Nursing homes provide care to persons who are chronically ill or recuperating from an illness or injury and need 24 hour nursing care and other health services but not hospitalization. They usually provide rehabilitation programs, social activities, supervision, and basic room and food services. Nursing homes are licensed by the North Carolina Division of Facility Services and most are certified for Medicare or Medicaid reimbursement.
Nursing homes have an administrator who has the responsibility of managing the facility. A licensed nurse serves as Director of Nursing (DON) and supervises the residents’ personal care. Certified nursing assistants provide routine care. The number of assistants on duty depends on the number of residents. Social workers, activity coordinators, physical therapists and dietary staff provide specific services in the facility.
The Division of Facility Services (DFS) is a facet or component of the Department of Health & Human Resources. DFS Inspections are conducted annually and complaints are investigated when reported. Facilities that accept residents receiving Medicaid and Medicare are certified by the Division of Medical Assistance (DMA) and must post their inspection reports.
Under North Carolina’s Nursing Home Bill of Rights, all residents are to be treated with respect, consideration, and full recognition of personal dignity and individuality. The Regional Long-Term Ombudsman (an advocate for the residents) works to see that these rights are respected.
The cost of nursing home care often seems overwhelming to the resident and her/his family. Facilities typically charge $5,000 – $6000 per month. This cost covers 24 hour nursing care and meals. Most facilities charge additional monthly fees for personal laundry, and some therapies require additional charges. Residents receiving Medicaid do not pay an additional fee for laundry services. Ask the appropriate facility personnel about these costs and charges.
Over 70 percent of the residents in nursing homes receive Medicaid – an entitlement program for those with limited incomes and resources. Often residents enter a facility with their own resources and then convert to Medicaid when their personal funds are used. A private pay resident may not be discharged from a facility certified to serve Medicaid residents only because he or she needs Medicaid to reimburse the facility. Medicaid reimburses facilities for the “cost of care” (which includes wheelchairs, medical transportation, bandages, etc.). Residents should inquire about the costs already associated with their care before they pay for additional services from their own funds. Call the Medicaid worker at the Department of Social Services if you have questions about what Medicaid covers and to see if you are eligible.
Few people in nursing homes (less than 5 percent) are covered by Medicare – a federal health insurance program. Medicare only pays for specific needs and procedures and for a limited period of time. A physician must certify the resident’s medical care needs. The resident is evaluated on admission and a determination is made then about Medicare coverage. Currently, Medicare may cover up to 100 days of nursing home care; however, the resident is responsible to pay a co-payment of 20% after the 20th day of Medicare coverage. A secondary insurance will pay the 20%.
Some older adults have insurance policies that will cover some, if not all, of the costs of nursing home care. These policies should be read carefully to determine what level of care is covered. Veterans may also be eligible for assistance from the Veteran’s Administration. Ask if the facility handles insurance billing. Residents eligible for Medicaid will receive a small Personal Needs Allowance to purchase personal items. Most facilities charge the private pay daily rate to “hold the bed” should the resident have to be hospitalized.
How to Apply
The Admission Coordinator of the nursing home will assess the applicant’s medical and social needs and will provide the necessary forms. A contract will include the cost of care and other services. All residents entering a nursing home are required to have an FL-2 form completed by their physician. This FL-2 form may be obtained from the County Department of Social Services or from the nursing home itself.
An individual care plan will be developed to meet the resident’s medical and social needs. The resident and family members should be involved in the care planning at the time of admission and thereafter at the resident’s quarterly care planning meetings.
Life in the Nursing Home
Residents in facilities should be allowed and encouraged to participate in the activities of day-to-day life as much as they are able. A Resident’s Council provides the opportunity for residents to have input into the activities of the facility. Family, friends, colleagues, and church members should be encouraged to visit the resident and continue the relationships that they have had in the past. If the resident or the family has a concern, he/she should feel free to discuss the issue with the Administrator.
Many facilities encourage family involvement with family nights and Family Council meetings. Residents who are private pay my leave the nursing home to visit their families as long as the daily rate is paid at the nursing home. Those receiving Medicaid are allowed to take 60 days of therapeutic leave per year to visit their families if they are medically approved to do so.