Jennifer Meagher RN is a Geriatric Care Manager and Registered Nurse. She had a 21 year nursing career at Genesee Hospital, which included 11 years as Nurse Manager. She was the primary evening instructor for a local Home Health Aide training program. She has been a geriatric specialist since 1998. She is a member of Greater Rochester Area Partnership for the Elderly, is the founder and president of Better Businesses Partners Serving Seniors, and is called on by local attorneys and physicians for her expertise. She is the owner of Senior Life LLC, Independent Consultants and Advocates | www.SeniorLifeGCM.com
My neighbor is trying to tell me that her father is in the hospital and that no Nursing Homes in town will take him. How is that possible? How can that be legal? I don’t believe her, but she insists it is the truth.
What say you?
It is absolutely possible. Nursing Homes look at the client’s life projection, cost of daily physical care, and cost of medications. This total is compared to the elder’s financial situation. Medicaid pays only 50-60% of costs, and therefore Nursing Homes must have a mix of private pay and Medicaid reimbursement. I have given some examples of elders whose situation makes it difficult to find a Nursing Home.
- If the individual is younger, running out of money, with a long life expectancy, it is harder to get into a nursing home, although I am quite certain he would be accepted somewhere locally.
- Sometimes the cost of an individual’s care is significantly more expensive than the daily charge at the Nursing Home; in these cases the Nursing Home expects to lose money every day and will not be able to accept the individual. This will be true of all Nursing Homes.
- If the elder is combative as part of dementia or delirium, and is assaultive, it is very difficult to find a Nursing Home who will subject their staff to this situation. These cases are referred to “Behavior Units” which you may consider “Behavior Rehabilitation Units.”
- Sometimes the person’s care need does not match the requirements for admission. This means the elder does not need skilled nursing care. See today’s article on these admission requirements.
I don’t have the facts of your neighbor’s situation, but as you see, she deserves the benefit of the doubt.
The Insider’s Scoop on Nursing Home Admissions
If you didn’t already, read today’s Ask Jennifer entry for additional information.
1. If you need admission ASAP, the first question is whether the Nursing Home has an available room. Understand this: gentlemen may be harder to find a room for, if the gentleman is going into a semi-private room. Why? There are more women than men – there may not be a room available for a man.
2. The next thing a nursing home looks at is the “PRI and SCREEN” which is often referred to only as the “PRI.” It stands for Patient Review Instrument, which didn’t really explain anything did it? Basically, it is an interview tool / form which must be completed by a certified assessor. The PRI demonstrates the level of care need which is then assigned a score. It also reflects insurance, medication and problem lists, housing circumstances and elder understanding / agreements. The final “score” must show there is enough “skilled nursing care” or physical care / supervision to merit a nursing home stay.
3. Next, the Nursing Home asks for “Financials” about the individual.
4. The Admissions Team meets to discuss your submission and makes a decision as outlined in today’s “Ask Jennifer.”
5. The Admissions Social Worker communicates their decision.
6. It is wise to plan ahead; ask friends about their experiences in Nursing Homes. Visit the Five Star Federal Rating System for Nursing Homes online. Visit the Homes. If your loved one needs a Nursing Home, which would you most prefer? Try to pick five. It is very hard to think straight when you are in the middle of a crisis. Hospitals need their discharges as efficient as possible – you won’t have time to research then. Make an appointment with yourself to get this homework done. If you are crossing your fingers that your beloved elder is “all right” at their current home, then get this done soon – you are playing with fate.