LONG-TERM CARE (Additional Information)
Paying for Long-Term Care
Rest home costs are covered by an individual's ability to pay privately or qualify for social security disability insurance, or other benefits. While a rest home resident may use Medicare or Medicaid to pay for medical care, neither Medicare nor Medicaid will pay for room and board.
In nursing homes, costs may vary according to the level of care required and the extent to which it is covered by private insurance, Medicare, or Medicaid. It is important to realize that neither private nor public insurance cover all nursing home costs.
If the cost of care exceeds an individual's income and assets, then the MassHealth Enrollment Center should be contacted for a MassHealth application. Call them at 1-800-242-1340.
If help is needed in determining financial eligibility, a consultation with an elder law attorney is recommended. SHINE counselors (Serving the Health Information Needs of Elders) also can assist with completing a Medicaid application. They can be reached at 1-800-334-9999.
Selecting a Facility
The goal should be to select the right facility for the individual, one which best meets his/her needs and assures safety and well being. Know what to look for and evaluate options.
Call the Admission Coordinators of the facilities being considered and arrange for a visit. Act like a consumer who is purchasing something of value. Visit more that one home and visit at different times of the day. During your visit, observe your surroundings. Note how residents are being treated by staff. Bring questions with you and inquire about facility policies for issues such as personal possessions, room assignments and changes, and visiting hours. Give an accurate description of the individual's physical status and care needs to the Admission Coordinator to be sure that the facility can provide the necessary care.
All nursing and rest home resident are protected by federal and state laws and have specific rights regarding their treatment and care. Elder Services' Long Term Care Ombudsman Program can assist in the protection of residents' rights. Ombudsmen visit facilities on a weekly basis to monitor conditions and to address residents' complaints. The Ombudsman Program is also a good resource for information about the selection and admission process and other nursing/rest home related issues.
How to Get Good Care
Once a nursing/rest home has been selected and the new resident has settled into the facility, many family members are uncertain about their continuing responsibilities. They may feel that since they are no longer assisting with activities such as personal care, help at mealtime, or transportation to medical appointments then their role as a caregiver is over. Actually, the family member is just entering a new phase of care-giving by assuming the role of an advocate for good care.
An effective advocate:
Becomes educated about resident rights
Stays involved and visits often
Observes conditions and asks questions
Learns the names and positions of key staff
Develops mediation/negotiation skills
Avoids confrontational behavior
Helps the facility to see the family member as part of the care-giving team
One good way to make sure that a resident is receiving good care is to regularly attend care-planning meetings.
Every new resident receives a comprehensive evaluation by the various departments of the facility (physical therapy, nursing, dietary, activities) and the collected information becomes part of the resident's care plan. This plan is reassessed at least once every ninety days. The resident and family members can be present at these meetings and they provide an excellent opportunity to ask key questions and to make sure that the different caregivers are functioning as a team.
The Ombudsman for the facility may attend as well to act as an advocate for the resident.