Family & Caregiver Resources

Using Informed Decision Making to Determine Your Skilled Nursing Facility and Rehabilitation Care Provider

 

Deciding what type of care you or a loved one needs is not easy. When skilled nursing and round-the-clock care are needed, it’s important to make an informed decision about the right facility. Our family and caregiver resources will help you do just that. 

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You may be making a decision quickly based on a recent event such as surgery or a hospital stay that required additional care before you could go back home.

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You may be seeing a loved one’s disease progress, like Alzheimer’s or a recent stroke. This can make it hard to do basic activities, like dressing or bathing. You may need to make a life transition.

Activities of Daily Living

Activities of daily living are activities that people do every day to take care of themselves. These activities include bathing or showering, dressing, getting in and out of bed or a chair, walking, using the toilet, and eating.

 

A person is deemed to have a limitation in an activity if they have difficulty performing it by themselves and without special equipment, or if they do not perform the activity at all because of health problems.

It is important to define how much help you or a loved one needs with activities of daily living, to ensure you receive the appropriate level of care. This can be done through a variety of resources, including the ADL checklist. This will help to balance medical and financial options and make the best decision for you and your family.

DOWNLOAD THE ADL CHECKLIST

Make Sure Your Loved One Participates in the Transition to a Skilled Nursing Facility and the Selection of the Care Team

When you can, try to have your loved one involved in the decision-making process with you. Have them join you when you are visiting potential new residences and meeting the care team. Help them choose what items they would like in their room, such as photographs, special blankets, or other objects that will make them feel comfortable and at home.

Does My Loved One Need Assisted Living, Skilled Nursing and/or Rehabilitation?

There are several differences between skilled nursing facility care and assisted living care. It’s important to understand these differences so that you or your loved one can get the appropriate level of care. Examples include:

Essex Nursing & Rehabilitation Center chart listing the differences between skilled nursing facility care and assisted living.

Important Questions when Considering a Skilled Nursing Facility and Rehabilitation Care

 

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Have you received a medical assessment determining you or a loved one require skilled nursing facility care and/or rehabilitation services?

If you recently had a hospital stay or surgery requiring continued care before you are able to return home— you’ve more than likely received a medical assessment determining additional care is needed and you’re considering skilled nursing and rehabilitation services as the next step. However, if you’re considering a life transition for a loved one who is no longer able to live independently, a medical assessment by your family physician can help clarify your needs and determine if a skilled nursing facility is the right option (also referred to as long term care and nursing home).

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Do you or loved one require 24-hour supervision?

If care is required round the clock, it may be time to seek a medical assessment from your physician determining if skilled nursing care is appropriate. Some things to consider when determining a life transition to long term care include a loved one who:

 

  • Needs assistance with most adult daily living tasks such as dressing, preparing meals and shopping safely, taking medications, bathing or has incontinence and there’s no one at home to help them.
  • Needs assistance swallowing and nutrition is being compromised
  • If they need supervision or a controlled environment to reduce falls— or they are at risk for wandering
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Who pays for skilled nursing facility care (short & long term care)?

Skilled nursing facility care is typically paid for by Medicare, Medicaid, private pay (or self-pay) and long term care insurance. Coverage may also be available for eligible veterans through their VA benefit. Additionally, private insurance plans cover most costs associated with short term skilled facility nursing care for insureds that meet criteria.

 

  • Medicare pays for skilled nursing facility care for its beneficiaries but only pays the full amount for 20 days (short term care). For the 80 days following, Medicare will pay for 80% of the cost. After 100 days, Medicare does not pay for skilled nursing facility care.
  • Centers for Medicare & Medicaid (CMS)

    cms.gov

    Skilled Nursing Facility (SNF) Care

  • Medicaid will pay 100% of the cost of nursing home care for approved beneficiaries. If an individual lacks enough savings to cover the cost of a skilled nursing facility – or if the cost exhausts a person’s assets – they may become eligible for assistance from Medicaid. State Medicaid programs are required to cover skilled nursing facility (or nursing home care) if the person meets their state’s level of care criteria and financial eligibility requirements.
  • State Medicaid in geo-regions we serve:

    KY Medicaid

  • Coverage for eligible veterans:

    US Department of Veteran Affairs

Helpful Links

medicaiddoneright.com Medicaid Done Right wants to help residents and their families apply for Medicaid benefits. We use our experience and technology to make it easier for patients and families to focus on their well-being.

ncoa.org  The National Council on Aging is a non-profit that helps older Americans get access to services, resources, and initiatives that improve their lives.

alz.org The Alzheimer’s Association was founded in 1980 by a group of family caregivers and people who recognized the need for a place where caregivers could come together and find support. This national resource also provides information about local chapters.

apdaparkinson.org The American Parkinson’s Disease Association (APDA) is a large group of people who are fighting PD. This disease affects about one million people in the United States. The APDA helps these people to have the best life possible, even though they have a chronic neurological disorder.

diabetes.org The American Diabetes Association (ADA) is a nonprofit that educates the public about diabetes and helps people affected by it by funding research to manage, cure, and prevent diabetes.

heart.org The American Heart Association has been around for a long time and is the biggest volunteer organization in the country that helps fight heart disease and stroke.

cancer.org The American Cancer Society is a nationwide, community-based organization that focuses on cancer prevention and helping people who have cancer.

neilmedical.com Neil Medical Group provides pharmacy services and medical supplies for residents in skilled nursing facilities and their care teams.

Take The Next Step

Visit Essex Nursing & Rehabilitation Center Today