Choosing a Long-Stay Nursing Home

People come to long-stay nursing homes either from home, as part of a continuing care retirement community, after being hospitalized, or from a short-stay nursing home. Often there is more time to review and choose a long-stay nursing home than there is for a short-stay nursing home. However, since this will likely be your/your loved one’s final home, there can be many more emotions associated with it. It can be difficult to decide if it is the right time for a long-stay nursing home and similarly difficult to make the transition.

ProNobis Health can help you sort through your and your loved one’s feelings, think about what is important to you, and assess the information available about long-stay nursing homes. We can help you think about what is important to you or your loved one as well as what you or your loved one needs to feel at home and happy in the long-stay nursing home. We can also guide you to good information about nursing home quality that is important to consider.

Deciding That It Is the Right Time

For some people, this can be the most difficult part. Recognizing that your loved one can no longer safely live independently and talking to them about it can be very sensitive. While you want your loved one to be as independent as possible, you also don’t want him or her fall or have an accident while at home. It may also be that your loved one is less aware than you are of his or her limitations for independent living. It may also be that your loved one’s dementia has progressed and she or he needs extra help. Starting the conversation can be hard. The process begins by talking to one another. Make sure that you listen to your loved one’s concerns. You may want to include other family members. By including your loved one in the process of selecting a nursing home, he or she may feel better about the transition.

Transitioning to a Long-Stay Nursing Home

Leaving home can be a major transition for your loved one. Many long-stay nursing homes encourage residents to bring things from their homes to make the room feel more like their own. While coming from the hospital or a short-stay nursing home or even transitioning as part of a continuing care retirement community may be a less abrupt change for your loved one, it can still be very emotional. Accepting one’s limitations and letting others care for them can be very difficult. Also accepting that they will not be returning home can be difficult.

For you, as the family member, there can be many emotions. You may feel guilty that you can’t care for your loved one yourself. Your loved one may become angry at you for suggesting that she or he consider a long-stay care facility. There may be disagreement within your family about whether this is the right time. It is important to listen to and respect all perspectives. Sometimes the transition to a long-stay nursing home is a journey, and it may take time.

What You Value: The ART of Choosing

Discuss with your loved one what they value in a long-stay nursing home, what is important to them. Because this may be their home for a long time, it is important to consider their values and what services the nursing home provides. Things like culturally appropriate meals, regular religious services, or other residents that your loved one can relate to are important considerations. If your loved one’s first language is not English, it may be important to them to be with other native language speakers. For LGBTQ persons, it may be important that they feel part of a community and not isolated. Whatever your loved one’s values, whatever is important to them, talk about it and look for it in a long-stay nursing home.

Location: Being close to family and friends is for some people one of the most important considerations in choosing a long-stay nursing home because it makes it easier to visit frequently and more convenient when it comes to things like doctor’s appointments. Especially since your loved one is likely to be in the long-stay nursing home for many months or years, convenience may be a large factor in how often your loved one has visitors and how connected he or she feels to family and friends.

Nursing Home Culture: Some long-stay nursing homes are large facilities, possibly run by a corporation. Others are smaller and may have been part of the local community for many years. There are private and public facilities. Each long-stay nursing home will have its own distinct culture. It is important to make sure that the culture of the nursing home is a good fit for your loved one. Many times, talking with the other residents and their families will help you sense the culture.

Culturally Appropriate Care: Making sure that the Long Stay nursing home is a place where your loved one can be happy and find community is very important. Particularly if your loved one isn’t fluent with the commonly spoken language in the nursing home, it will be essential to make sure that there are interpreter services always available. The same is true with culturally appropriate meals and even a community composed of other residents who either share the culture or understand and respect it. This will make a huge difference in how happy your loved one is at the Long Stay nursing home. Especially if the transition is difficult, having a place where your love done feels like he or she fits in and can find community is very important.

Specialized Care: If your loved one requires specialized care, such as for dementia, inquire as to what services are available and whether they are included in the cost of care or are extra. Some long-stay nursing homes focus on dementia care, but what this entails and the costs can vary. Make sure you ask in advance. The same is true for services like physical therapy (PT) and occupational therapy (OT). Ask what is available and what the cost is. Ask if these services are offered daily or just on certain days and what the frequency is.

Religious Considerations: If your loved one has a strong religious or spiritual affiliation, you should inquire whether chaplains are available and how often they visit. You should also ask about the frequency of specific religious services, if that is important to your loved one. Particularly if your loved one has attended a weekly religious service, this may be very important to her or him, and not having that in her or his life may affect them profoundly. Also ask about whether there are spiritual or devotional services led by other residents that your loved one can join. This is frequently an excellent way to develop a community in a long-stay nursing home.

LGBTQ: Leaving their familiar community to live at a long-stay nursing home may be particularly frightening and difficult for LGBTQ individuals. They may fear being isolated or even harassed by staff or other residents at a nursing home. These are real fears. You can ask the nursing home staff about their comfort with LGBTQ residents, if there are other LGBTQ residents or even social groups at the long-stay nursing home. You may also want to be sure that spouses and friends will be respected and made to feel welcome.

Amenities: Long-stay nursing homes may offer a range of amenities including private or shared rooms, transportation options, outings and day trips for residents, activities, hair and skin care, and meal service options. Find out everything that is available and the price, since the costs can vary considerably. Ask your loved one what is important to him or her. What is available and how much it costs may be key considerations.

Mental Health Services: It is not uncommon for people transitioning to long-stay nursing homes to experience some depression and/or anxiety. This can be a very stressful event in a person’s life. Find out what mental health services the nursing home offers and at what cost. There may be counseling and/or medication management. Some nursing homes have psychologists; some have social workers or nurse practitioners. Find out about the frequency of services and qualifications of providers.

Family Council: Most long-stay nursing homes will have a family council which is an organization of family members and friends of nursing home residents. In fact, nursing homes that accept Medicare or Medicaid are required to allow family councils to form. Family councils are extremely important ways for residents and their families to voice concerns about care or to make a specific request of the nursing home. In selecting a nursing home, speaking or meeting with a member of the family council may provide valuable insights. Particularly if you are concerned about a specific aspect of service, whether it be dementia, culturally appropriate or LGBTQ care, you may want to talk with someone from the family council.

Information About Nursing Home Care: The SCIENCE of Choosing

It is also important to consider how well the nursing home performs in areas like safety, staffing, and quality. The Centers for Medicare & Medicaid Services (CMS) has a website called Nursing Home Compare, which has good information about the quality of care at different nursing homes.

CMS pays long-stay nursing homes to take good care of their residents and keep them from having complications, such as falling and injuring themselves or developing pressure ulcers. CMS wants to make sure nursing homes are doing a good job. Nursing Home Compare gives nursing homes an overall score (5 stars is the best) that is based on three things: health inspection, staffing, and quality measures. Each of these categories also has a score; again 5 stars is the best.

If you are searching for a long-stay nursing home on Nursing Home Compare and you don’t see it listed, it is probably because they are not Medicare or Medicaid certified. Some nursing homes that only provide long-stay care do not accept Medicare or Medicaid. In that case, they may not be certified and will not appear on the list. Even if a nursing home is not CMS certified, they should be able to discuss with you all the care information that we explain below.

Health Inspection: Inspectors go to nursing homes to check things like smoke alarms, disaster preparations, how the residents and staff interact, and how food and medication are stored. These things ensure a safe environment for the residents. If the nursing home has a deficiency, they may get a penalty and have to pay a fine, or CMS may refuse to pay a nursing home until they correct the problem. We will discuss this more below under penalties.

Staffing: This measure lets you know if the nursing home has adequate staffing based on the ratio of nursing staff hours worked to the number of residents at the nursing home. It looks at two factors: first, registered nurse (RN) hours per resident per day; and second, total staffing hours, which include RNs as well as licensed practical nurses (LPNs), licensed vocational nurses (LVNs), nurse aides, and physical therapists (PTs). More stars means more staffing. Some nursing homes don’t have an RN on site every day, so they would get fewer stars based on this.

Quality Measures: CMS uses specific outcomes to gauge how well a long-stay nursing home is doing at helping keep residents from losing function or having a complication. The emphasis is on two things: (1) making sure residents remain as independent as possible, and (2) making sure that residents don’t have a complication while in the nursing home.

Here are a few examples of the important quality measures:

  • Number of hospitalizations per 1,000 resident days at the nursing home
  • Number of outpatient emergency department visits per 1,000 resident days at the nursing home
  • Percentage of residents experiencing one or more falls with major injury
  • Percentage of residents with pressure ulcers
  • Percentage of residents with a urinary tract infection
  • Percentage of residents who have or have had a catheter in their bladder
  • Percentage of residents whose ability to move independently has worsened
  • Percentage of residents whose need for help with daily activities has increased
  • Percentage of residents who were physically restrained
  • Percentage of residents who lose control of their bowels or bladder
  • Percentage of residents who lose too much weight
  • Percentage of residents who have symptoms of depression
  • Percentage of residents who received an antianxiety or hypnotic medication
  • Percentage of residents who received an antipsychotic medication

Penalties: If nursing homes have deficiencies, CMS may fine them until they correct the problem. Also, CMS may withhold payment to the nursing home until the deficiency is corrected. Unfortunately, CMS does not list the penalties directly on their website, making it cumbersome to search the data.

Abuse IconAbuse: This symbol beside the name of a nursing home on the CMS Nursing Home Compare site means that the nursing home has been cited for resident harm, abuse, or neglect. This is important information to know.

Paying for a Long-Stay Nursing Home

While Medicare and private health insurance often pays for short-stay nursing homes, Medicare does not cover long-stay nursing homes. The financial considerations become more important when considering a long-stay nursing home because most long-stay nursing home costs are paid by the individual or family themselves. Specific long-term care insurance may pay a portion of the cost, depending on the plan. Medicaid may also pay a portion, but typically only after most of your assets have been used. Be prepared to discuss these things with your loved one, regardless of how sensitive the issues may be. Many long-stay nursing homes offer a choice of private or shared rooms, or other amenities, and there may be a difference in price. It is important to know everything that is included in the price and what is not included. Many long-stay nursing homes will have social workers or other resources to help you determine what the costs are and what financial assistance is available.