Nursing Home Checklist

A nursing home staff member will assist a family through the admittance process, but it helps to be prepared. If your loved one is currently in the hospital, the first five items on this nursing home checklist will be taken care of by hospital staff. Otherwise, make an appointment with the primary care physician to discuss the following items to help prepare for the move to a convalescent home.

1. Physician’s Order for Admission to a Skilled Nursing Facility: A doctor needs to confirm that a patient needs to enter a nursing home for care. This order is similar to writing out a prescription.
2. Physician’s Order for Medications and Treatment: Your loved one will have a new physician and caregivers at the nursing home. To care for him or her, they will need orders from a primary care physician or hospital staff.
3. Medical History and Physical: The nursing home’s attending physician needs up-to-date information on your loved one. The primary care physician should perform a physical and write up a current medical history.
4. State-required Form: Every state has a required form-which goes by different titles-that certifies a patient meets state nursing home criteria. This means his medical needs can be fulfilled at a skilled nursing facility. Either the hospital or the primary care physician will fill out and sign this form. It can be obtained at any nursing home in the state where they will be receiving. (The hospital should also already have the form.) Because financial assistance is only granted if the patient meets state criteria for nursing home care, this form meets the first requirement for funding, before monetary need is ascertained.
5. Negative Tuberculosis (TB) Test or Chest X-Ray TB is an airborne communicable disease. Nursing homes need to make sure their residents do not have or carry this disease.
6. Completed Admissions Paperwork: Usually, paperwork can be filled out prior to or on the day of admission. Although nursing homes have different rules, most often these forms are filled out at the facility with a staff member. The patient (or agent) will sign her name several times after learning pertinent information. Because nursing homes are regulated by state and federal laws, the community needs written proof that the patient learned this information. Part of the paperwork gives the patient’s consent to be treated. As part of the application process your loved one may need to bring his or her social security card.
7. Completed Financial Assessment: This step ensures that each patient has the means to pay for care. The patient or her family needs to disclose financial information (along with corroborating paperwork), including, but not limited to, answers to the following questions:
   1. Is the patient currently enrolled in Medicare (Part A or B) or Medicaid or plan to apply? Does he have supplemental insurance?
   2. Does the patient receive Veterans Benefits, Railroad Retirement, SSI funds, or a private or government pension?
   3. What are the patient’s assets, including cash, checking and savings accounts, stocks, bonds, CDs, trust funds, and real estate holdings?
   4. Does the patient have any paid-up life insurance policies or paid-up burial insurance or long-term care insurance?
   5. Has the patient transferred assets in the last 3-5 years?
   6. What is the patient’s current living situation (rental housing, own a home)? What is the amount of the monthly rental or mortgage payment?

The nursing home has an obligation to determine if incoming residents meet the criteria for any state or federal funding. This process is similar in nature to a person divulging financial information to get a mortgage; the nursing home is, in effect, the patient’s new home.

Residential Care Home Services

Also called board and care homes, adult family homes, and residential care facilities for the elderly, this is a live-in housing and care option for people who do not have skilled medical needs, such as a feeding tube or daily injections. Generally, a residential care home provides the following:

• A room, either private or shared
• Meals
• Varying levels of assistance with daily living activities, such as toileting, bathing, and even money and health care management
• Custodial care, such as laundry, housekeeping, and transportation to doctor appointments
• Reminders to take medications or actual medication administering.

Adult family homes “are wonderful for individuals who are looking for a smaller-home-like setting,” says Charlotte. “They’ll eat home-cooked meals in the kitchen. [The home] will have a front porch or back porch and a garden. [It] will offer lots of one-on-one tender loving care.”

Small, Tight-Knit Community

This family-like atmosphere is fostered by a high staff-to-patient ratio, which is typically higher than the same ratio in a nursing home or assisted living community. Most often there is one caregiver for every three or four residents. “If my mom is in a nursing home and she can’t walk under her own steam, it could take 30 to 45 minutes to have someone take care of her after she pushes the call button,” says Jerry G., a former Senior Living Advisor for A Place for Mom.

For a senior citizen who is very active, though, a residential care home may not offer enough stimulation. A larger assisted living community has a wider array of social activities, such as on-site aerobics or outings to near-by events. A residential care home is a better fit for a frailer adult who can benefit from more individual care, says Charlotte.

Researching potential adult family homes for loved ones is complicated by the fact that there are no federal standards for these communities. Each state follows its own regulations and licensing rules. (Some states have no set standards.) For states that license residential care homes, surveys on each home are available at local licensing offices. Homes usually must provide this survey if asked by potential clients. To find a local licensing agency, contact the state’s department of aging.

Just as every house on a block is different, residential care homes are not all styled the same. Some are modest, while others feature crystal chandeliers and granite countertops. “It depends on how potential residents have been living their lives,” says Jerry G. “They are going to be more comfortable in a home like they have been living.”

Adult family homes are run by all kinds of individuals, from registered nurses to recent immigrants. Sometimes the homeowner lives in the facility, while others are run like a business with shifts of caregivers. “They [usually] have nursing oversight, but the nurse is not onsite at all times,” says Jerry. Because residential care homes vary so greatly, it’s vital to assess the needs of the future resident, deciding if they need around-the-clock staff attention, for example. It’s also important to visit several homes, comparing and contrasting to find the best fit.

The price tag for a living in a residential care community is often half the cost of nursing home care, and in some states, it is even more affordable than assisted living community care. Although prices vary vastly, care usually costs $3,500 to $4,500 per month, although some cost as little as $1,500 each month. Some charge $5,000 to $6,000 per month; these are typically homes that specialize in dementia care.

Some long-term care insurance policies pay for residential care home costs. Medicaid-health insurance that helps pay for medical and long-term care for people with low income-often covers fees for people who can’t afford the cost of private care. “Most [residential care homes] want you to pay privately for a year or two before you convert to Medicaid,” says Jerry. Some residences don’t accept Medicaid at all. Since Medicare doesn’t pay for custodial care, it doesn’t usually cover residential care home fees.

This type of care home is a good fit for many elderly adults. Many of them can provide care until the end of a life, and helps residents feel like they are living in their own homes, says Jerry.