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assisted living

Choosing the Right Nursing Home

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What Nursing Home Is Right For My Loved One?

When families are advised that their loved one will need skilled nursing care, one of the first questions they will ask is are there any facilities that we recommend. There are a lot of factors that go into deciding if a particular facility is right for your family member. Some of those factors to consider are:

  • Proximity to where advocates and family members reside – having family visit regularly and being engaged in the care and services provided to their loved ones is critical to ensure they receive the best possible care
  • Understanding the level of care needed: certain facilities are geared toward particular conditions. Understanding a facilities specialty, if any, is important to determining if there is a fit.
  • Know how you are going to pay for the care. Once the family members Medicare benefits are exhausted, and you still require skilled nursing, understanding how to pay for the care needed and developing a path to Medicaid which will help subsidize the cost of nursing home care is critical.
  • Private Pay versus Medicaid – when visiting a facility, know what forms of payment they accept. The overwhelming majority accept Medicaid but a few do not. Follow the link in this article to find out if your facility accepts Medicaid.

Understanding The Different Levels of Care

A Nursing Home (NH) is a facility that provides 24 hour 7 day a week medical care and supervision.

A Skilled Nursing Facility (SNF) provides skilled nursing (examples: wound care, pain management, or bowel/bladder training),  and physical, occupational or speech therapy services. A SNF may also be referred to as a sub-acute rehab. Medicare may cover up to 100 days in a skilled nursing facility if you have met very specific Medicare eligibility guidelines.

Medicare does NOT cover ongoing long-term Nursing Home care. You may require additional care after your Medicare coverage ends. You may choose to pay the nursing home privately, use long-term care insurance or apply for state Medicaid.

A nursing home may also provide long-term care.

Ranking All Rhode Island Nursing Homes and What Payment Options They Accept

Since 2002, Healthcare Quality Reports has published information on the quality of care administered by nursing homes, including data on resident and family satisfaction and care outcomes. If you know in advance that you or a family member will need nursing home care, this information can help you compare nursing homes and choose among them. You can also visit nursing homes or ask friends and family for their thoughts and experiences.

The RI Department of Health’s Healthcare Quality Reporting Program has developed a Nursing Home Summary Report to help you compare Nursing Homes and choose among them. To find the most recent LIST OF NURSING HOMES and REPORT CARD click here. 

The PDF that the above link takes you to assembles many of the key pieces of information that any family will need when making an initial assessment of What Nursing Home is Right For My loved one!

Still have questions about how to proceed? Call me at 401-600-0143 for a no obligation consultation.

ELDER LAW - ASSET PROTECTION

Helping families help their loved ones.

Medicaid for Assisted Living

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Assisted Living

The RI Medicaid program covers assisted living services in State-licensed Assisted Living Residences (ALRs) that are certified to participate in the long-term services and support (LTSS) program. Covered services include on-site, 24-hour personal care assistance, homemaker and chore services, medication management, therapeutic, social and recreational activities, and health-related transportation. The amount of these services a person receives may differ based on the scope of their needs.

Medicaid does not cover ALR room and board and add-on services. A person who chooses this Medicaid LTSS option must pay from other resources housing charges and any non-Medicaid covered services (like cable and internet access) they choose to receive from the ALR. To ensure individuals applying can afford these costs, the dollar amount a certified ALR can charge for housing each month is capped. Rhode Island also has a State Supplemental Payment (SSP) program that provides financial help to low-income Medicaid beneficiaries living in ALRs. Depending on the scope of a person’s needs, access to some of the Medicaid certified assisted living residences may not be available.Assisted Living Activities

How to receive services

Case management agencies contracted by the Office of Healthy Aging assist individuals in completing a Medicaid LTSS application, assess the scope of their needs, and assist them in developing a person-centered plan of care. These agencies are also responsible for monitoring the delivery of services in the plan of care and coordinating linkages to benefits across community-based health and social service agencies.

Related Service

Nursing and skilled therapy services are not part of the Medicaid-assisted living services but may be authorized by Medicaid and/or other health insurance, as ordered by a physician.

Who is Eligible?

Adults 19-65 with disabilities, or anyone 65 or older who is eligible for Medicaid LTSS.

Need Assistance Applying?

For more information about Medicaid covered assisted living services and to apply for the same, call THE POINT at 401-462-4444.

A list of assisted living communities is located here

 

What are the 4 Alternatives to Nursing Homes?

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“I don’t ever want to go to a nursing home.”

Certainly, when people are asked to list goals in life, “living in a nursing home someday” is never on the list.

There are however 4 commonly used alternatives for seniors and elders prior to the need for living in a fully skilled nursing home:

1. Continuing Care Retirement Communities (“CCRC’S”)  can provide an alternative solution for many. Such village_at_waterman_lake_assisted_livingcommunities vary enormously in their structure. Some provide life care i.e. an individual may start by living in an apartment, may move to an assisted living wing -where nursing staff is available if necessary and meals may be provided, and intermittently or finally move into the nursing home portion of the community. Many such communities require up-front fees ranging from approximately $25,000 to $900,000 which may or may not be refundable in part or full upon the death of the resident. In addition, there are monthly fees ranging from a few hundred dollars to a few thousand dollars. Frequently, these communities self-insure and guarantee lifetime health care for the residents.

2. Adult Day Care Centers– are similar to child day care centers with which we are more familiar. Adults who need supervision, due to cognitive and/or physical impairment, can be “dropped off” at the beginning of the day. Nursing staff and programming is available throughout the day and the individual returns home for the night. Most long term care policies will pay for adult care.

3. Home Health Care – is another way of dealing with long term illnesses. Most individuals prefer to remain in their own homes for as long as possible. If you were to have a long term care policy of insurance, most comprehensive policies address this preference. Most policies will pay for home health care only if provided through a licensed home health care agency. Some policies will pay for home health care at a percentage of the full nursing home daily benefit amount. A new type of life care at home plan based on the concept of CCRC’s (requiring an upfront fee and a monthly payment) is now being marketed in some areas.) However, if you should not have a LTC policy, many families find themselves private paying for these services or possibly applying for Medicaid if eligible and receiving in-home care services.

4. Assisted Living – many people who live in nursing homes do not really belong there. Frequently, individuals can function very well in an assisted living or personal care facility. These are licensed facilities which often enable individuals to remain in an apartment-like setting. Meals are usually provided and nursing staff is available to help adNewport_Lighthouse_RI_MIminister medicines, handle emergencies, assist when necessary. Often personal care facilities cost about one half as much as nursing homes. Long term care policies generally pay benefits in assisted living facilities as long as the individual qualifies under the terms of the contract. In Rhode Island there are 35 Assisted Living Facilities. The average cost of Assisted Living in Rhode Island is $5,325 per month.

 

Want to learn more about how you can help a loved one plan for their future needs?  Contact our office to schedule a no cost consultation.