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Choosing a place to live: the move to a nursing home is not a favorite topic of family conversation. But the transition is much smoother with proper planning.

The move to a nursing home is not a favorite topic of family conversation. But the transition is much smoother with proper planning.

Today, more than 1.5 million Americans live in nursing homes. And that number is on the rise. With the rapidly increasing number of senior citizens in our population and the aging of the baby boom generation, that figure will double in the next 25 years.

Nursing homes are a part of our culture and could be part of each family's future. Nonetheless, most of us still find it extremely difficult to discuss the subject with those we love for several reasons.

First, Americans love their independence. The idea that we would confine a parent or grandparent to the four walls of a nursing home runs contrary to our heritage. Yet, in most instances, residents of nursing homes admit they're happier now than when they were living with children or living alone. They certainly feel safer, and enjoy the company of other persons their age.

Perhaps some of us feel guilty even discussing the subject. After all, didn't our parents and grandparents care for us when we were young? Don't we have the obligation to nurture them when the time arrives? The situation becomes even more complicated if we have promised any of them that we would never let them be sent to a nursing home.

But circumstances do change. When we were young, we didn't require constant and vigilant medical care-we were able to care for ourselves. The aging process can alter our ability to do this. It places a strain on the caregiver. When the aging process demands that your loved one be somewhere where round-the-clock medical help is available, the nursing home is your only viable alternative.

The truth eventually hits home. We no longer debate whether or not we'll use a nursing home; our only question is which nursing home to select. All the evidence tells us one thing: early planning for nursing-home care will save caregivers and their families a lot of time, anxiety, and money.

When Should You

Consider a Nursing Home?

Most of us start too late. We wait until Grandma is too sick to function on her own. We fear not only for her health, but also for her safety. Time is precious. We need to make a decision now ! The best time for a family to begin thinking about a nursing home is when there are warning signs of deterioration, such as a change in behavior patterns or daily functions. When visiting the local mall, does Uncle Charlie wander off aimlessly down the aisle of a store? Does he forget simple things-family member names, the year, telephone numbers, and addresses? Has his physician diagnosed a degenerative disease, such as Alzheimer's? Is he forgetting or skipping meals, or does his health and appearance seem different or in distress? These are a few of the clues that tell you it's time to do some serious planning.

Popular nursing homes often have long waiting lists, so it's best to enroll the patient early once the decision as to which nursing home has been made.

Whom Should You Ask

about Good Nursing Homes?

Your initial thought would be to seek advice from your family physician. Unfortunately, most doctors know very little about nursing homes because they spend so little time in them. Normally, nursing homes employ their own staff physicians.

Your best sources for information are your clergyman or the social service department of your local hospital. They regularly work with staffs and residents of nursing homes.

Check for articles and stories in local magazines and newspapers. Word of mouth from friends and neighbors is a prime source of good information.

Some larger cities have senior citizen centers or United Way offices that employ people familiar with the nursing homes in your locale.

What Should You

Look for in a Home?

That depends on the needs of the future resident and on your finances.

Nearly one-fourth of all nursing homes do not provide 24-hour nursing care. They're less expensive, of course, but these homes are designed for residents who need only intermediate care. And if the condition of the resident suddenly worsens, requiring more extensive care, there's no qualified help nearby to administer aid.

Here's another point to consider: Only those nursing homes with certified skilled care are eligible for coverage by Medicare.

A lot of us may prefer church-sponsored nursing homes that promise better, more personal care. The hard truth, however, is that with nursing homes, as with other things in life, you get only what you pay for.

How Much Will the

Nursing Home Cost?

This might be your biggest shock. In most instances, nursing homes charge between $100 and $150 a day.

Can the future resident afford this? Most elderly people cannot-at least not for an extended period of time. Let's say, for example, that someone has accumulated $50,000 in savings and investments over a lifetime (excluding a home). At $100 - $150 a day, all this can be eaten up in less than 18 months. If this happens, a nursing home might attach a lien to the patient's house. In short, a stay in a nursing home can completely erase the patient's estate.

Medicare will pay for a maximum of 100 days of care in a nursing home. Specific guidelines must be met before such payments are made. Check with the nursing home administrator to see if the future resident is eligible.

What about Medicaid?

Medicaid applies only if the resident is indigent or the estate has been nearly exhausted. To qualify, a resident must have no more than $1,800 in personal assets (excluding a house, car, and furnishings). All other income, including pensions, must be used to offset the nursing home bill.

Some nursing homes will not allow residents to remain at the home once the resident is eligible for Medicaid. The reason is simple: Medicaid pays only a portion of what a private-pay resident is charged.

Can You Preserve an Estate and Still Pay Nursing Home Bills?

Yes. But this will require planning and careful reading as well as sound legal counsel.

So-called "nursing home insurance plans" may help, but premiums can increase rapidly, and most plans agree to pay a fixed daily fee which covers only a portion of the costs. Some have a limit of two or three years; a few limit care to only 60 days. But it is worth checking out.

You can get additional information about available plans from: United Seniors Health Cooperative, 1331 H St. NW, Suite 500, Washington, D.C. 20005.

More and more families today prepare a "living trust" into which assets may be placed in the name of a spouse or adult children who serve as trustees. In this way the estate can remain intact when the resident becomes eligible for Medicaid.

Advanced planning with a qualified attorney is your key to forming a workable living trust. Administrators for Medicaid will count all assets that have been transferred to others within the last two years as subject to the criteria for Medicaid benefits. Unfortunately, many lawyers know little about Medicaid payments or living trusts. You would be wise to contact your state bar association for the names of attorneys who specialize in either or both of these subjects.

How Should You

Inspect a Nursing Home?

Before you visit a nursing home, establish in your mind specific things you're looking for. These may include: 24-hour nursing care; a physical therapy center with possibly a resident physical therapist; convenient dining facilities that provide balanced meals; privacy for patients; clean floors and bedding; and a friendly, well-groomed staff.

Don't visit the home during a special "open house" for the community or the typical visiting days-holidays or Sunday afternoons. During these times the staff wears its biggest smiles and the charm is turned up to full power. Instead, drop in unannounced sometime during a weekday. Tell the receptionist that you're there to look at the facility before making a decision as to where to house a patient. Then walk around the halls, keeping a sharp eye open for cleanliness of the facility, attitude of the staff, and the other standards you have set.

Don't be afraid to ask questions of the staff and current residents. Are you comfortable with their answers? If not, look elsewhere.

It's Your Decision.

Nursing homes are not "prisons for the elderly" as pictured by some skeptics. They can be havens of rest for those who have reached an age when they need extra measures of security and medical attention.

Decisions about nursing homes may not be the most pleasant you'll ever have to make. However, your job will be made much easier with proper planning and a positive attitude.
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Copyright 1991 Gale, Cengage Learning. All rights reserved.

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Title Annotation:includes do's and don'ts about nursing homes
Author:McCollister, John
Publication:Saturday Evening Post
Date:Jul 1, 1991
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