Page Contents
Selecting a
nursing facility
Decision-making
resources
Paying for a skilled
nursing facility
After admission
Site Contents
Patients & visitors
Medical professionals
Yale-New Haven
Children's Hospital
Yale-New Haven
Psychiatric Hospital
General information
Calendar
Online resource
Press information
Phone Numbers
Directory assistance
(203) 688-4242
Patient Information
(203) 688-4177
Adult emergency
(203) 688-2222
Children's emergency
(203) 688-3333
Admitting
(203) 688-2221
Children's admitting
(203) 688-3331
Psychiatric admitting
(203) 688-9907
Mailing address:
Yale-New Haven Hospital
20 York Street
New Haven, CT 06510-3202
What to look for in a skilled nursing facility
A skilled nursing facility, also known as a nursing home, is a residence for those who need short-term care following a hospital stay or long-term nursing supervision because of health issues or disabilities. Some facilities also provide respite care, adult day care and transportation for area seniors.
The need to choose a nursing facility cannot always be anticipated. An unexpected illness or injury may force you to make a choice with little or no preparation. However, even if you are learning about this process after being admitted to a nursing facility, there is a lot you can still do to make your choice a satisfying one.
Selecting a nursing facility
The majority of skilled nursing facility residents have been transferred from a hospital. If you are hospitalized, your hospital's care coordinator will help you select a facility that can best meet your needs. If you think you or a family member may need a skilled nursing facility in the future, you can get names of facilities in your area from the care coordination department of your hospital, your local Visiting Nurses Association or department on aging (in Connecticut, 1-800-994-9422). Here are some questions to ask:
- Location. The degree of care you require may not make it practical to choose a skilled nursing facility in or close to your community. However, if circumstances permit, consider choosing a skilled nursing facility that will allow family and friends to visit often and look out for your welfare.
- Level of care. Each facility defines its own level of care; not all facilities accept residents with complex medical problems. To select a facility that is best for your needs, it's important to know and accurately describe the services you or your family member require. For example, does the facility care for residents who are ventilator-dependent (on a breathing machine), use a feeding tube or have a tracheostomy? Can it meet special dietary requirements or care for a patient with dementia who wanders?
- Payment sources. Does the facility accept all forms of payment including private pay, health or long-term care insurance, Medicare and Medicaid? Does the facility have both Medicare and Medicaid beds so you can switch from one to the other if needed instead of moving to another facility?
- Unscheduled visits. Visit the facilities that interest you or ask a trusted friend or family member to do it for you. Make unscheduled visits at different times to observe as many interactions as possible. Observe the condition of the property inside and out. Is it clean and odor-free? Are residents clean, dressed and active? Do they appear happy? Speak with the staff and observe how they engage with residents.
- Physician affiliation. State and federal guidelines require all skilled nursing facility residents to be under the care of a physician so that their plan of care and medications can be evaluated at least every 30 days. Is your physician affiliated with the facility so that he or she can continue to follow your care after you move there? Does the facility have a physician who cares for many of the patients?
- Availability. Is a bed available and if not, how long before one becomes available? Can you add your name to a waiting list?
- Staffing. How many nurses are on permanent staff and how many come from agencies that supply temporary nursing staff? The majority of nurses at the facility should be staff members who are familiar with residents' ongoing care needs. To find the ratio of staff to residents at each facility, visit Nursing Home Compare on the official government web site for Medicare patients.
- Activities. Does the nursing facility provide interesting daily activities for residents to engage in? How often are they held? Are religious services included?
- Communication. If you are making arrangements for a family member, how often will staff contact you with an update on his or her condition?
- Contract and fee schedule. Get a copy of the nursing facility's admission or contract agreement and fee schedule. Use the fee schedule to compare charges at different nursing facilities. Be aware that the fee schedule does not include the cost of a required physician's visit at least every 30 days or expenses incurred for treating other illness or injury. These costs represent additional expenses; you are responsible for any that are not covered by your insurance. If you plan to rely on a long-term care policy to cover skilled nursing expenses, review the terms now to acquaint yourself with your plan's covered services.
Decision-making resources
Other resources that may help you with your decision:
- Long-term care ombudsman. There are more than 600 long-term care ombudsman or “patient advocate” programs nationwide. Ombudsman volunteers visit nursing facilities regularly and are familiar with their strengths and weaknesses. An ombudsman cannot recommend a nursing facility, but can provide the results of the latest state inspection and information about the facility's complaint history (in CT, call 1-860-424-5200).
- State inspection report. You can also obtain the results of a state inspection by requesting the report from the skilled nursing facility you are considering, by visiting Nursing Home Compare on the Medicare web site, or call Medicare toll free at 1 (800) 633-4227.
- Nursing Home Compare. Use Nursing Home Compare on the Medicare web site to find an information summary for a specific facility. Click on “View all information” to find all categories of data available on that facility.
Select “Inspection Results” to find the date of the last state inspection, the number of deficiencies for which the facility was cited, the nature of those deficiencies and how many residents were affected.
Select “Nursing Home Staffing” to find how much time the combined nursing staff has allotted to residents each day and how this number compares to the state average.
If you need help understanding the data, call the division of health systems regulation at your state department of public health (in CT, call 1-860-509-7400) and ask for a nurse consultant for assistance. - Family council meetings. Some nursing facilities have very active family councils—groups of family members who meet regularly to discuss issues of concern and generally act as “patient advocates”. Members can be informative and reassuring to someone just entering the decision-making process. Ask if a family council meets at the facility that interests you and if you can attend a meeting.
- Continuity of care. You may feel more comfortable if your own physician or another physician from your hospital continues your health care after your move to a skilled nursing facility. Yale-New Haven Geriatric Services, PC, has an agreement with several nursing facilities to continue providing care to patients who have been discharged. To ask about this service and the nursing facilities with which it is associated, call (203) 688-8200.
- Recovery care centers. For short-term care, you may be able to go to a recovery care center instead of a skilled nursing facility. There are at least 20 recovery care centers across the country, such as Yale-New Haven Hospital's Temple Recovery Care Center, specializing in short-term (maximum of three weeks), subacute care for patients just discharged from the hospital. Medical services are covered by many insurance plans and include skilled nursing, wound care and physical, occupational and intravenous therapies. For more about services and insurance coverage, call Temple Recovery Care Center at (203) 498-3203.
Paying for a skilled nursing facility
Skilled nursing facility care is estimated at $7500.00 a month.* Depending on your insurance coverage, this may cover room and board only or room and board as well as medical expenses. Your insurance company may be billed for the cost of any medical and nursing care you may need, either for routine physician's care required for all nursing facility residents, injury or illness or medical services such as dressing changes, blood sugar testing or feeding tubes. You are responsible for medical expenses not covered by Medicare or by your secondary insurance.
Many of those entering skilled nursing facilities rely on their own financial resources or use long-term care insurance for their expenses. Medicare pays fully only for the first 20 days of care. From day 21 through 100, the patient must share the cost of care by paying a daily coinsurance rate, which changes each year. A patient must meet certain conditions before Medicare will pay for skilled nursing care:
- Spend at least three consecutive nights in a hospital,
- Be admitted to the nursing facility within 30 days after discharge from the hospital following the three-night stay,
- Have a physician certify that skilled nursing services are needed for the same illness for which the person was hospitalized.
When Medicare benefits are exhausted, a resident may either pay privately or qualify for coverage under Medicaid but may have to reduce personal assets first to meet income qualifications. Under the “spousal impoverishment” rule, the person entering a skilled nursing facility is allowed to protect a certain amount of assets and income for a spouse who remains at home. More information is available from the following agencies:
- Centers for Medicare & Medicaid Services:
Call for information about Medicare or Medicaid coverage and qualifications.
Phone number in CT: 1 (800) 633-2477 - State Health Insurance Assistance Program (SHIP):
Call for free health insurance counseling and assistance for people with Medicare.
Phone number in CT: 1 (800) 994-9422 - State Medical Assistance Office: Call for information about Medicaid or programs to help with medical bills for low-income residents and help with prescription drug coverage.
Phone number in CT: 1 (800) 842-1508
* Figure is accurate as of August 2004.
After admission
Bring personal belongings that have special meaning to you such as family photos or a favorite quilt. Transfer subscriptions to newspapers or magazines to the nursing facility to keep current with the news. Participate in as many activities as you can, including the facility's resident council, similar to the family council described above.
Don't assume you can't go anywhere. Nursing facility residents are encouraged to go out with family and friends whenever they can or to invite them to the facility for meals. Overnight or weekend visits outside the facility may also be permitted, depending on your insurance. For example, while Medicare A does not allow overnight stays, Medicaid permits 21 overnight stays per year.
Knowing your rights may relieve anxiety or misconceptions you may have about living in a nursing facility. The skilled nursing facility must provide you with a written description of these rights. They include the right to be treated with dignity, freedom from restraints, abuse and involuntary seclusion from others, the right to privacy including private time with visitors and the right to be involved in regularly scheduled planning meetings where your condition and care are discussed.
Finally, if you decide that this is not the right place for you, you can move to another facility with an available bed. Moving can be difficult, but may be better than remaining in a facility that doesn't suit you. Follow the facility's rules for leaving to avoid paying extra fees.
The following organizations contributed information for this issue: Dorothy Adler Geriatric Assessment Center, Yale-New Haven Hospital; Division of Health System Regulations, Connecticut Department of Public Health; Jewish Home for the Aged, New Haven; Mary Wade Home, New Haven; Visiting Nurse Association of South Central Connecticut; Yale-New Haven Ambulatory Services; Yale New Haven Geriatric Services PC.
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Call (203) 688-2000 or toll free (888) 700-6543 to speak with a health information coordinator or request an appointment. You can also get physician information or request an appointment on this web site. |
Last revised: October 28, 2004 (mv)
