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What You Should Know About Nursing Home Applications

Just like the old college days, you will need to complete an application for the nursing home, and you'll be required to send other documents: A physician will have to certify that your parent really needs nursing home care, you'll need documentation as to how Mom or Dad's care will be paid, as well as any legal documents such as advance directives, a living will, a durable power of attorney for health care, and/or a power of attorney.

Mom or Dad's physician will need to fill out a pre-admission screening form regarding any history of mental illness or mental retardation to assure that the home provides your parent specialized care if needed for either of these conditions. Make sure you take steps to have the admission pre-authorized by any insurance carrier involved in your mom or dad's care. If this admission isn't okay with the insurance carrier before your parent enters the home, you'll get socked with a pretty hefty bill. The nursing home can advise you on those steps.

Senior Alert

Don't waive your rights to Medicare or Medicaid benefits. Nursing homes prefer residents who are private pay—the homes get paid more and have no hassles. But it's illegal for a nursing home to ask you in writing or verbally to not apply for Medicare or Medicaid reimbursement for your parent's care. If a home asks you to do that, talk to the local ombudsman and start looking for another home.

Senior Alert

Senior Alert Your parent—not you—should sign the nursing home agreement. There will be language that identifies the person who signs the document as being responsible for all bills. Unless your parent is legally declared incompetent (unable to make decisions) don't sign it and become liable for payments that your parent can't make.

Don't sign on the dotted line until you've really taken the time to carefully read the admissions agreement. Nursing homes must provide you with a fee schedule of what is covered under their basic rate and extra charges for personal services like haircuts, manicures, telephone, or dry cleaning. The basic rate is usually referred to as the per diem charge, meaning the charge per day. Make sure the home spells out what is being covered by Medicare, Medicaid, Medi-gap, Medicare managed care or long-term care insurance and for how long. Also ask the home what its policy is when a resident has spent all of his or her private dollars and subsequently becomes a Medicaid beneficiary. Does the resident have to leave?

The law also protects you and your siblings from being financially liable for your parent's care. It's illegal for the nursing home to require this of you as a condition of admission to the facility. Also avoid any advance payments to the home. Medicare rules prohibit nursing homes from requiring you to pay an advance unless it is absolutely, positively clear that Medicare will not pay for the care.

Here are some questions you should ask before signing the admissions agreement:

  • How much do you charge per day? What's included?
  • How do my parent's records remain confidential?
  • Are pharmacy services made available? Who prescribes? Who pays?
  • What are the facility and state rules for transferring my parent from the home to the hospital or other medical facility?
  • If my mom or dad is in the hospital, how long do you hold the bed at the nursing home and how does my parent's per diem rate change?
  • What are your billing practices? Are there late charges? If my mom or dad should go on Medicaid, will anything change regarding his or her care or residency at the facility?
  • What are your rules and policies regarding personal fund accounts (small amounts of money your parent has access to for incidental spending)?

At the time of admission, you will receive a packet of information on how to apply for Medicaid and Medicare, a resident's bill of rights, a description of your parent's legal rights, how to file a complaint, how to accept or refuse medical or surgical treatment, and how to contact the physician providing care to your parent at the nursing home. Be sure to take the time to read these materials.

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Excerpted from The Complete Idiot's Guide to Caring for Aging Parents © 2001 by Linda Colvin Rhodes, Ed.D. All rights reserved including the right of reproduction in whole or in part in any form. Used by arrangement with Alpha Books, a member of Penguin Group (USA) Inc.

To order this book visit the Idiot's Guide web site or call 1-800-253-6476.


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