THINKING ABOUT A NURSING HOME?
Today's nursing home is for the young and old alike. It is for
convalescents of all ages who expect to recover fully, as well as for those in need
of long-term care. The emphasis is on providing the highest quality care to help
patients care for themselves and to assist them in returning home whenever possible.
Whether you're thinking about a nursing home for a relative, a friend or yourself,
this directory will help you make a wise selection. The type of facility you select
depends on the needs of the individual. Your personal physician or social worker
is best qualified to discuss those needs with you.
Nursing Care Facilities. NCFs provide regular medical, nursing,
social, and rehabilitative services in addition to room and board for people not
capable of independent living. NCFs may participate in the Medicaid program. Facilities
which participate in either Medicare or Medicaid must meet the National Fire Protection
Association Life Safety Code and federal regulations for long-term care facilities.
All facilities must meet state licensure requirements.
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Six basic types of services are offered by nursing homes.
Nursing Care
. Nursing procedures require the professional skills of a registered or licensed
practical nurse. These include administering medications, injections, catheterizations,
and similar procedures ordered by the attending physician. Post-hospital stroke,
heart, or orthopedic care is available with related services such as physical therapy,
occupational therapy, dental services, dietary consultation, laboratory and X-ray
services, and a pharmaceutical dispensary.
Personal Care
. These services include help in walking, getting in and out of bed,
bathing, dressing, eating, and preparing special diets as prescribed by a physician.
Residential Services . These include general supervision and protective
environment, such as room and board and a planned program for the social and spiritual
needs of the resident.
Medical Care
. Each patient in a nursing home is under the care of a physician who visits
periodically, and who is responsible for the patient's overall plan of care. In
most cases, the patient's personal physician refers the patient to the facility
and certifies the need for admission. Once the patient is admitted, the physician
writes orders for medication and develops the patient care plan, including restorative
and rehabilitative procedures, special diets, and other treatments. Every nursing
home usually has at least one physician on staff or on call to handle emergencies.
Subacute Care
. Skilled nursing facility subacute care units offer a wide variety
of medical, rehabilitative, and therapeutic services once provided only by hospitals.
Common conditions treated in subacute units include brain and spinal cord injuries,
neurological and respiratory problems, cancer, stroke, AIDS, and head trauma. Because
nursing facility subacute care costs are 40 percent to 60 percent less than hospital
costs, HMOs and other managed care entities have begun moving hospital patients
to nursing facilities for subacute care.
Rehabilitation
. All nursing facilities are required to provide services to enable
the resident to meet the highest practicable level of functioning. Nursing care
facilities provide intensive rehabilitative services. These services are designed
to enhance the resident's highest functional abilities and encourage discharge to
the community at a lower level of care. Nursing facilities are demonstrating enormous
success at providing these services at a lower cost to the consumer.
Nursing homes provide different levels of care. The individual's needs will dictate
the type of facility you select.
Nursing Care Facilities provide 24-hour nursing service for convalescent
patients. Registered nurses, licensed practical nurses, and nurse aides provide
services prescribed by the patient's physician. Emphasis is on medical nursing care
with restorative, physical, occupational, and other therapies also provided. NCFs
are eligible to participate in both Medicare and Medicaid.
Residential Care Facilities . RCFs provide sheltered living to
individuals capable of "functional independence." The residential care
facility stresses the social needs of the "resident" rather than the medical
needs of the "patient." Residents are provided dietary and housekeeping
services, medical monitoring, and social, recreational and spiritual opportunities.
These relieve the "functionally independent" person of the anxieties of
old age or disability and allow enjoyment of a full productive life.
In addition, some nursing homes offer specialized services and alternative care
services. These services include but are not limited to:
Adult Day
Care Facilities which provide nursing and nutritional services
and medical monitoring in a clean and comfortable non-residential environment. Adult
day care gives seniors an opportunity to make their own decisions, while extending
the long-term care facility's participation in the community.
Alzheimer's Disease Care Centers provide both skilled and intermediate
levels of care to those individuals with Alzheimer's Disease. Specialized nursing
care utilizing a team approach as well as secured areas, both inside and outside,
allow for maximum freedom to those afflicted with this disease.
Hospice Services
are provided by some nursing facilities. These services include 24-hour nursing
care to those diagnosed with a terminal illness. The primary concern of the hospice
is to deal with pain control and to maintain dignity of life. Counseling is available
to the patient and family members.
Respite Care involves
short term (usually two weeks) care in a nursing facility for individuals who are
usually cared for at home. This service allows caregivers to take vacations or tend
to business, knowing the needs of the family members are being met by trained staff.
After you and your personal physician discuss the type of services
needed, obtain a list of nursing homes in your area offering those services.
Your doctor or social worker will be familiar with area facilities.
Also, contact CHCA, your local medical society, community welfare agency, or health
department. Friends and neighbors may offer information if they are acquainted with
someone in a nearby home. Your church or synagogue will be able to give you names
of area homes.
By telephoning the homes on your initial list, you will be able
to narrow the field to two or three offering the specific services and location
you desire. Plan to visit each of the homes at least once. Talk with the administrator
and tour the facility. Contact the Colorado Health Care Association regarding a
brochure entitled "Thinking about a Nursing Home? - A Consumer's Guide to Long
Term Care." This is a very informative and helpful brochure. Don't be afraid
to ask questions.
All nursing homes monitor internal quality assurance standards.
Each department is evaluated; patients, family members, and staff are asked to evaluate
the care provided.
Be selective in choosing a nursing home. As your physician will
confirm, the services offered by a facility should reflect the needs of the patient.
Basing your choice on the needs of the individual also will help keep down costs
and allow others in greater need of higher levels of services to obtain them.
Not all residents pay for their own nursing home care. In fact,
almost 64 percent of NCF consumers rely on public support.
When meeting with nursing home administrators, discuss financial
conditions in detail. All payment agreements should be in writing, and you should
have a copy of the final arrangements. You may wish to cover the following areas
before signing the papers:
What are
the forms of available public support?
Will the
patient or resident receive a refund of advance payments if he leaves the facility?
How are
cash and assets entrusted to the home protected? Is a receipt given to the resident?
Are withdrawals
noted by signed receipt so that the resident can keep track of his account?
There are many ways to finance nursing home care. These might
include social security payments, your own funds, assets in escrow or as an endowment,
assistance form the local Social Services department, or from private organizations
such as veterans’ groups, trade unions, fraternal organizations, or health
insurance plans. Many insurers now have developed long term care coverage policies.
Be sure to check with your agent and/or group insurer to see if you have nursing
home benefits or if they offer long term care policies. The social services staff
in the facility you visit can help in your financial planning under these methods
or under Medicare/Medicaid.
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Nursing homes provide the services of a variety of full-time
and consultant staff specialists. The numbers and types of personnel reflect the
needs of the patients.
In nursing care facilities, 24-hour nursing coverage is provided
by licensed nurses.
When you tour a facility, look to see if the nursing staff is
interacting with patient, answering call signals quickly and talking with the patients.
If special treatments or nursing measures are needed, ask if they will be available.
Activities are provided in all facilities. Ask to speak with
the activity coordinator and find out what types of individual and group activities
are sponsored. Ask whether social services are provided by the facility staff or
through an outside agency.
The dietary department is under the direction of a food service
supervisor.
Other specialists are on staff or available on a consultant basis;
a registered dietician, physical therapists, occupational therapists, therapeutic
recreators, psychiatric personnel, a medical director, consultant pharmacists, podiatrists
and dentists.
The overall management of the facility is the responsibility
of a licensed nursing home administrator.
Most important, be sure that the people who care for the residents
are kind. People providing services to people is what nursing home care is all about.
TO BE FULLY INFORMED
You are entitled to receive a copy of all rules and regulations
pertaining to your rights and responsibilities, to be informed in writing of services
available to you, and all matters related to charges.
You have the right to be informed of the address and telephone
number of the local and state ombudsman and the Department of Public Health and
Environment.
You have the right to see that state survey reports on the facility.
In fact, you may visit http://www.medicare.gov/Nursing/Overview.asp
for the most recent survey results.
You have the right to communicate in your own language and to
assistance if you have sensory impairment. You have the right to be informed about
your rights to financial assistance under Medicaid. TO PARTICIPATE IN YOUR OWN
CARE
You have the right to adequate and appropriate health care. You
have the right to select your health care facility, to choose you own physician,
and to review your medical records. You are entitled to participate in planning
your care, including discharge planning, to be informed of all aspects of your care,
to refuse medication and treatment unless otherwise ordered by the physician.
TO MAKE INDEPENDENT CHOICES
You have the right to make choices and independent personal decisions
and to be encouraged in this by staff. You have the right to participate in community
activities inside and outside the facility. You have the right to vote and manage
your own finances. TO PRIVACY AND CONFIDENTIALITY
You have the right to private and unrestricted communications
with any person of your choice, privacy for telephone calls, for meetings with family,
friends and other residents, consensual sexual activity, and unopened mail.
You have the right to privacy in treatment and caring for your
personal needs, to confidentiality regarding your medical, personal and financial
affairs. TO DIGNITY, RESPECT AND FREEDOM
You shall be treated with consideration, respect and full recognition
of your dignity and individuality. You shall not be subject to physical or emotional
injury or harm. Except on orders of physician, you may not be subjected to medication
or to physical restraints. TO SECURITY FOR YOUR POSSESSIONS
You may file a complaint with the state health department for
abuse, neglect, or misappropriation of your property. TO REMAIN IN THE FACILITY
You may be transferred only for medical necessity, for non-payment,
for your welfare if your welfare cannot be met in the facility, or if the safety
and welfare of other residents is endangered.
You cannot be transferred or discharged for raising concerns
or complaints. You must be given reasonable advance notice except for an emergency.
This means thirty (30) days notice for a transfer out of the facility, and five
(5) days notice of a room change. If you do not agree with the transfer, the facility
must provide you and your family member with a written notice that includes your
right to appeal (to be filed within one day), the staff member you should notify,
and the phone number of the Colorado ombudsman for assistance.
You have the right to receive written notice about facility policies
in regard to holding a bed if you should be hospitalized. You must be notified three
(3) days prior to a lapse of bed hold. TO RAISE CONCERNS OR COMPLAINTS
You have the right to raise concerns or use the grievance procedure
to recommend changes individually or as a resident council to staff or to outside
representatives. There may not be reprisals for your action. The full grievance
procedure is available from the facility staff or the ombudsman.
Every facility must have a resident council. The council shall
be conducted by the residents and establish a process for representing the views
of all the residents. It shall have the opportunity to meet without staff present,
yet at least monthly with the administrator to make recommendations concerning facility
policies. These issues must be responded to in writing by the next meeting. Minutes
of council meetings shall be available to residents. The council may present grievances
to the grievance committee on behalf of residents.
YOU HAVE THE RESPONSIBILITY TO RESPECT REASONABLE FACILITY RULES AND THE RIGHTS
OF OTHERS
This is a condensed version of state and federal law and regulations.