Choosing a Long-Term Care Facility

The choice of a long-term care facility is challenging, but chances are very good that you, along with many Americans will someday be faced with the need to find such a facility for themselves or a loved one. How many Americans make are required to find a long-term care facility you ask? According to the National Institute on Aging (as of 2015) there were approximately 4.7 million seniors utilizing home-health care; 730,000 in assisted living facilities and 1.4 million in skilled nursing facilities (a/k/a long-term care facilities). Current statistics published by nursinghomediaries.com, 5% of the older population lives in nursing homes with an average life-expectancy of six months upon admittance. If that trend continues, 3.9 million of the 78 million baby boomers will find themselves in a long-term care facility during their lives.
Because the choice of a long-term care facility will be so important to many American families, care should be taken to make the process strategic. There were approximately 15,600 nursing homes in the United States in 2014 according to the Centers of Disease Control and Prevention so it goes without saying that driving by a facility, watching a television ad, or reading a promotional brochure will not be sufficient if you hope to make a well thought out decision. The following is an example of a strategic checklist when looking for a great facility.
Step 1: Determine the level of care required for your senior adult
Long-term care isn’t always occurring at a residential care facility. It can occur in many places. While many Americans will be treated in a long-term care facility, others will receive less involved treatment at their home or in an assisted living facility, special retirement community or senior center. The determination of where treatment will occur can result from an analysis of the type of care to be provided; more specifically, is the care “medically necessary” care or merely “custodial” care. Medically necessary care is covered by Medicare, but custodial care is generally not.
To help evaluate what level of care will be required by your senior adult, ask if the person seeking long-term care will need help with any of the following: eating, dressing, bathing, getting in and out of bed, using the bathroom, remembering to take medicine, shopping, paying important bills, transportation, housework (cleaning, laundry, etc.). While this list is not exhaustive, it does provide many of the most important daily tasks for senior citizens.
Step 2: Evaluate the senior adult’s finances
Let’s face it, in America the amount of money one has may impact the type of services they will receive. While no American ever goes without hospitalization or medical care, if you save well and have some financial stability, you may be rewarded with better care than others – it’s a traditional benefit of a capitalist society. In the alternative, if you waste money, live an unhealthy life, don’t earn well, or don’t build some wealth with the income you do have, you may suffer the consequences. LongTermCare.gov reports the national average costs of long-term care were as follows in 2016: $225 a day or $6,844 per month for a semi-private room; $253 per day or $7,698 per month for a private room; $119 a day or $3,628 per month for a shared room (single bed unit); $20.50 an hour for a health aide; $20 an hour for homemaker services; and $68 per day for services in an adult day health care center. People often experience sticker shock regarding long-term health care, so take time to evaluate the complete financial picture before choosing a facility.
Any evaluation of a financial picture involves exploring all sources for funding. The following represent some examples of the ways in which people fund long-term healthcare.
• Personal savings: This one is obvious. The more you save, the more you have to spend on your well-being.
• Long-term Care Insurance: Long-term care insurance can be effective but often too expensive if the senior waits until an advanced age to purchase a policy. Of course, if you begin paying at an earlier age, you may spend money on a policy that is never needed. Because insurance coverage varies widely, be sure to review a policy’s coverage fully with your agent before completing the purchase. Some plans cover many items while others may include medical equipment and in-home care only.
• Medicare: Medicare is conditional coverage. If conditions exist, it may pay for certain skilled nursing or home health care. If you do not qualify, it may not pay for daily living care or other luxury items. Visit www.medicare.gov to see if you meet the eligibility conditions for coverage
• Medicaid (Missouri HealthNet): Medicaid is primarily a state program and its coverage varies greatly from state to state. Generally, eligibility is income-based with the most help being offered to those with low incomes and limited resources.
• PACE: The Programs of All-inclusive Care for the Elderly (PACE) is a benefits program designed to offer in-home care that is integrated with Medicare and Medicaid and is only available in some states, so check to see if your state has a PACE program.
• Veterans benefits: The Department of Veterans Affairs (VA) does offer some of its participants long-term care if they are eligible. Make sure these benefits don’t complicate your other forms of coverage like long-term care insurance, Medicare and Medicaid.
• Accelerated Death Benefits: This is a life insurance policy rider and can provide cash advances against future death benefits while the policy holder is still alive.
• Reverse Mortgages: A reverse mortgage is a type of home loan for older adults that allows an owner to remove equity from a home without selling it. These loans can sometimes seem too good to be true. Momma always said, “If it seems too good to be true, it probably is.”
Step 3: Compare the types of care facilities in your area
There are various care facilities in your area offering a variety of care and services. Not all senior adults will require a long-term care facility. Several with lesser disabilities or age-related issues utilize the assistance of less-involved services. Because there are nearly as many types of long-term care as there are types of seniors in need, you should compare the senior adult’s finances to the types of various care providers in your area. The following are just some of the most common forms of long-term care programs:
• Community service centers: Some communities have service centers that provide meal programs, games and activities and transportation services among other things. These less invasive services don’t lessen an adult’s independent nature but can supplement home health care to keep costs down.
• Home care: This one is obvious. Historically, family, friends, volunteers, and professionals came to a senior adult’s home to provide necessary services or they allow the senior adult to reside within their home in a spare bedroom or newly constructed accommodation. Remember, it wasn’t until the nineteenth century that nursing homes even existed. Americans routinely welcomed their loved ones into their homes for care and comfort. When home care is used and the senior adult remains in his or her own home, the help provided is generally limited to daily tasks such as shopping, transportation and cooking.
• Assisted living facilities: These facilities provide 24-hour assistance and health care in a residence-like setting. These slightly more involved services often cover everything such as bathing, eating, dressing, and taking medicine.
• Nursing homes: Nursing homes provide care when senior adults cannot care for themselves at their own home. This community setting can provide all the essential needs a senior adult will require such as transportation, primary care physician appointments, dental appointments, skilled nursing, rehabilitation services, meals, bathing, and help with daily activities.
Once you’ve decided on the kind of long-term care you desire or need, begin networking to request advice and referrals from others, preferably from people who have actually employed a facility or had family members or friends treated at the facilities in question. Among those references you may seek include friends and family, doctors, churches, government agencies (Medicare, Health Departments, etc.), and national organizations such as the AARP and the National Association for Area Agencies on Aging.
Step 4: Make visits to facilities on your list
Finally, nothing beats an in-person inspection of a potential care facility. Make certain you address any checklist of expected needs for the senior adult while inspecting facilities and ask questions of administration and staff such as the following:
• Who is the staff physician for your facility and how often does he or she visit?
• Is the physician on staff or merely on call?
• What physician addresses emergency calls and how long does it take?
• What is the ratio of staff to residents?
• Please explain your visitation rules and who can visit the senior adult?
• Are staff members trained in first aid and CPR?
• What is the monthly cost and what are your extra charges?
• Is the facility covered by Medicare or Medicaid?
• Does the facility have liability and/or malpractice insurance?
Questions to Ask Yourself:
• How comfortable was I when visiting the facility?
• Would I feel comfortable staying there for an extended period of time
• Did they listen to my questions and provide intelligent answers?
• Did the facility have an odor or urine or feces?
• Was the facility clean and professional?
• Did the staff seem professional?
• Does the facility meet the remainder of my requirements?

Todd Miller is an attorney at the Law Office of Todd Miller, LLC and a monthly contributor to the Active Times. He annually receives the AVVO.com Top Contributor distinction with a perfect 10.0 rating and in 2017, he was awarded the distinction of Advisor of the Year by GolfInc. Magazine. He also receives the annual Client Distinction Award by Lawyers.com and he writes and lectures on various legal topics. You may find him on Facebook, Google+, LinkedIn, and Twitter and at 1305 Southwest Blvd., Suite A, Jefferson City, Missouri 65109 staff@toddmillerlaw.com, www.toddmillerlaw.com (573) 634-2838.