Elder Independence is Our Focus

Selecting Long-Term Care

Deciding whether to seek placement and then selecting a long-term care facility (nursing or rest home) can be a difficult and emotional process. The move to a long-term care facility is rarely anyone’s first choice. By being prepared, individuals can have more control over their lives and the transition can be smoother.

Long-Term Care Facilities

Nursing homes provide long-term skilled health care for residents whose needs cannot be met in the community. They are designed to care for people who are chronically ill or recuperating from an illness and need skilled nursing care, but do not require hospitalization. Rest homes provide custodial care for those who require room and board, supervision of personal care, and medication management, but do not require routine nursing services. Both nursing and rest homes are licensed and inspected by the state Department of Public Health.

Eligibility

Once the decision has been made to seek nursing home placement, medical eligibility must be determined through a long-term care “screening”. This screening is required for all individuals applying for Medicaid. It is also available, for a fee, to individuals who will be paying for their nursing home care with private funds.

The screening team will need to obtain information from the individual’s primary health care provider, so it is important for anyone considering a move to a nursing home to inform their physician and/or nurse of the decision to seek placement.

Contact the Elder Services Information and Referral Department to arrange for a screening at 508-394-4630 or 1-800-244-4630.

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 than 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.

Residents’ Rights

All nursing and rest home residents 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.

The Massachusetts Money Management Program assists income-eligible adults aged sixty and older, who may be at risk of losing their independence due to failure to pay rent, utility, or other basic bills on time. Individuals request money management assistance for a variety of reasons including limited support, visual impairment, disability, or cognitive issues. This program is offered free of charge to income-eligible individuals and at a small fee to others.

Trained volunteer bill payers meet with individuals in their homes to help them pay monthly bills and manage their money wisely. Volunteers also help elders avoid becoming victims of fraud, scams, or financial exploitation.

The Massachusetts Money Management Program serving Cape Cod and the Islands was developed by Elder Services of Cape Cod and the Islands, Inc. in 1999. The Money Management Program is collaboratively sponsored by the Executive Office of Elder Affairs, and Mass Home Care.

Under the Massachusetts Money Management Program’s guidelines, volunteer bill payers assist individuals with budgeting, writing checks, balancing checkbooks, and reconciling bank statements. The individual makes all bill paying and budgeting decisions, remains in control of their money, and retains check-signing authority.

Money Management Volunteers are trained, insured, and supervised by the Program Manager. Program safeguards include monitoring and supervision of all volunteer activities, file monitoring, and an annual survey of all individuals served to assess satisfaction with the services provided.

The Community Transition Liaison Program (CTLP) assists nursing facility residents with any diagnosis or any type of insurance. The CTLP team supports any adult resident of a nursing facility who is interested in receiving support & assistance to transition to the community.

The CTLP team can assist nursing facility residents by:
• Meeting with residents to discuss their needs and providing options for a safe plan to return to community living;
• Assisting in identifying needs that should be addressed in discharge planning;
• Assisting with applications for housing and public benefits, including collecting all necessary documentation;
• Mitigating issues that may impact a resident’s ability to successfully transfer to the community;
• Coordinating with state and community agencies to identify resources and make referrals; and
• Providing other supportive services as appropriate.

The CTLP Team members visit area nursing facilities on a weekly basis and can be approached at that time. They can also be reached by calling our Information and Referral Department at 508-595-8106.