What Is A Nursing Home
Nursing homes are places to live where care is available for people of all ages who need 24-hour nursing care and supervision outside of a hospital. Although all nursing homes must provide certain basic services, some provide specialized care. For example, some nursing homes provide services for people with neurobehavioral disorders, some for those who are ventilator-dependent and some for people with AIDS. Some nursing homes specialize in the care of children.
An Advocate And Resource
The Ombudsman Program is an effective advocate and resource for older adults and people with disabilities who live in nursing homes, assisted living, and other licensed adult care homes. Ombudsmen help residents understand and exercise their rights to good care in an environment that promotes and protects their dignity and quality of life.
Ombudsman:
Advocate Act on behalf of residents to assure rights are not violated, identifying, investigating and working towards resolution of resident complaints.
Mediate Work collaboratively with residents, family members, and staff towards achieving mutually beneficial solutions to the issues they are experiencing in long term care facilities
Educate Provide information and consultation to residents, families, facility staff, and community about issues in long term care and specific issues they are experiencing in facilities
Refer When resolution through the Ombudsman program is not achievable, complaints are referred to theNew York State Department of Health or other appropriate agencies.Contact Claudette Royal, the New York State Ombudsman.
This fact sheet reviews how the Ombudsman program advocates for residents of nursing homes, board and care homes, assisted living facilities, and other similar adult care facilities. Ombudsman programs work to resolve problems individual residents face and effect change at the local, state, and national levels to improve quality of life and care.
Regulations For Nursing Homes
It can be tough to uncover information on assisted living facilities. Thankfully, finding data on nursing homes is easier. These two tools are excellent starting places:
Nursing Home Inspect on ProPublica
Nursing homes must keep a lot of federal rules, regulations and recommendations in mind . Oversight to some extent is necessary, although it’s debatable to what extent. At some point, do regulations become more of a burden than a help, burying nursing homes under growing mounds of paperwork and taking away from time with residents?
Whatever your thoughts, there’s no question that before regulation, which began in the late 1960s, care quality was poor. The 1987 Nursing Home Reform Act established requirements in three main areas: service provision, residents’ rights, and administration and other matters. Further reforms followed with the 2010 Affordable Care Act and with the rollout of even more regulations in 2016. The 2016 requirements in particular were supposed to strengthen infection controls, emergency preparedness and facility assessment. Unfortunately, COVID-19 still hit many nursing homes hard.
The pandemic has led CMS to issue guidance on topics such as screening and restricting visitors, setting aside separate units for COVID-19 patients, and testing residents and staff. CMS has also issued recommendations and a toolkit with best practices for each state.
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Assisted Living Disclosures And Costs
Assisted living facilities must give prospective residents disclosure documents that detail the charges and fees for the different services available. This information should be in contracts, too.
If you’re just in the search stage, you’ll have to contact facility administrators to get specifics on charges. Only two states’ assisted living websites offer data on facility pricing . Cost is definitely something to pay extra attention to in disclosure documents and during conversations with administrators. Also, look over the sections having to do with eviction so you understand what happens if you cannot pay any longer.
When you’re about to sign a contract, review it carefully. Too many folks seal the deal in a hurry and don’t fully understand everything they’re on the hook for.
Nursing Home Vs Assisted Living: The Differences Matter
Many folks use the terms, nursing home and assisted living, interchangeably. This is understandable, especially since some assisted living facilities provide memory care or low-level nursing care. However, the distinction matters quite a bit, especially with regulations and cost.
Some quick background: Skilled nursing facilities and assisted living facilities are part of the many Continuing Care Retirement Communities across the United States. These communities offer a continuum of housing and care so residents can stay in the same place if their needs change or live near a spouse with different care needs. Of course, plenty of standalone skilled nursing facilities exist, as do standalone assisted living facilities.
State Medicaid programs for assisted living may require that participants meet what’s called a nursing home level of care. That doesn’t mean these folks need skilled nursing care around the clock. Rather, it typically means they cannot perform two of the activities of daily living . Criteria varies by state and program. For example, one state may require the inability to perform two ADLs, while just one ADL suffices in another state.
If you have second thoughts about entering a nursing home, chances are you mean assisted living and not skilled nursing. Check out the table below for a refresher on the differences.
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Spousal Protection Assisted Living And Nursing Homes
If you’re married, Medicaid spousal protection rules can help a healthy spouse continue to live at home instead of becoming impoverished to pay for the other spouse’s assisted living or nursing home care. More commonly, it’s nursing home care but applies to some assisted living situations. Here are Wisconsin’s spousal impoverishment regulations as an example.
You can continue to receive SSI. Check out the 2020 SSI and Spousal Impoverishment Standards here. The community spouse is the one who continues to live at home or otherwise in the community.
Complaints And Incidents Received
Information is presented at the Facility and Statewide level for the following information:
- Received
- The number of complaints and incidents, which were received by the Department during the reporting period.
- Received per 100 Occupied Beds
- This rate demonstrates the number of complaints and incidents received per 100 occupied beds. Occupied beds are approximated by taking the daily occupancy rate data from the most recent year’s audited Nursing Home Cost Report. This rate allows the user to compare a specific facility’s complaint experience with that of other homes or a statewide average.
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Citations By Deficiency Category:
A single complaint or incident may result in multiple citations, which are included within the Statement of Deficiencies. The Citations by Deficiency Category presents information about the citations issued as a result of the Department’s inspections. The information includes:
- Deficiency Category
- This is the area of nursing home service delivery for which a deficiency has been found. The categories are described in the Deficiency Categories section of this site.
- Number of Citations
- The number of citations issued during the reporting period, as a result of the complaint and incident on-site inspections.
Paying For Nursing Home Care
Few people can afford to pay for nursing home care out of their own pocket for very long . Most nursing home residents are reliant upon State and Federal subsidies.
Meet with an elder law attorney to get advice on estate planning, Medicare, Medicaid and long-term care insurance before you apply for admission to a nursing home. The New York State Bar Association’s Lawyer Referral and Information Service can provide you with a list of elder law attorneys. The Lawyer Referral and Information Service can be contacted at 800-342-3661 or .
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Complaints And Incidents On
Information is presented at the Facility, and Statewide level for the following information:
- On-site Inspections
- The number of inspections at the Nursing Home completed by the Department of Health during the reporting period, as a result of complaints and incidents.
- Citations
- The total number of citations issued during the reporting period, as a result of the complaint and incident on-site inspections.
- Citations per 100 Occupied Beds
- This rate demonstrates the number of citations issued per 100 occupied beds. Occupied beds are approximated by taking the daily occupancy rate data from the most recent year’s audited Nursing Home Cost Report. This rate allows the user to compare a specific facility’s complaint experience with that of other homes or a statewide average.
State Regulations And Transparency For Assisted Living
Every year, the National Center for Assisted Living publishes the Assisted Living State Regulatory Review. It summarizes the key requirements that assisted living facilities in each state must meet to gain or maintain licensure/certification. Take a look at your state so you have a good idea of the standards there. The review covers issues such as:
- The state’s definition of assisted living and any specialty licenses offered
- If there are differing levels of assisted living care provided
- Recent legislative or regulatory changes
- Disclosure items for prospective residents
- Scope of care
- Administrator education and training
- Staff education and training
Take the time to study disclosure items. For example, disclosures are where you should be able to find figures on charges and fees. Other rules and regulations to pay special attention to include these:
Resident assessments and their frequency: Staffers should conduct a needs assessment when a new resident is admitted. The assessment aids in the development of a personal care plan. Re- assessments are supposed to be done about once a year and when a resident’s needs change .
Medications: Who is allowed to administer medications, what is the level of assistance allowed and what happens if a resident doesn’t agree with taking medications or doesn’t want to? Many facilities can cut ties with residents who refuse medication. Generally, though, residents have the freedom to make their own medical decisions.
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Medicaid Ssi And Financial Qualifications
If you’re applying for regular state Medicaid, expect stricter income requirements . If you’re applying for a waiver program, you have more income flexibility. If you’re already on Medicaid and apply for a waiver program, you may be fast-tracked.
Here’s a link to a Washington state Medicaid eligibility chart. Check out other states here.
What if you’re over the income or asset limits? A good option is to meet with an elder planning or estate planning lawyer. See how you can comply with federal and state regulations while working toward Medicaid eligibility.
Other options for checking eligibility are to go to Benefits.gov and click on your state program . Enter your household size to see if your income falls within Medicaid guidelines. The page also has links to apply online for Medicaid and to contact staffers for assistance.
Some assisted living facilities that accept Medicaid require that you pay a certain amount up front before Medicaid kicks in . Always ask facilities and your local area agency on aging about these issues.
Many seniors use monthly SSI payments to cover room and board in assisted living. As of January 2020, the federal SSI benefit rate is $783 for an individual and $1,175 for a couple.3 Many states offer additional supplements to seniors in assisted living, so check with your state or federal SSI office .
- Arizona
- West Virginia
- North Dakota
Rhode Island’s SSI Enhanced Assisted Living program is one that addresses assisted living specifically.
What Is A Pa In A Nursing Home
The Role of the Physician Assistant in Geriatric Medicine. Physician assistants treat geriatric patients in long-term care facilities, nursing homes, physician offices, and outpatient clients, among others. Their role is consistent: to provide medical care to seniors under the supervision of a physician.
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When Nursing Homes Do Not Comply With Rules
If a survey finds that nursing homes are out of compliance, what happens depends on how serious the non-compliance is. An immediate jeopardy finding means that temporary management could be appointed while the nursing home remedies its deficiencies. Otherwise, the facility is terminated from the Medicare and Medicaid programs and the residents moved elsewhere.
- Immediate jeopardy means that there’s a reasonable expectation that residents would die or become seriously injured or impaired if adverse circumstances persist.8
- Nursing homes can still receive Medicare and Medicaid funding for as long as six months after an immediate jeopardy finding if it’s in the best interest of residents to stay put . The facility must repay funds received during this period if it doesn’t correct its deficiencies during an approved timetable.
- If a survey reveals deficiencies but they’re not immediate jeopardy, the nursing home has up to six months to undertake corrective action.
- Civil money penalties can be imposed, with the range for immediate jeopardy being $6,525 to $21,393 per deficiency. Penalties range from $107 to $6,417 for deficiencies that caused harm or had the potential to cause more than minimal harm.
- Part of these CMP funds go back to the states to enhance nursing home care.
- Nursing homes found persistently deficient on three standard surveys in a row are subject to state monitoring and denial of Medicare and Medicaid payments.
Table : Differences Between Skilled Nursing And Assisted Living
Skilled Nursing Facility
More on comparisons: If the facility you’re considering is part of a CCRC, check both the Medicare comparison tool and your state’s assisted living inspection reports . Do this even if it’s just the skilled nursing aspect or the assisted living aspect you care about.
Looking at both gives you a more rounded picture of how well the CCRC follows regulations. For example, some of the same staffers may work in both assisted living and nursing care. Residents from both may socialize with one another, too. That’s one reason CCRCs appeal to couples with different care needs. They no longer live in the same room or apartment but are close together for meals and socialization.
A third tool to use is ProPublica’s Nursing Home Inspect. It draws from the same CMS data that goes into the Medicare comparison tool but is organized differently. For example, there are state pages such as Michigan’sthat enable comparisons among all nursing homes in the state. At a glance, you get total deficiencies, serious deficiencies, fines and even COVID-19 cases . Unfortunately, there’s no similar tool for assisted living since it is state regulated.
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New York Nursing Home Laws
Nursing home accountability is a subject near and dear to our hearts. All across New York, thousands of seniors reside in hundreds of nursing homes, and yet the quality of life in these homes is difficult to discern from the outside.
We know that nursing home abuse and neglect run rampant throughout the United States a fact that the federal government is equally well aware of, though its attempts to fight back have had mixed results.
The State of New York understands the problem, too. State regulators work hard to hold nursing homes to certain minimum standards. These regulations represent societys basic expectations for safety, security, and comfort for the elderly.
Unfortunately, nursing homes routinely breach these standards and violate state and/or federal regulations, dishonoring and potentially endangering the seniors whove been entrusted to their care.
At Kaplan Lawyers PC, we care about the dignity, contentment, and health of our great states seniors. As New York nursing home abuse attorneys, we are dedicated to seeking justice for the elderly and their families, and that often means taking legal action in response to violations of state or federal law.
Nursing home abuse is insidious, and family members often arent sure if its happening. To help you understand some of the states most fundamental expectations, weve outlined a few of the nursing home regulations in New York below.
Medicaid Assisted Living And Spotty State Regulations
About half of assisted living facilities are Medicaid-certified to accept Medicaid funds. The money goes toward help with the activities of daily living and other services. Medicaid doesn’t pay residents’ rent, but residents can use SSI to partially or fully pay that expense.
- Medicaid assisted living qualifications and coverage vary by state depending on factors such as your age, marital status, where you currently live, and your income and assets.
- Many states cap the dollar amount that a Medicaid-certified facility can charge, and it’s similar to SSI rates.
- Medicaid waiver programs are waivers from regular program requirements. Among other things, waiver programs can raise income thresholds to let higher-income seniors qualify for assistance. However, these programs have limited slots and may cover only certain regions of a state.
- Waiver programs can end. A new program may or may not replace an older one.
- Alabama, Kentucky, Maine, Pennsylvania and Virginia have Medicaid programs that don’t pay anything for assisted living . However, these states may have Medicaid programs that help seniors stay at home or receive care in a residence such as an adult foster home.
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Medical Qualifications For Assisted Living
You must qualify medically for Medicaid/a waiver program to pay for assisted living services in any form. Often , you must meet what’s called a nursing home level of care. That doesn’t mean you need skilled nursing facility care or similar 24-hour medical care. Rather, in many states, it means you can’t perform at least two of the activities of daily living. Criteria varies by state and program, so one state may require the inability to do two ADLs, while just one ADL may suffice in another state.
It is usually professionals such as nurse practitioners and social workers who certify you’re unable to carry out these ADLs. Get started as soon as possible to expedite the process and save money. Ask your physician to refer you for an assessment or to otherwise get the ball rolling.