Clients call me daily to discuss their loved one going to a nursing home or other facility for medical care and supervision. There is so much new information and experiences that face the client that I end up address many of the most pressing big picture discussions like how do you pay for the care and how do you protect the assets. This is understandable but a recent personal experience with my own family member brought home all the other issues face by my clients in day to day care.
There are many good books written on how to advocate for your loved one when they are in a nursing home. I will highlight some of the tips that I have found useful and pass on some recommended reading by those authors that I have found more useful.
One of the most common questions I get is how do you pick the “best” nursing home or which ones are good or bad. Before I tell you some of the helpful tips, let me deflate your zeal and ease some of this burden right up front (because you will need these things for better results once your loved one is placed). If your loved one is heading to a nursing home (either from a recent hospitalization or from home), you will not have the luxury of time for doing a great deal of research. Even if you make the time in an emergency circumstance, you will have a small selection of nursing homes at that time from which to choose. Though we have a fair number of skilled nursing homes in Southwest Florida, they are not empty. If your loved one is looking for rehabilitation from their recent hospital stay, then there tends to be more choices for placement. The reason for greater choice is that most nursing homes reserve a fair number of beds for this type of rehabilitation patient. These patients are most often covered under Medicare and payment for these services are often the highest form of reimbursement available to the nursing home, partly because they are receiving more treatments and services. These patients are also typically short term, so there is a fairly regular turnover rate for these beds which means more availability. When your loved one is coming straight from home, it is usually less about “rehabilitation” and more about long term custodial care, which limits the number of beds per facility available for choosing. There are fewer beds reserved for the purpose of long term custodial care and the patients don’t rotate in and out as often.
The time of year also affects availability. During tourist or snowbird season, our local population swells. Probably not surprising, this means more people are in our hospitals and this trickles down to the nursing homes. In the summer you will probably be able to choose from four or five nursing homes; but in season your choices could be one or two.
Many clients want to be diligent and research the choices now before there is an immediate need. If you are doing this while you are still healthy (years before the need – long term effort) then you are talking about Continuing Care Communities (CCCRs) and this is a life style choice more than an immediate health care decision. If you are looking for a nursing home because the need for one is likely in the next year (short term search), I love the diligence and honor the desire. Unfortunately, your early short term efforts may be wasted. In this industry, the compensation for the labor market (staffing) is very tight. This results in a constant turnover rate in staff from the top of the facility on down to the lowest level of staffing. Yes, some companies distinguish themselves with long term consistency but rarely in this industry, so its all about the people who are running the show at each physical plant. So a nursing home that is preforming well this month may be very different in six months to a year when there is a different “Administrator” or “Director of Nursing”. A study by the American Health Care Association (nursing home trade group) showed CNA (Certified nursing assistant) turnover rate nationwide to be 71% in 2002, 66% in 2007 and 55.3% in 2011. So even in the recent times with the highest unemployment rates – this staff position, nationally, changes by half each year.
Another question on client’s minds are, should I avoid facilities that accept Medicaid. The short answer is No. With the exception of one or two facilities in Lee, Charlotte, Hendry and Glades counties, every nursing home facility accepts Medicaid. They have Medicaid as part of their business model even though Medicaid is one of the lowest forms of reimbursement that they receive. In the past, patients were often segregated into the private pay section and the “welfare” wing. This is not the case today and for the most part, the direct care staff are not aware of the source of payment for your loved one’s stay. In my view the number one factor in getting good care (whether in a resort style facility or in one with more modest arrangements) is having an active advocate that participates and monitors the care provided.
One of the best ways to get direction is from your local Elder law attorney. We have the knowledge of the various providers and typically track who is having changes in personnel or care related difficulties. A good example of factors to consider can be found in the blog article by Martha Brown here. This knowledge doesn’t open beds when facilities are full; so no matter what, when you need a bed you choose from those available – good, bad or indifferent. You can also get a list of facilities that have received a good or bad rating by AHCA, which is the agency governing nursing homes in Florida. You can also check CMS at http://www.medicare.gov/nursinghomecompare/search.html. This will give you some objective track records and survey results for each nursing home or skilled nursing facility. Even if you don’t have much of a choice, when the time comes, this information will better equip you to advocate for your loved one when they are placed.
The next few posts shall cover ways to be a better advocate for your loved one in a nursing home.
At Osterhout & McKinney, PA we regularly assist clients in choosing nursing homes and care providers for their loved ones. We can assist you in being a better adovcate for your loved one and how to generally get and pay for good care. You can contact us at 239-939-4888