Learn About Nursing Home Care

Don’t see the answer to your question. Submit your own question on our information form.

 

What is a Nursing Home?

A nursing home provides skilled nursing care and rehabilitation services to people with illnesses, injuries or functional disabilities. Most facilities serve the elderly. However, some facilities provide services to younger individuals with special needs such as the developmentally disabled, mentally ill, and those requiring drug and alcohol rehabilitation. Nursing homes are generally stand alone facilities, but some are operated within a hospital or retirement community.
[Back to top]


When is a nursing home needed?

Speak with your doctor or a member of your health care team to see if a nursing home is appropriate. Early discussion should allow time for everyone to participate in developing the plan of action.
[Back to top]


How will my family or friends and I know which nursing home to choose?

If your loved one is in the hospital, your social worker will help in planning for nursing home placement. You may speak with the social worker and select a nursing home that you may prefer. Placement often happens very quickly after applications are completed. You may contact, visit and tour our Nursing Homes.
[Back to top]


Why can’t I stay in the hospital rather than going to a nursing home?

Hospitals are designed for patients who have serious medical problems that can be treated only in a hospital. Insurance companies can review and stop insurance benefits when you no longer need acute hospital care.
[Back to top]


Who pays for the nursing home care?

Depending on your situation, you will be a "private pay" (you use your own funds) or covered by Medicaid. Some people have commercial insurance that covers nursing home costs. In limited cases, Medicare pays for nursing home care. If you need Medicaid to cover the cost of nursing home care, you may need to apply for Medicaid.
[Back to top]


WiIl my long-term care insurance pay for the nursing home?

Long Term Care Planning and Insurance is becoming more common, but not all policies are accepted in Pennsylvania. Contact us and we can speak with you about your specific case.
[Back to top]


Can I leave the nursing home and return home?

Nursing home residents who, following assessment from a psychiatrist, have "capacity" (the ability to make sound decisions about their own care) always have the right to leave a nursing home if they choose to do so.
[Back to top]


What is Medicare and what does it cover?

Medicare is a federal health insurance program (administered by the Centers for Medicare and Medicaid Services (CMS) for people age 65 and over and certain disabled people under 65.

Medicare is divided into two parts:

Hospital Insurance - Part A:

Part A covers care provided by a skilled nursing facility to help a beneficiary recover from an acute illness or injury. Medicare provides full coverage for the first 20 days of care in a skilled nursing facility and a portion of the costs for skilled nursing facility care for days 21-100. During this period, the patient pays a daily coinsurance rate. Any Medicare A stay requires a 3-day hospital stay within 30 days of admission to a skilled nursing facility.

Medical Insurance – Part B:

Part B is a supplemental program for which you must pay an annual premium and a deductible for all covered services, including physician services. Essentially, Part B coverage relates to ancillary services such as physician services, lab work, x-rays, and therapy. In some cases, Part B may cover short-term services – such as physical or other therapies – within an assisted living facility. After meeting the deductible, Part B pays 80 percent of the reasonable charges for covered services only. Part B may pay for covered services you receive from your doctor while in a skilled nursing facility from the time of admission.

[Back to top]


What are the eligibility requirements for Medicare coverage in a nursing facility?

The nursing facility must be a skilled nursing facility that provides 24-hour nursing care to patients for recovery, rehabilitation and/or long-term care. The individual must require skilled nursing care or rehabilitation services (as defined by the federal government) on a daily basis. The patient must have spent three consecutive days in a hospital and the admission to the Skilled Nursing Facility must occur within 30 days of discharge from the hospital. A physician must certify that the services required by the patient in a skilled nursing facility are needed for the same or related illness for which the person was hospitalized.
[Back to top]


What services does Medicare Cover within a skilled nursing facility?

• A semi-private room
• Meals, including special diets
• Regular nursing services
• Rehabilitation services
• Drugs furnished by the facility
• Medical supplies
• What services are not covered by Medicare at a skilled nursing facility?
• Personal convenience items
• Private duty nurses
• Extra charges for a private room, e.g., TV, phone, laundry, etc.

[Back to top]


What is Skilled Nursing?

Skilled nursing facilities are traditional nursing facilities that provide 24-hour medical nursing care for people with serious illnesses or disabilities. These facilities are state-licensed and care is provided by registered nurses, licensed practical nurses, and certified nurse aids.
[Back to top]


What is the difference between skilled and custodial care?

A skilled service is a service that has to be provided by licensed professional (i.e. restorative therapies, wound care, dressing changes, tube feedings). A non-professional (i.e. family, friend) can provide custodial care. Custodial needs are generally chronic and occur when the individual requires ongoing supervision and assistance with activities of daily living (i.e. bathing, dressing, eating, and medication).
[Back to top]


Will I have to spend all of my savings if my spouse has to go in a nursing home?

No. Medicaid guidelines for eligibility for a spousal situation differ from those that apply to an individual. The "community" or well spouse is allowed to keep some savings and the home in which they reside. Please contact your designated social worker with any additional questions you may have.
[Back to top]


How will my loved one get to the nursing home?

The physician is consulted to determine the most appropriate mode of transportation. In order for a patient to be transferred by ambulance, certain medical criteria must be met. Some patients can be transferred to the facility by a wheel chair van or by family if they request to do so, and it is felt the patient can be safely transported by that mode of transportation. Depending upon the circumstances, the patient may be charged for transportation services.
[Back to top]


What is Intermediate Care?

Intermediate care is nursing home care for residents needing assistance with activities of daily living, but without significant nursing requirements.
[Back to top]