Difficulty of Nursing Home Admissions May Actually Be 'Safeguard'
Difficulty of Nursing Home Admissions May Actually Be 'Safeguard'
by Brittany Lebling
Henrietta's eyes are suddenly unfocused and distant, as if her brain is reliving the move from her home to the nursing home, "Nothing was easy. I had a nice home, we had a nice cat, and we were happy," she says.
Henrietta is a resident at a local nursing home. At 93, she is a bright woman with clear intellect and a kind disposition. However, when I began to discuss with her the admissions process into her nursing home, Henrietta took a serious tone and described nursing home admission formality as "unnecessary" and "red tape." As my research revealed, her opinions are not without substance.
According to a few admissions directors that I spoke with, the entire procedure begins with a call from the potential resident's social worker or family member to admissions director of the nursing home. The admissions director oversees the entire process. The nursing home must be faxed a copy of the person's medical records, and those records are reviewed and then must be approved clinically by the director of nursing at the particular home.
Next, the business office will verify insurance and financial order in the accommodations of the potential resident by calling their insurance company and getting information about their coverage options.
The admissions director calls the social worker and makes a bed offer. If the person accepts, the social worker arranges transportation and begins the discharge process if the new resident is in the hospital. "When it comes to admissions process, it is all about paperwork," a local nursing home admissions director said.
Unfortunately, at some nursing homes the barrage of "hurry up and wait" does not end when the patient is admitted. Within 48 hours, the patient may have to sign an "admission contract" which consists of about 70 pages that the admissions director will explain to either the patient or the power of attorney. This will explain how the insurance coverage and skilled nursing services will be employed. Various other forms such as pharmacy instructions, a patient's bill of rights, and a statement about HIPAA (Health Insurance Portability & Accountability Act of 1996) and its privacy acts will be signed by the new resident.
The process indeed alters from nursing home to nursing home, but the bottom line is that being admitted can be a very daunting process if the senior is not well prepared. So many cultures are known for holding their elders in such high esteem, and somehow our culture, which is wonderful in so many ways, has made it common protocol to serve them stacks of paperwork tied up with a bow of red tape and as nursing home resident Henrietta described, then "it's bingo, it's bingo, it's bingo, it's bingo."
According to an assisted living employee, education is the key to making the process easier. It's necessary to plan ahead. "Come [and] contact assisted living; take tours. Eight out of ten times most people don't really want to be in assisted living, they want to be home. So I would probably say [it's about] communication and education," he said.
Residents that had help with the paperwork from family members tell a different tale than those who must fill it out on their own. When asked about her admissions paperwork, area nursing home resident Lillian, said that her family helped her with everything and that she would "not change anything" about the process, but that she did in fact wait a few years to get the particular cottage that she requested.
The problem with finding blame for the currently overwhelming transition between home and nursing home is that the facilities have little control over what paper dialogue must exist between them and the insurance companies, the government, and the patient. Certain state government requirements and other bureaucratically tainted documents are just plain necessary to protect nursing homes and their respective patients legally.
In example, the Health Insurance Portability & Accountability Act of 1996 is a piece of legislation that produces paperwork for the elderly to fill out. Congress passed this act with four major goals that include the following:
1. To improve portability and continuity of health insurance coverage in the group and individual markets.
2. To combat waste, fraud, and abuse in health insurance and health care delivery.
3. To reduce costs and the administrative burdens of health care by improving efficiency and effectiveness of the health care system by standardizing the interchange of electronic data for specified administrative and financial transactions.
4. To ensure protecting the privacy of Americans' personal health records by protecting the security and confidentiality of health care information.
(Found at www.dhmh.state.md.us, the website for Maryland's Department of Health and Mental Hygiene)
"As a facility it's a safeguard for us and for the residents. We're protecting ourselves and bringing in residents that we can meet their needs," said one local nursing home admissions director.
Most of the other forms that nursing homes press upon the entering residents are just to make sure that they can provide what the resident needs medically. This is especially necessary for the patient that is not sure whether he or she should be in an assisted living community or a skilled nurse equipped nursing home. Certain medical factors will determine where he or she should be living.
Nursing homes are not unaware of the anxiety that residents are enduring. A nursing home employee explained, "I mean I'm sure it is frustrating for people who are caught in a stressful situation and they're trying to get all the information together," she continued, "but on the other hand we would be doing a disservice to the person if we admitted them and couldn't meet their care needs."
A good way to assure that your transition from home to nursing home is as smooth as possible is to do your homework on the facility. As with any service, some facilities are much more concerned with the happiness of their customers.
It is fairly easy to get a sense of a nursing home's atmosphere by simply taking a tour or calling to talk to the admissions director and staff. A superior nursing home's staff will be organized, helpful, and willing to provide you with any information that you need about living there. This will be your new home, so to jump into anything at the last minute is ill advised by professionals, "We always encourage residents and families to come in and take the tour and be informed consumers," said one local nursing home employee.
Volunteers in nursing homes are not normally allowed to be involved with the admissions process due to confidentiality agreements. However, when residents move in, they often find a fast friend or two with the volunteers that can always be seen scuttling about the nursing home. The volunteers are there to make the transition as smooth as possible.
Finding a good nursing home is much easier than it was before the Internet existed. Larger nursing homes have web pages with photo galleries, insurance information, and location information. You can also easily find web pages that rate nursing homes on various categories such as cleanliness and injury records.
It is impossible to be over prepared for such an important step in life, and it is never to early to start researching area nursing homes and becoming familiar with legislation such as HIPAA.
If you know the basics, expect the paperwork, and have support from family members or a social worker, getting into a nursing home will become a much less frightening leap of faith, and hopefully turn into a bump-free transition.
Nursing Home Statistics
* The national average rate for a private room in a nursing home is $206/day, which works out to just over $75,000 per year.
* The national average rate for a semi-private room is $183/day or $66,800/year.
* 72% of nursing home residents are women. That means they outnumber the men by 2.6-to-1.
* The average length of stay in a nursing home is just under 2.5 years. 28% reside there for less than 6 months, 30% for 1-3 years, 13% for 3-5 years, and 14% for 5 or more years.
* Yes, Medicaid can pay for your nursing home care, as a means of last resort. But the coverage is much more limited, and no one can predict how long and how well Medicaid coverage will continue.
Source: MetLife Mature Market survey for 2006