Making the decision to place a family member in a nursing facility is one of life's most difficult and emotional challenges. It's often a decision that occurs when the physical, emotional and economic burdens are at their peak.

When it becomes apparent that a skilled nursing facility is the best answer, families are often unfamiliar with what to expect. This helpful information is provided to answer some common questions and concerns. The admissions staff at any NHCA facility can provide additional details.

In the majority of cases, the decision to enter a nursing facility lies with the individual and/or their family.

Most often, individuals are admitted to a nursing facility directly following a hospital stay. Other times, they are admitted from home or other community settings.

Admission into a skilled nursing facility always requires a physician’s order. If your physician does not have privileges at the NHCA facility you choose, the admissions staff will assist you in discussing alternatives.

Staffing
NHCA's interdisciplinary care teams are comprised of many professionals, including physicians, nurses, certified nursing assistants, physical, occupational and speech therapists, social workers, dieticians, and recreation therapists.

Daily staffing schedules, by shift, are posted in every NHCA facility and are available for review. For additional information, contact the director of nursing services or administrator directly at the facility.

Safety measures for residents who may wander
Upon admission, individuals are evaluated for all of their care needs, including the risk of wandering. If the treatment team determines that a risk may exist, they develop a care plan that includes interventions to reduce the likelihood that the individual will wander and potentially harm themselves or others. In some instances, a bracelet-type device may be worn that activates an alarm system alerting staff to the danger of leaving the building in an unsupervised manner.

In all instances, individuals who tend to wander are encouraged to participate in specialized activities to keep them focused on programs and other facility activities.

Feeling at Home
It is important that each person's room feel as much like home as possible. Therefore, individuals and families are encouraged to bring personal items and special possessions with them. The amount or type of furniture is not generally limited unless it interferes with space designated for a roommate or if it creates a safety hazard. The admissions team will be glad to assist with any concerns or questions relating to personal items or furniture.

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Some common concerns and questions regarding payment for care are answered here. The admissions team at any NHCA facility can provide additional information to help further evaluate payment options and eligibility.

Financial Options

Medicare benefits are available to

• people over age 65, or
• some people under 65 who are disabled or have serious medical conditions

Medicaid may be an option for eligible low-income individuals, regardless of age. Eligibility requirements vary from state to state.

Many insurance companies and employers now offer HMO Choice + Plans, Long-term care insurance and supplemental insurance. Veteran’s benefits are accepted at some NHCA facilities through the Department of Veterans Affairs.

Medicare Coverage

For eligible individuals needing daily skilled nursing care, Medicare Part A coverage will pay for a semi-private room, nursing care services, medications prescribed by a physician, medical supplies and equipment, meals and special diets, rehabilitation services and other ancillary services for up to 100 days.

For days 1 through 20, Part A covers 100 percent of approved charges. For days 21 through 100, the individual is responsible for paying a daily co-insurance fee. Medicaid and some private insurers may pay this required co-insurance.

Eligibility Requirements for Medicare Coverage

Admission to a skilled nursing facility must take place within 30 days of the day of discharge from the hospital. The hospital stay must be for at least three consecutive days, not including the day of discharge. A physician must certify that the individual will require skilled nursing care.

Re-admission criteria can be further explained by the admissions department at any NHCA facility.

Private Insurance

Certain private insurance plans and HMOs will pay for all or part of the daily room and other charges for a certain period. Many Medicare HMOs (Choice + Plans) have similar requirements and pay similar benefits as Medicare.

HMOs and PPOs

Health Maintenance Organization (HMO) plans vary widely but all require that their covered members utilize a certain network of skilled nursing facilities. Most HMO plans require pre-authorization for services as well as other administrative processes. It is best to check with the HMO to determine what their specific policies are. The admissions team can assist you in obtaining necessary information, upon request.

Preferred Provider Organization (PPO) plans offer a higher percentage of reimbursement for using nursing facilities within their network but typically offer “out of network” benefits at a higher co-payment cost to the individual. Again, it’s best to check with the PPO to determine their specific reimbursement structure.

Supplemental Insurance

Many supplemental insurance policies e.g., AARP, will cover some of the costs not covered by Medicare, such as the co-payment for days 21-100. Some insurance policies pay for additional days beyond 100. The admissions department can help verify benefits and explain how they apply to the overall costs of care.

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Family support helps with recovery
Families are an important part of the care-giving process. Family involvement tends to raise spirits and help with the patient's recovery or rehabilitation. As such, families are always welcome to attend social gatherings, celebrate special occasions or stop in and visit. Visiting hours may vary by facility but are always very flexible.

NHCA staff works closely with families to ensure a comfortable and stress-free transition from the hospital, home or other setting. Because they are an integral part of the care-planning process, our professional interdisciplinary team encourages family members to participate in pre-admission interviews, therapy sessions, support meetings, and personal meetings with our administrative staff.

Arranging for a tour of a NHCA nursing facility
Families are always welcome and encouraged to call any NHCA nursing facility to arrange for a tour. The admissions team will gladly accommodate your schedule any day of the week, including evenings and weekends.

Visiting a NHCA Facility
Family and friends are always welcome to visit. When planning a visit, please consider special needs such as rest, medications or medical treatment. Every NHCA facility has flexible visiting hours to accommodate the schedules of family and friends. Check with the NHCA facility of your choice to discuss their specific policies.

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