payment for Nursing Home Care
The cost of nursing home care is very expensive. The general rule is that you and your spouse must pay nursing home costs not covered by Medicare, by a Medicare supplement, by Long Term Care insurance, or by Medicaid. Medicaid coverage for nursing home care is available after your resources are spent down below a certain level.
If you have a spouse the rules allow for protections of resources and joint income for your spouse to maintain a home and independence.
The Medicaid rules are complicated and it is very important that you review your options for paying for nursing home as soon as possible. Planning ahead is important. You need to talk to an attorney with expertise in the Medicaid issues.