HOW TO SELECT A VIRGINIA NURSING HOME

 

At age 29, I am looking into home healthcare options for a loved one. I share this simply because, as unpleasant as it may be, most of us will be asked to help make healthcare decisions for a family member. Many of us will begin the process much earlier than we anticipated.

 

When do you start the search?

What kind of help do you look into? Nursing Home, home health care, assisted living?

What facilities are the best?

Who will pay for it?

 

Although our firm specializes in elder abuse and neglect cases across Virginia and West Virginia, as an advocate I want to provide helpful information that may prevent families from making health care decisions they later regret.

 

My general advice to all Virginians looking into long term care options, is as follows:

 

1.                  Have the conversation early

 

      Talk to your loved ones before they need the help. Would they be willing to living in a healthcare facility (nursing home or assisted living facility)? Would they be willing to move to a different city to be near family? This conversation gives all involved peace if someone has expressed his or her wishes early on. Sadly, when an emergency happens, it may be too late to engage someone in a serious conversation about long term care.

 

      If your loved one is not opposed to receiving inpatient care, start visiting facilities. People will visit 20 colleges before they apply but rarely take 1 hour to tour a nursing home in their hometown. Ask about policies, waiting lists, payment options, etc.

 

      If your loved is NOT willing to enter such a facility – you need to make alternative plans. Can you afford home health? Is someone in the family willing to provide care? It is most difficult to arrange home health care at the last minute – so planning is almost always needed.

 

2.                  Discuss the Cost

 

      Does your loved one have enough money to pay for a facility? Are they on Medicare? Medicaid? Have long term care insurance? Find out what options they have and what facilities cost, home health care, etc.

 

      Many long term care plans will pay up to $4000 a month, but most local nursing homes exceed $6000 a month for private pay. Who will pay the difference?

 

      When discussing the cost, call an attorney who specializes in Estate and Medicaid planning. They can help you plan including provide advice on whether gifts and home sales are permissible, while protecting your future rights and access to Medicaid assistance. Do not try to “spend down” without legal help. I have seen families lose access to Medicaid by trying to navigate the system without professional assistance.

  

3.                  Research each facility.

 

      In the age of the internet, there is no excuse not to research each facility. Find out of they are for profit or non-profit. How many beds? What did the most recent Medicare survey say about their skills?

 

      You can get a lot of information in 30 minutes on the internet:

·         www.medicare.gov  (will provide most recent inspection information)

·         Check if any pending lawsuits are going on:  http://www.courts.state.va.us/caseinfo/home.html

 

4.                  Know what type of care is needed, and therefore, what kind of facility

 

      Assisted living facilities and nursing homes are not the same in Virginia.

Retirement communities and assisted living facilities are not health care facilities and have no legal duty to provide health care – did you know that? Also, they have no legal duty to employ physicians.

 

      Does your loved one only need help with medication? Assisted living may be appropriate, but if he or she cannot eat independently, they should not be in an assisted living facility.

 

      Discuss the needs and if they are great, nursing home may be your only option. Ask a primary care physician what level of care he or she would recommend.

 

5.                  Visit the facilities in your area

 It is too late to make a decision when the social worker at the hospital says “SMITH NURSING AND JONES NURSING HAVE BEDS – YOU CHOSE.” If you have done your research and looked around, you can make a more appropriate decision.

 

6.                  Keep other family members in the loop

 

      I have a twin brother and he and I make sure we discuss all of these options together. It often happens, that one family member is not included in these decisions. This causes stress, anxiety, and sometimes can effect your options.

 

 This is a very serious decision. Choosing a long term care facility (or not) should take time and consideration.

 

Want to know the right questions to ask and factors to consider as you walk this path? Below is a cheat sheet -  HOW TO SELECT A VIRGINIA NURSING HOME. Here are the steps you should take, and questions to ask:

 

1. Talk to your loved one early.

·         What do they want? Home health care? Where?

·         Would they be willing to enter a facility if needed? If so – what amenities would they like? What activities? What area?

·         Have they saved for long term care?

·         Do they have a plan on payment?

 

2. Visit facilities:

·         Call ahead and schedule a tour.

·         Ask if you can join the facility at meal time to see what meals taste like

·         While there – strike up conversations with any family members present: ask them if they are satisfied with the facility.

·         Ask for copy of latest MEDICARE visit and Department of Health report.

·         Ask if the facility is for profit, or not for profit.

·         Ask who the owners are (local? Large company based out of California?).

·         Ask if they take Medicare or Medicaid.

·         Ask the name of the Medical Director and find out how long he/ or she has been the physician on staff.

·         Ask how many days a week the Medical Director is on site.

·         What activities do they offer and how often?

 

3. Do your research online:
   • www.medicare.gov
   • Freedom of Information Act requests to Department of Health / Department of Social Services
   • Check local Circuit Court records for recent lawsuits: http://www.courts.state.va.us/caseinfo/home.html

 

4. Discuss cost with a professional:

·         Is your loved one Medicaid eligible?

·         Will their insurance cover?

·         Do they have Medicare?

·         If they are a Veteran, will any local programs help pay for care?

 

5. Prepare Legal documents:

·         Do you have a Medical Power of Attorney?

·         General Power of Attorney?

·         Will  (even if you have few assets)?

·         Have you sought assistance in Medicaid planning (especially if you have few assets)?

·         What about end of life measures – do you have a DNR? Do you want one?

 

If you don’t have these records prepared – surprise, the nursing home will prepare them for you and you will have to sign their copy! It is always better to have your own professional help.

 

6. Read any contract before you sign:

·         Most nursing home contracts have arbitration agreements – please read    before you sign.

·         Do you have POA? If not, don’t sign a contract that states you do.

If you need additional help – contact your local Agency on Aging. They can answer general questions as well as provide specific help.

 

Again – choosing a nursing home in Virginia is a big decision. We would encourage you to do your research before signing the dotted line.

 

Should you have any questions, do not hesitate to call my office at 540-985-0098.

 

Lauren Ellerman