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Guide to Choosing a Nursing Home (Part II)

Health Care Financing Administration (HCFA) has published a booklet entitled "How to Choose a Nursing Home."

Table of Contents



Nursing homes are only one of a range of long-term, comprehensive medical, personal, and social services designed to meet the needs of chronically ill and disabled persons. Before considering placement in a nursing home, therefore, you should explore the possibility of using home- and community-based care. What's important is that you discuss your needs and plans with your physician or caregiver and your family to decide on the most appropriate place in which you receive care. Your financial ability to pay will also affect your decision (see "Payment Considerations").

When a less intensive and less restrictive form of care is called for, a mix of services and/or programs popularly called "alternatives to institutional care" may be most appropriate. While most long-term care is still provided at home by relatives and friends, an increasing number and variety of community based health and supportive services and specialized living arrangements are now being created in communities throughout the nation. Among the home- and community-based services available:

    • Home Health Care
    • Respite Care
    • Adult Day Care Centers
    • Foster Care
    • Residential care in a board and care home
    • Retirement Communities and
    • Hospice Care.

When an individual needs 24-hour nursing care and supervision, however, a nursing home may be the best answer.

Once you decide that nursing home care is needed, you may become overwhelmed. It is normal to be anxious, angry, guilty, depressed, or scared at the thought of making such a big decision for yourself or a family member. This book can help ease those emotions by assisting you to make informed choices. By planning ahead, you will be better prepared to make the appropriate choice for care. By using this book, you will already be familiar with the individuals and organizations to whom you can turn if you need help.>

Why Do People Live in Nursing Homes?

The great majority of nursing home residents are elderly. Some are frail and unable to take care of themselves and live safely on their own. Other residents, regardless of age, suffer from chronic illnesses and need some medical attention, but do not require hospital care. Still others have been transferred to the nursing home from a hospital to convalesce after a serious illness, accident or operation.

Forty percent to 45 percent of everyone turning age 65 in 1990 will stay in a nursing home at least once in their lifetime. About one-half of those admitted to nursing homes stay less than six months. However, one in five will stay a year or more, and one in ten will stay three or more years.

Some nursing home residents have no families to care for them at home. In other cases, the families are not able to supply the kind of care the individual needs there may be no one home during the day, or the care needed may be too specialized or too expensive to provide at home. In still other cases, families may decide that keeping the person at home would be too difficult.

Facts About Long-Term Care and Nursing Homes

During the past two decades, the number of people over age 65 has grown dramatically, more than 55 percent. While people are living longer, the number of people with chronic illnesses or disabilities that will require long-term care services is also increasing. By the year 2000, almost 9 million older Americans will need long-term care services, up from almost 7 million in 1988. Many of these people will require nursing home services. Typically, these people are older women without spouses.

Almost 20,000 nursing homes in the United States now provide care for about 5 percent of older Americans.

Quality-of-Life Issues

When people enter nursing homes, they don't leave their personalities at the door. Nor do they lose their basic human rights and needs for respect, encouragement, and friendliness. All individuals need to retain as much control over the events in their daily lives as possible.

Consequently, nursing home residents should have the freedom and privacy to attend to their personal needs. That means several things: from managing their own financial affairs, if they are able, to decorating their rooms with personal belongings. It also means being able to participate in the planning of their treatment and being assured of the confidentiality of their medical records.

In the 1980s, several studies identified some problems with the quality of care that the nation's nursing homes provided to Medicare and Medicaid residents and recommended the implementation of new and higher standards of care in nursing facilities. In 1987, Congress enacted legislation to raise these standards. In October of 1990, these important new nursing home reforms took effect and are designed to strengthen both the quality of life and quality of care for residents. The reforms call for the provision and enforcement of certain rights of residents to dignity, choice, self-determination, and quality services and activities.

Knowing some of the key details of the law can help you make a better decision about selecting a nursing home. It can also better prepare you to be a resident, to know what to expect, and what to ask for if you are not receiving the care and services to which you are entitled. You will need to ask questions and observe how a nursing home is performing.

Under the law, nursing homes must train their nurse aides. Facilities must also conduct a comprehensive assessment of resident needs within two weeks of admission. The law also requires that nursing home residents have the right to choose activities, schedules and health care that are consistent with their interests and needs. Facilities are expected to provide a safe, clean, comfortable homelike environment.

Residents must receive the necessary care and services that enable them to reach and maintain their highest practicable level of physical, mental, and social well-being.

For example, married residents should be assured privacy for visits from spouses. If both husband and wife live in the home, they should be able to share a room, if possible. All residents should have freedom and opportunity to make friends and to socialize.

Residents and their relatives must be able to talk to administrators and staff about questions, problems and complaints without fear of reprisal. Administrators should be courteous, helpful and frank. They should treat residents and their requests with respect. Staff members should respond quickly to calls for assistance and treat residents with courtesy, respect and affection. A long-term care facility may meet every known standard, but that's not enough. Warm, professional relationships between staff and residents are an essential ingredient to quality care.

Residents should not be transferred or discharged arbitrarily and should be given reasonable advance notice if they must be moved.

Many of the specific items you should keep an eye out for are part of the regulations concerning residents' rights a set of rules that nursing homes certified by Medicaid and Medicare must follow. The law applies to referrals, admissions, accommodations, room assignments and transfers, policies regarding financial matters, care services, physical facilities, residents' privileges, and the assignments of medical staff and volunteers. In addition, a civil rights law ensures equal access regardless of race, color or national origin in all nursing homes.


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