Helping a senior get admitted to a nursing home can be an overwhelmingly complex process. When the senior will be relying on Medicare or Medicaid to cover the costs of skilled nursing care, it’s an even more challenging ordeal with strict qualifications.
Before making major financial or legal decisions pertaining to a senior’s long term care and estate, it’s important to discuss your case with an elder law attorney. An experienced attorney can help you protect your personal assets from Medicaid spend-down requirements, and prepare important estate planning documents like an advance healthcare directive and power of attorney.
8 Steps to Getting a Senior Admitted to a Nursing Home
Following is a brief overview of how to get a senior admitted to a nursing home, simplified into 8 easy-to-follow steps. Keep in mind, though, that the actual process may vary slightly depending on the nursing home’s procedures and the state’s Medicaid requirements.
Step One: Gather the Senior’s Information
The nursing home and physician will need to see the patient’s medical and physical history, including past/current conditions, surgeries, immunizations, allergies, and diagnostic tests. Now is also a good time to start gathering the senior’s financial information, which you’ll need when working with the elder law attorney, nursing home admission director, and Medicaid (if applicable).
Step Two: Meet With an Elder Law Attorney
The senior will need an advance healthcare directive (also known as a living will) to indicate their healthcare preferences in case they become incapacitated and cannot communicate with their doctor. They will also need a power of attorney to appoint an attorney-in-fact who can manage their financial, legal, and medical affairs should they become incapacitated.
If you’re applying for Medicaid now or expect to in the future, talk to the elder law attorney about protecting the senior’s assets from Medicaid spend-down requirements.
Step Three: Obtain a Doctor’s Order
The senior’s primary provider (family doctor) will need to write an order confirming that the patient requires skilled nursing care. The physician will be handing over care to the nursing home’s doctor, so he or she will also need to issue appropriate orders for medication, treatment, physical therapy, etc.
Step Four: Complete the State-Required Form
Each state has a required form that certifies a patient meets the state’s nursing home criteria. The patient’s doctor or hospital staff will fill out and sign this form.
Step Five: Complete a Tuberculosis (TB) Test
Nursing homes usually require a TB test to confirm that the patient doesn’t have an airborne communicable disease. Some nursing homes require additional tests, so be sure to check with the admissions director to see what (if anything) else is required.
Step Six: Complete the Admissions Paperwork
Most nursing homes let you fill out the admissions paperwork ahead of time so you’re not rushing to get it done the day the patient is admitted. The admissions director will assist you if you have any questions.
Step Seven: Complete the Financial Assessment
To ensure the patient has the financial means to pay for skilled nursing care, the nursing home will require a financial assessment that addresses personal assets, insurance, government benefits, and government assistance programs like Medicaid.
Step Eight: Complete Medicaid Application (if Applicable)
If the patient plans to use Medicaid benefits to pay for the nursing home, you’ll need to work with the state agency to certify the patient’s income and assets qualify for coverage.
Unfortunately, there’s often a catch-22 with Medicaid where the state agency won’t approve coverage until the patient is admitted, but the nursing home won’t admit the patient until Medicaid is approved. If you find yourself in this situation, you may need to speak with an elder law attorney to discuss your options.
FAQs on Getting a Senior Admitted to a Nursing Home
Q: What qualifies a person for a nursing home?
Skilled nursing homes are for seniors who are unable to care for themselves for a sustained period of time, and present a danger to themselves or others without the necessary assistance. To determine this, doctors will evaluate four key areas:
- Behavioral: Is the senior unable to control their mood or actions?
- Cognitive: Does the senior suffer memory issues from Alzheimer’s or dementia?
- Functional: Does the senior need assistance with activities of daily living?
- Medical: Does the Senior require IV drips, catheters, ventilators, or other medical devices?
Q: Can a doctor put someone in a nursing home?
Admittance into a skilled nursing home requires a doctor’s order, much like writing a prescription. In most cases, the patient must see their doctor less than 30 days before entering the nursing home.
Q: Can social services force someone into a nursing home?
No. Social services may recommend a nursing home after a care assessment, but the social worker cannot force the senior into a nursing home. In rare cases a senior may be detained under the Mental Health Act of 1986, but it’s exceptionally rare.
Q: Who pays for a nursing home if you have no money?
Medicaid is a state-operated government assistance program that pays for long term care for seniors who don’t have any money. In order to qualify for Medicaid, you must “spend down” your personal assets to a state-specified threshold and meet the state’s income requirements.
In Arizona, Medicaid is administered by the Arizona Health Care Cost Containment System (AHCCCS).
Q: Can a nursing home take all your assets?
A skilled nursing home cannot “take” a patient’s assets. When debts accrue the facility may send the account to collections and place a lien on personal assets, but they cannot simply take assets to pay the bill.
Q: Can a nursing home kick you out?
Skilled nursing homes can’t evict someone, but they may require a transfer or discharge under certain circumstances. Across the board, facilities cannot force a transfer or discharge for any reason if moving the patient would be more harmful to their health than letting them stay.
Assuming that moving the patient is not detrimental to their health, there are five situations where a discharge or transfer may be permitted:
- The patient requires medical care that’s not available in a nursing home (e.g. hospitalization or transfer to a specialized mental institution)
- The patient’s condition has improved and they no longer require skilled nursing care
- The patient jeopardizes the health and safety of others in the nursing home
- The patient has not paid for care in at least 15 days
- The nursing home plans to cease operations