Frequently Asked Questions:
Skilled Nursing Care Facilities
Q: What
services are included in skilled nursing
care facilities?
A:
A full
range of Medical, Nursing, Social Work,
Dietary and Rehabilitative services are
provided along with social and
recreational activities appropriate to
the needs of the residents. These
services can be obtained from:
Q: What
is the cost of skilled nursing home
care?
A:
Generally speaking, a skilled nursing
home stay costs approximately $6000 to
$7000 per month.
Q: Who
pays for skilled nursing home care?
A:
This is
a very complex question, because it
depends upon the person's insurance,
financial status, veteran status, and
medical condition. The best advice is to
discuss your individual circumstances
directly with the potential provider to
find out.
Q: Will
Medicare pay for the first 100 days in a
skilled nursing facility?
A:
Medicare can pay up to 100 days as long
as the resident has a three (3) night
hospital stay prior to admission and
their care needs meet the requirements
to qualify for coverage. Co-insurance
will pay co-payments for days 21-100 if
the residents care continues to qualify
for Medicare coverage. Medicare Managed
Care HMOs have essentially the same
coverage as Medicare/co-insurance, and
requires a pre-certification.
Q: If
one plans to go to a nursing care
facility, does that mean that they or
their spouse has to sell their home and
spend their life savings to pay for the
needed care?
A:
Typically, upon admission to the nursing
home, a resident needs to spend down to
a certain level before they can qualify
for Medicaid, which is a Federal
insurance program that pays for long
term care health benefits in a nursing
home (or other settings) for those who
meet the income and resource guidelines.
In 1989, the Spousal Impoverishment Act
was passed which allows the spouse of a
resident to maintain their family home
and a significant amount of resources.
Details on income and resource
eligibility are available from
Q: I'm
told that a PRI is necessary to be
considered for admission to a nursing
home. What is a PRI?
A:
Admission to Nursing Care Facilities
requires a Patient Review Instrument
(PRI) to be completed to determine the
level of care a person needs. The PRI is
conducted by the hospital, skilled
nursing home or rehabilitation center
when you are a patient preparing for
discharge; or if you are in your home or
other residential facility, the
following agencies can do this:
Q: Is
it necessary to have a doctor in order
to be admitted to the nursing home?
A:
Yes, a
doctor must complete medical forms
regarding current condition and medical
history.
Q: What
should I look for when evaluating
nursing homes to determine which one I
will choose to provide residential care
for myself or a family member?
A: The
New York
State Health Department
regularly surveys and monitors nursing
homes in New York State and provides
each nursing home with a survey report
identifying how they rated in the most
recent State survey of their facility.
Each facility should have a copy of that
survey report posted for visitors to
see. Also, the
New York
State Health Department
website has review criteria and reports
from New York State Survey results for
individual facilities posted on their
site. |
