Long-Term Care Health Facilities
Many people in their 70s, 80s, and 90s live full, rich lives and are able to run their own households with little or no assistance. When people need some level of medical care or assistance with activities like shopping and preparing food, they are often able to remain in their own homes with the help of family and friends, community-based services, and professional home care agencies. Contact your Area Agency on Aging for information and links to home and community-based services that may be available to assist you in maintaining independence. A listing of the Iowa Area Agency on Aging locations and phone numbers can be found at www.iowaaging.gov. The Eldercare Locator, a toll-free, nationwide telephone service (1-800-677-1116), is another resource to assist long-distance caregivers in locating services for older adults in their own communities.
When people have debilitating physical or emotional conditions, they often require the kind of care that can’t be provided by family or community-based services. Based on the person’s level of care needs, long-term care facilities or “nursing homes” may be the solution. Early research into long-term care facilities can aid in the planning and smooth the transition for care.
Consider Medical Needs
The first step is to consider the person’s medical needs. Nursing homes are designed for people who are chronically ill or need around-the-clock medical care. Some people go directly into a nursing facility after being discharged from hospitals because they need intensive or skilled care from a licensed nurse or therapy to recover from an injury or a disabling illness. Others are in nursing homes because they can no longer independently manage activities of daily living, such as bathing, eating, dressing, mobility and toileting needs. The goal of care in a nursing facility is to help individuals meet their daily physical, social, medical, and psychological needs and to return home whenever possible.
Nursing homes are not alike. Certain facilities are equipped to provide different levels of care while others have specialized units, such as an Alzheimer’s/dementia unit. Many nursing facilities, but not all, provide care at different levels.
Other Options in Long-Term Care Include
Assisted Living. Assisted living programs provide assistance for persons who are largely able to live independently but need some assistance with activities of daily living such as eating, bathing, using the bathroom, taking medicine, and getting to appointments as needed. Residents often live in their own rooms or apartments within a building or group of buildings and have some or all of their meals together. Social and recreational activities are usually provided. Some facilities have health services on site. Costs for assisted living facilities can vary widely depending on the size of the living areas, services provided, type of help needed, and where the facility is located.
Continuing Care Retirement Communities. Continuing Care Retirement Communities (CCRCs) are sometimes called life care communities. Entering a CCRC is often a once-in-a-lifetime choice. While the physical plans of CCRCs vary, many offer extended campuses that include separate housing for those who live very independently, assisted living facilities for those needing some support, and nursing care facilities for those needing a higher level of care. The CCRCs provide a continuum of care for older persons based on ability and need. Most communities require an entrance fee and monthly payments. Additional fees may apply for specific services.
Selecting a Long-Term Care Facility
Before you begin a search for a long-term care facility, determine the medical and physical needs and the financial resources of the prospective resident. The prospective resident’s opinions and desires should be considered as a major factor.
Facilities located near the people who will be visiting the resident most frequently should be seriously considered. Visits are very important in maintaining a resident’s morale and well-being.
Obtain a current list as well as compliance reports of licensed long-term care facilities from the Iowa Department of Inspections and Appeals, available online at www.dia.iowa.gov/health-facilities/reports or at www.medicare.gov/nursinghomecompare. Review the recent survey reports of facilities that interest you. Phone those facilities to obtain basic information about openings, basic charges and services, as well as any “extras” for which the resident may be responsible, such as laundry or disposable pads. If you are still interested, schedule an appointment to meet the administrator or the director of admissions and tour the facility. Follow up with a second unannounced visit to the facility.
Importance of Survey Reports
Nursing homes participating in the Medicare and Medicaid programs are required by federal law to undergo an annual survey and certification process. The purpose of the survey is to assess whether the quality of care, as intended by the law and regulations, and as needed by the resident, is being provided in the nursing home. Prior survey results are considered public and can be viewed from the Iowa Department of Inspections and Appeals website. The survey report must also be posted for inspection within the facility.
If a nursing home is found to be out of compliance, federal law sets forth enforcement options such as denial of payment for new admissions, fines, revocation of Medicaid and Medicare certifications, transfer of residents, and the imposition of temporary management. The expectations are that:
- Nursing homes participating in Medicare and Medicaid programs must remain in substantial compliance with the Medicaid/Medicare care requirements.
- All deficiencies will be addressed promptly.
- Residents will receive the care and services they need to meet their highest practicable level of functioning.
Benchmarks of Good Nursing Home Care
A long-term care facility provides the level of care necessary to meet the needs of residents, but it may also become a last residence for some. The choice of a good facility involves qualities that relate both to medical care and the comforts of home. Finding a facility that suitably fulfills both functions at all times may be difficult.
When looking for a long-term care facility, consider:
- Safety and good medical care. You need to know that the facility you consider places a high premium on meeting residents’ safety and basic care needs. For example, stairway doors should be locked to prevent accidents. Toileting needs should be met promptly. Exercise or rehabilitation sessions should be scheduled regularly so that residents don’t lose mobility.
- Interactions with staff. Research has shown that relationships with staff are one of the most important aspects of life in a nursing home. There should be adequate staff to manage the care needs of the residents. Staff interactions with residents and visitors should be pleasant and helpful.
- Interactions with other Residents. A nursing home needs to provide activities and do more than post a list of options on the bulletin board. Residents should be encouraged to attend activities and make the most of their abilities.
- Pleasant and safe environment. The nursing home should be pleasant, bright, clean, and odor free. It should be a place where you want to visit.
Financing Long-Term Health Care
Long-term care is expensive. The basic charge of the facility often does not include the costs of special services or supplies a resident may need. The four basic methods for paying for long-term care are: Medicare, private pay, Medicaid and long-term care insurance.
Medicare
Many people believe Medicare pays for long stays in a nursing home, but it does not. Under certain limited conditions, Medicare will pay some nursing home costs for Medicare beneficiaries who require skilled nursing or rehabilitation services. When skilled care or rehabilitation services are ordered by a physician, Medicare will cover some part of the stay. A three-day hospital stay prior to admission to the skilled care facility is required to qualify for this benefit. Medigap or supplemental insurance may assist with required care costs. Check your policies.
Private Pay—Personal Resources
Many nursing home residents pay nursing home costs out of their own savings. After these savings and other resources are spent, many people who remain in nursing homes for long periods eventually become eligible for Medicaid.
Medicaid
Medicaid is a state and federal program that pays most nursing home costs for people with limited income and assets. Eligibility depends on a person’s income, resources and circumstances. Medicaid will pay only for nursing home care provided in a facility certified by the government to provide service to Medicaid recipients. It should be noted that, even though most facilities are certified to accept Medicaid residents, some facilities limit the number of Medicaid admissions. If a person is eligible for Medicaid and is accepted as a resident by a facility, the Medicaid payment must be accepted by the facility as full payment for care.
Long-Term Care Insurance
Long-term care insurance is a private insurance policy. It is important to study any health facility insurance policy carefully before buying it so that you understand the financial obligations and policy benefits. The benefits and costs of these plans vary widely. For more information on these plans, contact the Senior Health Insurance Information Program (SHIIP at 1-800-351-4664 or visit https://shiip.iowa.gov.)
Managed Care Plans
A managed care plan will not pay for care unless the nursing home has a contract with the plan. Contact the managed care organization or HHS for coverage questions.
Nursing Home Residents Bill of Rights
Under federal regulations, all nursing homes are required by law to have written policies called the Nursing Home Residents Bill of Rights, which describe the rights of the residents. Nursing homes are required by law to make these policies available to any resident who requests them and to administer them to all residents regardless of race, color, religion, national origin, age, disability, ability to pay, or source of payment.
The Nursing Home Residents Bill of Rights should include and define (but not be limited to) the following rights:
The Right to be Informed of Your Rights and the Policies of the Facility
The long-term care facility must have written policies about your rights and responsibilities as a resident. You must sign a statement saying that you have received and understood these rights and the rules of the facility when you are admitted. As a resident, you have the right to be fully informed before or at admission of your rights and responsibilities as a resident and to be notified of any changes or amendments to those rights and responsibilities.
The Right to be Informed about the Facility’s Services and Charges
Every resident has the right to be fully informed of the services available in the facility and of the charges related to those services. These charges include services not covered under Medicare or Medicaid and charges that are not covered in the facility’s basic rate.
As a Resident, you have a right to:
- Be informed about your medical condition and treatment
- Every resident has the right to receive medical care, nursing care, rehabilitative and restorative therapies, and personal hygiene in a safe, clean environment. Also, residents have the right to be fully informed of their medical conditions. Residents have the right to be advised by a physician or appropriate professional staff of alternative courses of care and treatments and their consequences.
- To participate in planning your care and medical treatment, residents must be given the opportunity to participate in the planning of their medical treatment. Residents have the right to refuse treatment and to refuse to participate in experimental research.
- To choose your own physician. Every resident has the right to choose their own physician and pharmacy. Residents do not have to use the nursing home’s physician or pharmacy.
- To manage personal finances. Residents have the option to manage their funds or to authorize someone else to manage them. If someone else is authorized to handle a resident’s funds, the resident has the right to: know where the funds are and the account number(s); receive a written accounting statement; receive a receipt for any funds spent; and have access to their funds.
- To privacy, dignity, and respect. Every resident has the right to be treated with consideration, respect, and dignity in full recognition of their individuality. This includes privacy during medical treatment and care of personal needs.
- To personal possessions. Every resident has the right to retain and use their personal clothing and possessions as space permits, unless doing so infringes upon the rights of other residents or constitutes a safety hazard.
- To be free from restraints and abuse in nursing facilities. Residents have the right to be free from mental (humiliation, harassment, and threats of punishment or deprivation) and physical (corporal punishment and the use of restraints as punishment) abuse. Residents also have the right to be free from chemical and physical restraints unless authorized in writing by a physician for a specified and limited time period or when necessary to protect the patient from injury to themselves or to others.
- To voice grievance without retaliation. Every resident should be encouraged and assisted to exercise their right to voice grievances and recommend changes in policies and services to facility staff and/or outside representatives of their choice without fear of coercion, discrimination, or reprisal.
- To be discharged or transferred only for medical reasons. Residents may only be discharged or transferred for medical reasons, non-payment, or for their welfare or that of other residents. Residents must be provided with a written notice 30 days prior to transfer or discharge. The law provides residents the right to appeal discharge or transfer.
- Rights of access. Residents may receive any visitor of their choice and may refuse visitors to enter their room or may end a visit at any time. Residents have the right to immediate access by family and reasonable access to others.
Additional Information Regarding Transfers and Discharges
Discharges
Legally, a nursing home resident cannot be moved unless the resident endangers the safety or health of other individuals, or has medical needs that no longer can be met by the facility, or has recovered their health significantly so that the level of care is no longer necessary, or has failed to pay for services, or the facility closes or has lost its certification. In these latter situations, ordinarily special arrangements are made to transfer the residents to other housing accommodations. If a discharge occurs, the resident should receive assistance from the facility to ensure a safe and orderly discharge.
When a resident or responsible party receives an involuntary discharge notice, the notice must contain specific information about the reason for the transfer or discharge, the date it is effective, and the process to request a hearing before an administrative law judge to appeal the discharge. The Office of the State Long-Term Care Ombudsman is a resource to assist families and residents during such proceedings. Contact the Office of the State Long-Term Care Ombudsman at (866) 236-1430.
Transfers Within the Facility
Residents may not be arbitrarily moved from room to room within a licensed health care facility. Involuntary relocation may occur under the following situations and the situations must be documented in the resident’s record:
- Incompatibility with or disturbance of roommates.
- For the welfare of the resident or other residents of the facility.
- For medical, nursing or psychosocial reasons, as judged by the attending physician, nurse or social worker.
- To allow a new admission to the facility that would otherwise not be possible due to separation of roommates by sex.
If a move from one room to another is necessary for one of the reasons above, the resident must be notified at least 48 hours prior to the transfer and the reason explained.
Nursing Facility Neglect, Exploitation and Abuse
If you suspect that a nursing facility resident may be the victim of neglect, exploitation or abuse, immediate action can halt further tragedy. If you notice a problem, it should be brought to the attention of the nursing facility and reported. Contact the Iowa Department of Human Services Dependent Adult Abuse Hotline at 1-800-362-2178 to report the abuse or the Office of the State Long-Term Care Ombudsman at 1-866-236-1430.
How to Handle Problems, Concerns and Complaints
When problems, complaints or concerns occur between residents or their family members and the nursing facility, several mechanisms are available to assist in resolution of the issues.
Facility procedures. Residents have a right to submit complaints, concerns or recommendations concerning facility policies or services without restraint, interference, coercion, discrimination or reprisal. First and foremost, speak directly with the nursing facility management. Each nursing facility is required by law to have in place a formal complaint or grievance system to deal with residents’ issues. The procedure should make it easy and comfortable for a resident to air their complaint. The nursing facilities must follow up on the complaint quickly and make an effort to correct the problem(s).
Be sure you are following the facility grievance procedure. It should be posted, but if you do not see it, ask for a copy. Document the details of the incident or concern, who was told, and when and what happened. If the problem is not resolved, contact the Office of the State Long-Term Care Ombudsman or the Iowa Department of Inspections and Appeals.
The Office of State Long-Term Care Ombudsman. The “long-term care ombudsman,” created under both federal and state law, advocates for residents in long term care facilities and for tenants in assisted living programs. Originating in the Older Americans Act of 1978, the Office of the State Long-Term Care Ombudsman investigates and resolves complaints made on behalf of residents of long-term care facilities. At the request of the resident or family, a Long-Term Care Ombudsman may visit or call the facility, review records, meet with staff, and put a plan in place to address the problem. The Long-Term Care Ombudsman may also assist in situations where a resident is facing discharge from a facility involuntarily. This office monitors the standard practices in long-term care and clarifies the state guidelines on particular practices. The Long-Term Care Ombudsman represents the interests of residents before governmental entities, and provides education on long-term care, choosing care facilities, and about issues that affect the health, safety, welfare, or rights of residents. The name and address of the local Long-Term Care Ombudsman must be posted at the facility.
Contact the Office of the State Long-Term Care Ombudsman at (866) 236-1430 (in state only) or (515) 725-3308.
Iowa Department of Inspections and Appeals (DIA). The Iowa Department of Inspections & Appeals regulates nursing facilities in Iowa and maintains a Facility Report Card site that provides updated results of inspections, including any problems that may have been found in a facility in recent annual surveys or complaint investigations. The DIA takes complaints concerning care facilities either over the phone or in writing. The DIA has the authority to issue deficiencies or to fine facilities for violations of a resident’s rights.
Complaints can be registered with the DIA using the following methods:
Contact the toll-free complaint intake line: (877) 686-0027
Submit your complaint by regular mail to:
Iowa Department of Inspections and Appeals
Health Facilities Division/Complaint Unit
Lucas State Office Building
321 East 12th Street
Des Moines, Iowa 50319