Nursing Homes

WHAT IS A NURSING HOME?

Nursing homes are commonly referred to as skilled nursing and rehab centers or nursing centers. A nursing home is a senior living residence for people who need either long-term care or skilled nursing and rehabilitation services. These communities provide all of the personal care and services of an assisted living community with the addition of 24-hour nursing care.

Residents typically live in private or shared accommodations. Sometimes bathrooms are shared between patients or even between two rooms. Some rooms and suites have a private shower and most have a shower room or “spa” on each wing.

WHO LIVES IN A NURSING HOME?

Long-term care is for older adults who need around the clock nursing care. These residents need help not only with basic activities of daily living (ADLs) but need the supervision of staff to maintain their safety.

Skilled nursing and rehabilitation services are also provided in most nursing centers. This higher level of more complex medical care is typically for patients who have had an injury, acute illness or a surgery. This level of care requires the services of a licensed nurse and often times physical, occupational or speech therapy. These patients usually require more frequent, intensive treatment and/or therapy services.

HOW ARE NURSING HOMES PAID FOR?

Reimbursement for nursing home fees is a bit complex. If a patient is there for a short-term rehabilitation stay or respite stay, Medicare and/or private insurance typically covers the charges for the stay. If the patient continues to meet what is known as the “skilled criteria” during his or her rehab stay, Medicare covers 100% of the charges accrued during the first twenty days and then 80% of the charges accrued during the next 80 days. If a patient has a secondary insurance, it often covers the 20% not covered by Medicare during those last 80 days.

For long-term care residents, private funds, Medicaid, and long-term care insurance are the typical methods of payment.

HOW ARE NURSING HOMES REGULATED?

Nursing homes are regulated at both the state and the federal level. They are licensed and regulated by the state Department of Public Health, and are certified by both Medicaid and Medicare. In addition, there are licensing standards for the administrators and the clinical staff. In order to make sure that nursing homes are up to state and federal regulations, state or federal agents inspect or “survey” the facility and the agents show up unannounced at least one time a year.

To learn more about senior care options in your area, call your local Care Advisor at (866) 510-9738. Your Care Advisor will discuss the type of care you are looking for your loved one and work with you to find the community that will best meet those needs.