Finding a good nursing home is like finding a needle in a haystack… Many families prefer not to admit their ailing or aging loved ones into a nursing home. However, sometimes the circumstances of daily life prevent a family from providing adequate hospice care. In these situations, finding a quality nursing home is helpful and could significantly impact a loved one’s medical and end-of-life care.
For those reading this blog post, understanding Medicare eligibility may already be as simple as riding a bike. However, it is essential to explain the basic requirements. Medicare is split into two parts:
- Medicare Part A: all hospital care.
- Medicare Part B: medical insurance coverage.
To be eligible for Medicare, a person must be at least 65 years or older, experiencing a disability, or suffering from End-Stage Renal Disease resulting in permanent kidney failure requiring dialysis or a transplant. In addition, to avoid paying Medicare Part A coverage premiums, a person or their spouse is 65 years or older and pays at least ten years of Medicare taxes.
The U.S. Centers for Medicare and Medicaid Services (CMS) established Medicare.gov, which allows the public to research Medicare services and apply for coverage. Although CMS updates the site often, members of the public may feel overwhelmed navigating the website. Below are valuable tips and resources to help those interested in nursing home care.
Paying for a Skilled Nursing Facility (SNF)
A skilled nursing facility (SNF) is designed to offer hospice care (care designed to treat a terminally ill patient and provide the physical and emotional needs for quality of life and reducing pain).
Medicare Part A covers temporary hospice care if the following conditions apply:
- Patient has Part A coverage and has limited time left in their benefit period.
- Patient has a qualifying inpatient hospital stay.
- The doctor has determined the patient requires daily skilled care, which means care provided by a skilled nurse or therapy staff or under their supervision.
- The patient receives services in a certified SNF.
- SNF is treating a hospital-related medical condition during the patient’s three-day qualifying inpatient stay, or the patient’s condition started while receiving care from the SNF for a hospital-related condition.
Medicare will not automatically require a recipient to pay for medical costs associated with SNF care. Instead, payments are divided into three time periods:
- Day 1-20: Medicare pays for SNF care; the recipient will pay $0 in coinsurance daily.
- Day 21-100: Recipients must pay up to $194.50 daily coinsurance premiums.
- Day 101: Recipients must pay for the total cost of SNF care.
Types of Skilled Care
Skilled nursing care encompasses numerous services and programs for patients. All care must be performed by, or under the supervision of, trained medical personnel employed or contracted by the SNF. Services include:
- Housing in a private or semi-private room.
- Daily meals.
- Skilled nursing care.
- Physical therapy.
- Occupational therapy.
- Social services for medical care.
- Medical equipment and supplies are used by personnel at the facility.
- Prescription medication.
- Ambulance transportation for additional medical care is not offered at the SNF for patients that cannot travel by conventional means.
- Counseling for dietary restrictions.
- Psychiatric care, depending on the facility.
Comparing Nursing Homes
On the Medicare.gov website, the public can search for nursing homes in their area and research the types of services offered and overall ratings from other users. Below are step-by-step instructions on how to use the site.
Step One: Access the Online Search Menu
Click here or enter the following link (https://www.medicare.gov/care-compare/) into a web browser. A window will open with the title: “Find and Compare nursing homes, hospitals & other providers near you.”
Step Two: Input Specific Information and Search
In the box below “My Location” type in your city, state, and zip code. Then designate the provider type by clicking the drop-down menu and clicking on “Nursing homes.” Users may also search for specific facilities by typing the name in the “NAME OF FACILITY (optional)” search bar. Once the search parameters have been entered, click “Search.”
Step Three: Search for Nursing Homes
After searching by location and type, a list of nursing homes should appear in the surrounding area. Users can see a complete list on the left-hand side of the screen or search their area by using the map on the right-hand side of the screen. In addition, users may filter by distance, overall rating, other ratings, the number of certified beds, and more.
Step Four: Compare Nursing Homes
Once users identify nursing homes they would like to compare, click the “Compare” for that facility. Users can compare up to three nursing homes at a time. Once a user has chosen the nursing homes they would compare, click “Compare” in the right-hand corner. A web page will open with information about each facility and how they compare.
Each nursing home will have a list of services offered, staffing information, health inspection information, and ratings. Facilities with a four or five-star rating are of higher quality, while those with one- and two-star ratings are of lower quality.
Special Focus Facility (SFF) Program
Medicare.gov users searching for a nursing home in their area should be aware of nursing homes designated by CMS as special focus facilities (SFF). The SFF identifies nursing homes that have demonstrated a pattern of poor or substandard care for their residents.
Included on the web page is a changing list of qualifying facilities, facilities currently undergoing steps to improve, facilities that have shown improvement over time, or facilities that are no longer eligible for Medicare Part A recipients. CMS is frequently updating its list by periodic inspection of these facilities, so current residents or potential residents should continue to check the progress of these facilities.
Families seeking Medicare-eligible SNFs for their ailing or aging loved ones can contact our office for legal counsel on options that best suit their needs. Although Medicare.gov offers free information about many of these facilities, families should always be prepared for issues regarding care associated with Medicare eligibility and financing. Contact one of our nursing home attorneys at (918) 359-6600 or visit our website.