Requirements for Assisted Living Facilities

Choosing the right long-term care facility for you or your loved one can be exhausting. There are many options of care providers to choose from, as well as much preparation to be done before moving in. In this article, we will go over how to choose the right facility for your needs, and exactly what are the requirements for an assisted living facility. 

What is Assisted Living?

If you clicked on this article, you probably have a good inclination that an assisted living facility is what you are after. Assisted living is a long-term care facility that ensures more senior independence by providing limited day-to-day care. There is less medical treatment than a nursing home or skilled nursing facility, and more focus on assisting seniors in activities of daily living (ADLs). ADLs include things like bathing, toileting, dressing, eating, and mobility.

For many, an assisted living facility (ALF), also known as a residential care home, feels like a more safe living environment than a nursing home. This is because they can maintain their privacy, independence, and keep a routine lifestyle of their design. Assisted living services are extremely flexible and can be tailored to your loved one’s wants and needs.  Having a loved one in an assisted living facility provides their family with peace of mind, knowing that they have 24-hour access to help if there is an emergency. This is much less stressful than knowing a senior is living alone at home.

Making Sure Assisted Living is the Right Choice For You

So we have established that assisted living is a great choice for those that want to maintain independence. And who doesn’t want to be independent? But the truth is, these kinds of facilities are not meant for everyone. Assisted living simply does not provide an advanced level of care for everyone. We do not recommend an assisted living facility for the following cases:

  • Those who use a wheelchair for mobility
  • Those who have a severe of late-state cognitive disability, like Alzheimer’s disease
  • Those with complex or involved medical needs
  • Those with dangerous behaviors, including wandering
  • Those with extensive medical needs

Analyze other health care options and determine whether a nursing home, skilled nursing facility, or a hospital might be a better fit for any of the above cases. A nursing home is a long-term care facility that provides medical treatment as well as ADLs. Skilled nursing facilities are more often short-term and focus on the recovery of an illness or injury after leaving a hospital and before returning home. And of course, hospitals provide the most advanced medical support but are short-term. Alternative care options to an assisted living facility could also include home care, adult day care, family care homes, supportive services,  independent living facilities, and medical alert systems. For an early-stage Alzheimer prospective resident, an assisted living facility could be a good option. Keep in mind, however, as the disease progresses, the resident will need to be transferred to a facility with a higher level of care, such as a memory care facility or nursing home. So now that we have an idea of what needs assisted living facilities do not provide for, let’s take a look at some of the reasons people choose these facilities over other options:

  • Personal needs and preferences are the priority. Personal care and medical attention are only provided on an as-needed basis, ensuring that seniors stay independent.
  • Residents can alter care plans as their needs shift.
  • Residents feel more self-sufficient, dignified, and in control as compared to other options.
  • Assisted living services facilitate interaction with residents’ friends, family, and community so they will maintain social support networks, good mental health, and thus better quality of life.
  • Residents do not need frequent medical assistance, but still need some help to a degree.
  • Residents may need help with specific, minimal tasks on a day-to-day basis.
  • Residents don’t yet need nursing home type of services but aren’t completely able to live on their own. 
  • Residents want to maintain their independence and privacy as long as possible.
  • Residents are still able to be active members of the community.

Assisted Living Accommodations and Services 

Accommodations in residential care facilities often consist of the resident’s semi-private or private apartment. These apartments include either a furnished or unfurnished bedroom, kitchen, and bathroom. It is also possible to obtain a private studio apartment, one-bedroom private apartment, one-bedroom shared apartments or a dorm-style bedroom. Services offered at assisted living facilities vary from state to state, but here is a list of the most common services:

  • Personal care services, including ADLs
  • Educational activities
  • Meal preparation
  • Emergency call systems in private and common areas
  • Exercise activities
  • 24-hour security
  • 24-hour supervision and support
  • Transportation arrangements
  • Laundry services
  • Housekeeping and maintenance
  • Health care services and medication administration
  • Dementia and disability care
  • Recreational activities
  • Social services and religious activities
  • Wellness programs

Many residential care facilities also work with home health agencies to provide skilled nursing care or hospice services.

When visiting potential assisted living facilities for your loved one, be sure to be aware of what services are and aren’t provided. The service coordinator should also make an initial evaluation of your loved one to determine what he or she needs. Upon moving into the facility, your loved one should also undergo evaluations regularly to modify the services received as needed. Your loved one should have copies of these evaluations for his or her records. Residents generally can choose which services they are provided. Having this control over their lifestyle allows seniors to relax and enjoy their day-to-day routine that suits their needs.  So now that we have covered what assisted living facilities are all about, and you’re still reading, let’s cover the next step of finding the right facility for you.

What to Look for in an Assisted Living Facility:

Types of Assisted Living Facilities: When looking for the right facility for you or your loved one, it is important to distinguish between the varying facilities. Once you can identify the type of facility that is best for your situation, your search will narrow down immensely. Keep in mind the following types of assisted living facilities are not clear-cut and followed by all states. Here are some examples of types of facilities you may be looking for: 

Type A Facility: In this facility, a resident is physically and mentally capable of evacuating unassisted. This may include mobile, non-ambulatory persons such as people in wheelchairs or electric carts. These are people who don’t require routine care during nighttime hours and can follow directions during an emergency.

Type B Facility: In this facility, a resident may require a staff assistant to evacuate. However, they are capable of following directions during an emergency. They may require attendance during nighttime hours or not permanently bedridden but require assistance in transferring to and from a wheelchair.

Type C Facility: These facilities are four-bed facilities that contract with the state and provide adult foster care. They have to meet specific contracting requirements.

Type E Facility: This type of facility limits the number of residents, all of whom are physically and mentally capable to evacuate in an emergency unassisted. This could include people who are mobile, and non-ambulatory, like people in wheelchairs or electric carts with the ability to transfer and evacuate themselves during an emergency. They do not require routine attendance during nighttime hours and are capable of following directions during an emergency. 

Abiding by State Laws

While nursing homes and skilled nursing services are regulated and rated by the federal agency Centers for Medicare & Medicaid Services (CMS), assisted living facilities are regulated by the states, not the federal government. Each state’s health department or social services office regulates assisted living communities, depending on the state. The CMS does, however, offer some guidance to the state Medicaid services for those assisted living facilities that are Medicaid-certified, which is about half of them. When researching your assisted living community, verify that the facility has obtained licensure, as well as make sure they have undergone the appropriate inspections required in your particular state. Here are some areas the state enforces regarding facilities’ assisted living requirements:

  • Resident agreements which inform potential residents of associated costs of care before move-in
  • Resident admission and retention policies which are clearly defined, and based on needs and/or behavior
  • Support services and service plans that which describe the type of care residents receive in detail
  • Required medication provisions, stating who can administer certain medications, and to what degree unlicensed staff can administer those medications
  • Foodservice and dietary provisions, as in how many meals residents receive daily, and any dietary recommendations the facility must follow
  • Staffing requirements, as in rules on background checks, training, and requirements of continuing education
  • Size of apartments, roommate rules, and the number of people allowed to share a bathroom
  • Inspection and monitoring requirements
  • Consequences to facilities for noncompliance

Even though all these aspects are all covered by state assisted living regulations, the specifics of these assisted living requirements vary for each state. One example is that 40 states enforce “direct care worker” training, but the required training hours can range from one to 80. This is a gaping difference that can determine the likelihood of competent and incompetent staff. Get to know the assisted living requirements in your state to see what are the mandatory requirements. 

Be aware that some facilities choose to remain unlicensed. Sometimes the facility offers quality care, not harming the residents. But keep in mind that without proper licensing and inspections, there is no way of knowing whether the facility is following standards for resident care, disaster planning, medication management, and so forth. It is also important that the facility complies with the Department of Health regulations. Not following these procedures and regulations may result in fines and eventual closure of the facility. Although a properly licensed facility doesn’t mean they will provide the highest quality of care, it does mean they are following the state guidelines. Be sure to verify the facility you are interested in is licensed to your satisfaction.

Touring the Facility 

Once you and your family have narrowed down the search a bit, select a few residential care facilities at the top of your list. Touring these facilities to learn about the different senior care services, programs, and amenities will help make you make your final decision. We have composed a list of questions you can ask as you tour the facility, particularly regarding their compliance with the required laws: 

  • How do you identify which care services my loved one needs, and how often will he or she be reevaluated?
  • Who conducts these evaluations?
  • What is the entire range of services offered at this facility?
  • How is the payment plan set-up?
  • Which services are included in the base monthly plan?
  • What is your policy regarding the use of outside services?
  • Is there a deposit, and is it refundable if my loved one needs to move?
  • If my loved one’s needs change, will the fees reflect these changes?
  • How much notice will my loved one be given if the fees change?
  • Can the fees increase if his or her needs do not?

When touring the facility, you and your family members will be met with assisted living staff. Ask the questions above, as well as any questions regarding senior living programs, activities, and other services you may be interested in. Most of these facilities offer free lunch so that you and your loved one can sample the food. If this is something you are interested in doing, make sure to inform the staff ahead of time so they can arrange that for you. 

Once you have toured the facilities that interest you, and your loved one and family have settled on their favorite, next comes the process of applying to the facility. Luckily the process to apply to an assisted living facility is much simpler than a lot of long-term care facilities. We have broken it down in the next steps to make it even easier for you. 

Requirements for Assisted Living Facilities

Room Deposit

As you’re touring the facility, it is a good idea to ask about reservations/deposit details with the staff. Oftentimes assisted living facilities are filled, so a deposit might be required as you attend to your paperwork in the next steps. You and your loved one will select a private or semi-private room depending on the availability and then pay the deposit, which varies between facilities.

Assessment of Care Needs 

A staff member or nurse at the facility will need to assess the condition of your loved one to determine what level of care he or she requires. If necessary, the assessment can even be done in the comfort of your loved one’s home. If the assisted living staff decides your loved one does not meet the required criteria, the room deposit will be refunded. 

Paperwork Submission

Once the representative has determined your loved one is an eligible candidate for their facility, you and your loved one will need to complete and submit the necessary admission paperwork, along with other documents required. Here is a list of all the required paperwork: 

  • Facility admissions forms, including a resident agreement outlining the services to be provided and the required fees
  • Medical history and physical assessment, which should be completed by the future resident’s primary care physician. Typically, the physical assessment should be done a month before the start date for services.
  • Negative Tuberculosis (TB) Test or Chest X-Ray
  • Care needs assessment is completed by a staff member. This assessment is completed to document the senior’s abilities to complete ADLs. This assessment will also record the senior’s individual needs and capacity for social interactions. It functions as a guide when determining how much assistance the senior will need.
  • The care plan, which will provide the resident with details on the services they’ll be receiving. The plan will explain when and how the services will be provided, and who will administer them. The care plan provides residents the opportunity to make adjustments as needed to fit their preferences and comfort level. Care plans are usually updated at least every six months to account for the resident’s changing needs.

After all the paperwork has been submitted, the administrator or staff at the facility will contact you to schedule the move-in date and time that will work best. Then, it will be time to review and sign the assisted living contract before move-in.

Resident Agreement Contract Signing and Payment Details

The contract is signed by the senior or their Power of Attorney. There is usually no annual contract at an assisted living community as it is usually a month-to-month basis. Carefully read all the details of the contract and be sure to ask any questions that may occur to you. The format should be clear, easy to understand, and uses words that have common and everyday meaning. Make sure any services listed in any brochures or advertising you have read are also highlighted in the contract. Be sure to specifically review the admissions and discharge agreement. The discharge policy will define the steps taken during the discharge process. Here is a list of the details your contract should cover:

  • Costs such as community fee and monthly rent payment
  • Services
  • Discharge policies
  • Grievance procedure
  • The rights and obligations as a resident

Higher Quality of Life at Assisted Living

We here at CareAsOne hope that you have learned a little bit more about what you can expect from your assisted living facility. You are also more knowledgeable about the application process and the requirements of residential care facilities. Understand that the step into assisted living is one that will ensure you and your loved one less stress. Your loved one will be able to live a functional, independent lifestyle, which is sure to promise a higher quality of life.

How to File for Guardianship of an Adult

An unfortunate truth is that we do not keep all our faculties towards the end of life. Some adults are unable to make sound decisions for themselves, which is where adult guardianship or conservatorship becomes necessary. Adult guardianship is when a guardian ad litem is declared by a judge to be fit to make decisions regarding the person’s finances, medical care, and personal care, or both. Not having an appointed guardian could be a huge mistake which may lead to bad decisions that are not in line with the person’s well-being. If no one has already been appointed, a court will have to assign guardianship.

A person declared to make decisions based on the person’s medical and personal life is called a “conservator (or guardian) of the person.” A person declared to make decisions based on the person’s financial aspect is called “conservator (or guardian) of the estate.” If the person in question needs both, the judge would declare the same person as both. The decisions made by the conservator are backed by the court legally. The word conservatorship is used interchangeably with adult guardianship, and different states use one or the other. 

The Circumstances that Necessitate an Adult Guardianship

Knowing when the guardianship of an adult might be necessary will help you make a confident step in the right decision for you and your loved one. To help give you an idea of when an adult guardianship is necessary, we will provide some examples. Consider filing for legal guardianship of your loved one has mental or physical impairment afflicted by:

  • Alzheimer’s or other forms of dementia
  • A stroke
  • An accident that has impaired his or her faculties
  • Mental illness
  • Mental incapacity
  • Developmental disabilities
  • Disease
  • Mental deficiency

And not only must the person be physically or mentally incapable of making important decisions for herself as with the examples above, but other outside factors would necessitate a legal guardianship. These outside factors would be that he or she has not already prepared the legal documents that cover decisions about personal and financial matters. Here is a list of outside circumstances, along with his or her incapabilities, that would prompt a legal guardianship:

  • A guardian of the estate would be needed if he or she hasn’t prepared a power of attorney for finances.
  • A guardian of the person would be needed for healthcare decisions if he or she didn’t have a medical directive, caregiver contract, or living will.
  • A guardian of the person to decide healthcare decisions might still be needed if there was a medical directive but his or her health matters were not covered in it, and there was no one named to make those decisions.
  • A guardian of the person would be needed to make decisions about his or her personal life even if there is a power of attorney for both health care and finances. This would include decisions like where he or she will live, or who is allowed to spend time with them.

The Process For Filing for Guardianship of an Adult 

To obtain guardianship of your loved one, you will need to file formal legal papers, after which you will have a court hearing in front of a judge. These formal documents must clearly emphasize his or her physical or mental impairments that cause the inability to make decisions. Family members and of course your loved one must be notified and given to opportunity to contest and file their paperwork in opposition. 

To do all this, legal help is necessary. Choose a local lawyer that has elder law or conservatorship experience. To find the right one for you, contact the state bar association in your county, and ask for the lawyer referral service. This must be the county in which you or your loved one live. Another way to find a lawyer would be to contact the National Academy of Elder Law Attorneys and ask for a referral of an attorney in your area. 

Here is the abridged version for the process of filing for adult guardianship, after which we will break down in detail: 

  1. Determine which type of adult guardianship is necessary.
  2. Complete the guardianship forms for adults.
  3. File the paperwork.
  4. Serve the relatives and required agencies.
  5. Attend court hearing in front of a judge.

1. Determine Which Type of Adult Guardianship is Necessary

Before starting the paperwork, be sure to know the types of guardianships to know which you are going for. It is also helpful at this stage to discuss with other family members in the decision-making process who would be the best person to be guardian, as well as which type of guardianship will be necessary. Figuring this out ahead of time will make the process smoother and reduce stress, not to mention a less expensive legal process. Get to know the different types of adult guardianships, decide which type may be necessary, and then agree on who is the best person for the job. Here are a few of the different adult guardianship titles you and your family members may be considering: 

Emergency Guardianship: It usually takes several months to complete the process of obtaining guardianship for a disabled adult, which sometimes is too long in some cases. Emergency guardianship can be sought in limited circumstances in which the individual’s mental or physical health is at risk or an immediate decision must be made regarding their health or estate. This form of adult guardianship is temporary, sometimes lasting only 72 hours. The laws on emergency guardianship vary from state to state.  

Guardianship of the Person: This form of adult guardianship requires the guardian to make decisions about the care and support of an elderly or incapacitated adult The best person for the job would probably be an adult child or sibling who lives close to the person. The guardianship duties would include making medical decisions, monitoring medical treatments, arranging professional interventions, ensuring healthy living conditions, and making the difficult end-of-life decisions. The appointed person may also be required to submit an annual report of any decisions made. All these duties should be done all while considering the person’s wishes and physical and financial needs. This guardianship lasts until the person passes away, or when the court decides guardianship is not needed anymore.

Guardianship of the Estate: For this form of guardianship, the person chosen should be someone who is competent in financial affairs and can handle substantial or complicated finances. If no family members are capable of making sound financial decisions, the judge can appoint a public officer or private conservator. The guardianship of the state would assume the responsibility of the incapacitated person’s personal property. The duties of this form of guardianship include preserving and protecting assets including bank accounts, distributing income, estate planning, and getting appraisals of the personal property. It is also in their duty to keep the court informed of the estate and any changes made. For instance, in some states the guardian must immediately provide a Proof of Blocked Account form, then after 60 days must submit an inventory and appraisal of the estate and asset valuation. A monthly budget and an annual accounting packet are sometimes required. Check the laws in your state to determine what will be required of you. Guardianship of the estate continues until the person passes away or the court decides a guardianship is no longer necessary. 

Guardianship of the Person and Estate: This form of guardianship is the combination of the previous two forms. This guardian would have total control of the person’s financial, medical, and personal decisions. The appointed person will decide about his or her everyday care, handle administrative matters, and decide how to best spend the assets on long-term care or where to live. Some examples of administrative matters would include dealing with doctors, Medicare, insurance, or the long-term care facility he or she resides in. The guardian would apply for benefits, medical coverage, or pensions that an incapacitated person might be eligible for. 

The guardian must keep clear records of any decisions that have been made on the person’s behalf. The court will require that these records are regularly reported to them, though different states have different requirements. A judge may even require the guardian to check in with the court before making any particularly important decisions, like when selling the person’s home, or transferring the person to any new place of living, especially if it is out of state. 

2. Complete the Guardianship Forms for Adults

Now that you’ve decided with your family members which type of guardianship will be necessary, you can obtain the applicable forms you will need to complete. In some states, you will need to complete a form acknowledging your duties. The forms used to gain guardianship all vary from state to state. However, all of them require the same basic information. Your lawyer will guide you through this process. You will pay for the correct forms to be drafted, or you can ask for legal advice to guide you through the process. It is possible to draw up your guardianship template as a low-cost solution to obtain guardianship. If you choose to do so, you must make sure the forms comply with state law and your state-specific court rules. To make sure that you get the right adult guardianship forms, visit your state’s legal aid office or the self-help section of the website for your county court. They sometimes have free adult guardianship documents you can use. Here are the major components of the adult guardianship forms:

Everyone Involved is Identified: This will include the full legal names of the disabled person, the person who is preparing the form, and the guardian or guardians who are being appointed. Any assets of the person should be listed, as well as the person’s date of birth and gender. Information about the appointed guardian or guardians should be included, such as their addresses, contact information, and the relationship to the incapacitated person.

The Time Period of Duties: You will need to specify what period of time the guardianship duties will be assumed. This will be especially necessary if the guardianship is temporary. Before adding in the dates, be sure to check what amount of time is allowed in your specific states. This is because maximum guardianship times can vary depending on what state you are in. 

Guardian Responsibilities and Limitations: Explicitly state in detail what duties the guardian will and won’t be in charge of. It is especially important to know what he or she is not legally able to do so that they do not cross any lines that could hold them legally responsible. For instance, they could be held liable when making decisions regarding medications when they aren’t allowed to, which may cause damage to the affected person.

Explanation of Why the Person Needs a Guardian: The person must be proven incompetent, and thus unable to make their own decisions. This will be done in front of a judge, but the documents must explain why the appointment of a guardian is necessary (list any related health issues), why the person appointed should be named guardian, and who should be notified of the appointed guardian. 

Witnesses, Signatures, and Notarization: Almost every state requires at least one neutral witness to the document’s signature and notarization. This witness or witnesses should have no personal gain regarding the appointment of guardianship. The form will be signed and dated by the proposed guardian. The rules for the signing and notarization of the document varies from state to state. 

3. File the Paperwork

Be sure to make copies for yourself and all the parties involved. Then it is time to file. You can typically file your paperwork in one of two ways. You can mail the documents in, or you can file them online. In either case, you will need to send any payments necessary for the filing fee. Sometimes a fee is not needed. The fee for the guardianship of the estate could also depend on the estimated value of the assets of the estate. Check with your local laws to see what fee you will need to pay. It is possible to even waive the fee in some cases if you cannot afford it. 

4. Serve the Relatives and Required Agencies

After successfully filing your adult guardianship forms, a copy of your petition must be served to anyone who must be notified. This would include relatives and any agencies that are affected by this change and have associated legal rights. This could be your responsibility to notify these affected parties. The guardianship process will be delayed if everyone is not properly notified. The people you serve could include the proposed protected person, their spouse, parents, children, siblings, grandparents, and older grandchildren. Any affected agencies could include the hospital or care facility the person is staying in, Medicaid, or office for Veteran’s benefits. Check the laws for your state on who specifically should be notified.

5. Attend Court Hearing in Front of Judge

You will be notified by the court of your hearing date. Next will be your guardianship proceeding on your appointed court day. The probate court judge will review your guardianship case and determine the court order, stating whether or not the person in question is capable of decision-making. Sometimes it will be obvious to them, for example in the case of someone who is unconscious or semiconscious or has an advanced form of dementia. However, some people have physical or mental limitations that are not as obvious. In these cases, the judge will have to weigh opinions and options. Here are some examples of what might happen:

  • If the person can communicate, the judge or a special court officer will speak with him or her directly, asking whether he or she understands the court proceedings and what his or her wishes are. The judge will also read doctors’ reports and testimony of family members.
  • If it still isn’t clear whether a guardian is needed, the judge can appoint a separate lawyer that will represent the person in the court proceedings.
  • The judge might appoint a limited guardian by limiting their authority. Another further court hearing will decide who will be in charge of the remainder of the issues.  

Changes to Guardianship 

The guardianship will last as long as he or she lives unless specifically stated otherwise. However, if he or she regains her ability to make decisions, the guardianship can be ended. Additionally, a guardianship of the estate can be ended if there are no longer assets to deal with.

It is also possible for the guardian to change. This is possible if the guardian dies, moves away, or can no longer manage the duties. A judge could replace the guardian if he or she repeatedly makes bad decisions or neglects his duties. The change of guardianship would have to be requested by a family member or an interested person through a filing of paperwork.

Ensuring Your Loved One’s Well-Being

The process of filing for adult guardianship can be costly, time-consuming, and painful for you, family members, and your loved one. However, if the incapacitated person has not completed a detailed durable power of attorney, living will, or medical directive, the process is necessary to ensure your loved one’s well-being. We hope that you now have a clearer idea of how to file for guardianship of your loved one. We here at CareAsOne wish you all the best in this difficult time. 

How To Get Your Loved One In a Nursing Home

The transition of your elderly loved one into a nursing home can be a delicate thing. It is hard to know exactly when is the right time to make this change. You may experience feelings of guilt and fear due to the uncertainty of such a decision. However, sometimes making this difficult decision is the best thing you can do for your loved one. To make this process a little less rocky for you, we will thoroughly discuss what you can do to navigate this difficult time. We will explain in detail what you can expect as you help your loved one transition into a nursing facility. But first, let’s make sure that this is the right decision for you and your loved one. After all, what qualifies a person for a nursing home? The following list includes some signs you can look for to determine if long term care might be the right thing for your loved one:

  • Needs 24-hour care or supervision
  • Frequently experiences trips and falls
  • Significant changes in wellness or behavior
  • Isolates him or herself
  • Has little to no nutritional food in their fridge or pantry
  • Eats foods that do not work well with his or her medications
  • Has no interest in caring for their home–it is messy or you notice that things are not getting fixed, such as the electrical or HVAC systems
  • His or her pets are malnourished
  • He or she exhibits signs of memory loss; including the inability to recognize family or friends, inability to converse, or repeating previously-held conversations
  • Requires help when buying groceries
  • Poorly manages his or her own medications
  • Needs help with dressing, bathing, showering, toileting, continence, eating, and getting around
  • Needs frequent specialist care
  • Requires rehabilitation

Perhaps your loved one displays some of the symptoms on the list. Enrolling him or her into a nursing home facility could dramatically improve these problems, and therefore his or her life quality. We will now discuss the process of how to get your loved one into a nursing home with as much ease as possible. To give you an idea of what you can expect, the following is a simplified list of the steps to getting someone in a nursing home. We will then explain each step in detail.

  1. Identify the best facility.
  2. Gather the necessary paperwork.
  3. Complete the application.
  4. Complete the Medicaid application.
  5. Complete the admission agreement.
  6. Moving day.

Finding the right facility for your loved one is key.

1. Identify Which Facility Best Suits the Needs of Your Loved One

Once you know what your loved one needs and why they need to be put into a nursing home will help determine what kind of care facility is necessary. There are many levels of care options, and which facility you should choose all depends on the person’s ability to take care of themselves. For instance, your loved one may still be quite functional and active, but still need some help with things like cleaning or yard work. In this case, an independent senior living community would probably best suit his or her needs. If your loved one has some medical issues and cannot properly take care of his or her daily needs, you will probably want to look at skilled nursing facilities. Skilled nursing care is meant to help someone recuperate from a temporary illness or injury, and will usually return to their own home after they have convalesced. If you are noticing Alzheimer symptoms, you may want to start considering a continuing care retirement community (CCRC). If your loved one needs help with their daily personal care, and not so much their medical needs, consider a nursing home which will provide long-term care services. 

Have a talk with your loved one about how they feel. Then talk to other family members in the decision-making process to make sure everyone is on the same page. It may be helpful to meet with your loved one’s doctor to assess their particular needs. Once you have decided what kind of care your loved one is in need of, review pamphlets of different options to consider. Do not just keep just one facility in mind. You may find yourself surprised as you research what some facilities offer. Then take the time to tour multiple facilities at the top of your list and figure out how each would benefit your loved one. Choose the facility that will best suit his or her medical, social, and daily needs. Here are some of the greatest advantages of nursing home care:

  • Socialization: Living in a nursing home allows seniors the ability to be around others their own age. Socializing is so important for our health and well-being, especially the older we get. Interacting in a social environment with other nursing home residents reduces the stress, anxiety, and depression that comes along with a life of loneliness and isolation. This also encourages more fitness, greater self-esteem, and even a longer life span. 
  • Consistent care: As your loved one ages, they may require more and more attention to their needs. This may not be possible for you to constantly keep watch of him or her and anticipate the needs of your loved one. Enrolling in a nursing home will allow consistent care through regular check-ins. The medical staff will have a better idea of what your loved one needs and can better anticipate any surprises in their health that may arise. 
  • Medication management: Your loved one may easily be mixing up their medications or keep forgetting to take them. This often leads to them taking it at the wrong time or wrong amount, which is detrimental to their health. And you may not have the time to remind them, or you may even mix them up yourself. Trained professionals in the nursing facility will easily ensure your loved one takes the recommended medication at the correct time, leaving the burden off of you.
  • Meal preparation: This allows your loved one with less stress about how and what they will eat next. In nursing homes, the meals are prepared and administered at consistent times. They are also prepared with your loved one’s specific diet in mind, ensuring the best quality sustenance for their individual needs. 

2. Gather the Necessary Paperwork

Now that you have decided which senior housing facility is the best fit for your loved one, it is time to gather the necessary paperwork the facility will need. Here is a list of the paperwork for nursing home admission requirements:

  • Patient Review Instrument (PRI): The PRI is a tool used to assess the physical, medical, and cognitive state of the patient to see if a nursing home is the right place for them. It also documents any services they may need. The test is administered by a registered nurse and can possibly be covered by insurance. If your insurance provider does not cover it, you may have to pay out-of-pocket. 
  • Medical Screen: A medical screen will check for any diseases or health conditions the patient may have. This has to be completed to assess what kind of care your loved one will need. 
  • Medical History: Your loved one will need to visit his or her primary care physician (PCP) to gather any medical history, prescription use, diagnoses, and any other documents that the nursing home would need. 
  • Financial History: Most facilities need to see proof of your loved one’s asset limits and resources. They will probably review the financial history of the last 5 years as well as make sure you have started a Medicaid application. 

Your loved one’s PCP should look over all the information above and help ascertain which kind of facility is best. He or she may have a different opinion than what you had in mind and could recommend either a higher or lower level of care. An example of higher level of care could be a dementia unit, while a lower level would be an assisted living facility. 

The nursing home may also recommend end-of-life planning documents, including a MOLST form (Medical Order for Life-Sustaining Treatment), a DNR Order (Do Not Resuscitate), power of attorney documents, a health care proxy, and a living will. It is wise to consult your elder law attorney if you haven’t already.

While you are gathering all the necessary paperwork, you will also need to be thinking about preparing your loved one’s home or property for the eventual move. If your loved one cannot afford the nursing home, sometimes a lien is placed on the home to be used to pay for costs in the facility. You may also think about transferring or selling the home to prevent it from being used to pay for costs. However, this could affect Medicaid eligibility. With the rest of your loved one’s assets, consider holding a yard sale to get rid of any unnecessary furniture or household items. Space in a nursing home is limited, so help your loved one prioritize what is most important to him or her.

3. Complete the Application

Next, you and your loved one should complete an application to turn into the nursing home’s admission staff. They will also need the documentation mentioned above to assess if the facility is a good fit for your loved one, whether it be medically or financially. Having a copy of the financial records will help them determine if your loved one can adequately afford nursing home costs. The application will also ask more questions about what kind of medical care your loved one may need. Try to get the nursing home application process started as soon as possible, due to the fact that some facilities may have a waitings list. This applies especially to those nursing homes that work with Medicaid.

It’s always a good idea to visit the nursing home first to see if it’s a good fit for your loved one.

4. Complete Medicaid Application if Applicable

The cost of nursing home care can be staggering. If you do not have long-term care insurance, you will need to consider other forms of payment assistance. Unfortunately, Medicare is not meant for long-term care facilities. Typically Medicare is only useful for those entering a skilled nursing facility for short-term recuperation. The Medicaid program, however, is the largest single payer for nursing home care. Keep in mind that Medicaid is a means-tested program, which indicates that the applicant must verify eligibility based on his or her means. Another factor to consider is that receiving Medicaid assistance can limit your social security income to as low as $30 a month. This is a big factor for those that rely on SSI.

As you complete the nursing home’s application process, it will become clear to you whether or not your loved one could be eligible for the federal government’s Medicaid funding. If he or she is eligible, it is important to start the Medicaid application process sooner rather than later, because the process can be lengthy. The nursing home may have a Medicaid coordinator that can help guide you through the process. If not, you can check at your local county Medicaid office for some assistance. 

Your loved one’s Medicaid application process will include an in-depth analysis of the past 5 years’’ finances. They will ask questions about any large sums your loved one has received, and require explanations of them. In order to complete the application process, the following documents will be needed:

  • Birth certificate (of both the resident and their spouse)
  • Marriage certificate
  • Military paperwork (if applicable)
  • Property documents (could include closing papers, deed, etc.)
  • Bank statements (from all accounts, and extending back 5 years)
  • Life insurance policies

Nursing homes have different procedures for admitting residents while their Medicaid eligibility is being determined. Some facilities will intake new residents while the application is in progress, while others will not admit them until Medicaid has already been approved. That is why we stress that you start this application process early to ensure your loved one enters the facility when the time is right. 

5. Meet with Nursing Home Staff Members: Complete Admission Agreement

If your loved one’s nursing home application is accepted, this means that they sufficiently believe that his or her medical needs can be met by the facility and that the financial aspect is in order. To complete the admission agreement, you and your loved one will meet with the admissions representative, a social worker, or another worker. The admission agreement will cover the following topics:

  • The Facility: The legal certifications of the facility will be discussed. It will be made clear what level of care they are able to administer.
  • The Resident: It will be discussed what is expected of the resident, including what his or her rights and responsibilities include. The rules will be made clear, such as the establishment of a non-smoking policy.
  • Finances: The agreement will make clear all the costs of the facility. You will know exactly how much room and board, care, food, and other expenses will cost. As an example, one room including food and care can be about $200 a day.
  • Personal Needs Account: This is for the residents that are receiving Medicaid assistance. A portion of the money they receive is allowed for personal use, and is put into an account meant for the patient and managed by the facility. 

After the paperwork has been thoroughly discussed and understood, the admission agreement will need to be signed by your loved one, or their representative. Be sure to ask for a copy for your personal records.

6. Moving Day

Moving into a nursing care facility is a big change for older adults. Your loved one will need your support in this sensitive time. They will be going from a familiar environment, surrounded by their own things and furnishings, to a single room nursing home placement. It may be helpful to tour and measure the size of the room beforehand to know what to expect on moving day. Take pictures to remember the room and the amenities so you can help pack all the things that will fit. 

Your loved one will have some new things to get used to, including possibly sharing a room, a bathroom, and be surrounded by louder residents. He or she may not be used to this type of environment and it is best to ease them into it, if possible. Try to fill the new room with things that will make your loved one feel at home and comfortable. However, keep in mind not to bring items that are valuable as dementia patients may misplace things, plus the possibility of theft.

Support Network

Taking care of aging parents can also take its toll on you. Family caregivers, usually adult children, can experience a lot of stress when making these types of difficult decisions. We hope that with this clearly laid-out process for your next steps will help alleviate some of that burden. Finding the right senior care facility for your loved one will help make their and your life easier. We here at CareAsOne wish you and your loved one ease in this transition process, surrounded by a caring support network of helpful nursing home staff.