America's Top Nursing Homes

Finding a nursing home a for a loved one is a very important decision. Consumers should take the time to investigate a nursing home thoroughly. Consumers can now go to a government web site to check and compare nursing homes. The government web site contains valuable information that is free to the public and can help you make a smart decision in your selection.

A quality nursing home will provide the kind of care which requires specific skills of a qualified nurse. Nursing homes fill a need when the persons health requires constant nursing care. Many of the duties performed include the administration of medication orally or injection, cleaning and dressing an open wound, artificial feeding and intensive rehabilitation following surgery and illness.

There are different types of nursing homes for ones particular needs. Some nursing homes specialize in caring for younger people that are physically disabled, people with learning disabilities and overall general mental health problems.

Nursing homes vary in services offered, the size of the facility and the cost. It is important to research and compare various nursing homes that are under consideration.

The government web site, www.medicare.gov , has recently released information on 17,000 Medicare and Medicaid certified nursing homes. This detailed information contains quality indicators on past performance that can be used to compare different nursing homes.

The comparison listed eight different deficiency descriptions that were evaluated. The deficiency categories are:

   Mistreatment Deficiencies

   Quality Care Deficiencies

   Resident Assessment Deficiencies

   Resident Rights Deficiencies

   Nutrition and Dietary Deficiencies

   Pharmacy Service Deficiencies

   Environmental Deficiencies

   Administration Deficiencies

When a deficiency was cited it was given an alphabetical code that represents the severity of the deficiency. Listed below are the severity codes:

A Isolated / Potential for minimal harm

B Pattern / Potential for minimal harm

C Widespread / Potential for minimal harm

D Isolated / Minimal harm or potential for actual harm

E Pattern / Minimal harm or potential for actual harm

F Widespread / Minimal harm or potential for actual harm

G Isolated / Actual Harm

H Pattern / Actual Harm

I Widespread / Actual Harm

J Isolated / Immediate jeopardy to resident health or safety

K Pattern / Immediate jeopardy to resident health or safety

L Widespread / Immediate jeopardy to resident health or safety

After all the data was researched the nursing homes that received a severity code of G, H, I, J, K and L were removed from the database. Only the nursing homes that received a severity code of A, B, C, D, E and F made the list of America’s Top Nursing Homes. This does not mean that if a particular nursing home did not make the list that they are a bad choice, it merely means that they had a deficiency in the G through L level of severity. It is possible and even probable that these deficiencies have been rectified. This is what you need to question the nursing home administrator about.

We strongly suggest that you investigate and research each institution thoroughly. Using the Nursing Home Compare from the free government web site you can find out:

Nursing homes characteristics

Number of beds

Type of ownership

Participates in Medicare and Medicaid

Percent of residents with pressure sores

Percent of residents urinary incontinence

State inspection information

Number of registered nurses, licensed practical or vocational nurses

No fees, donations, sponsorships or advertising are accepted from any individuals, professionals, corporations or associations. This policy is strictly adhered to, insuring an unbiased selection.

Choosing a nursing home is a very important decision. You need to think about whether a nursing home is the best choice for you. A nursing home provides care to people who cannot be cared for at home or in the community. For people who can't take care of themselves due to physical, emotional, or mental problems, nursing homes can provide a wide range of personal care and health services. For many people, this care generally is custodial, or non-skilled.

Care in a nursing home can be very expensive. Nursing homes usually provide 24-hour medical care as well as room, meals, activities, and some personal care. Most nursing homes charge a basic fee for room, meals, and some personal care. You may have to pay extra for other services or care for special medical needs. It is important to get a list of fees in advance and discuss these costs and how you will pay for them. For more information about paying for nursing homes, see below.

A nursing home may not be your only choice for your personal care and health services. Depending on your needs and resources, there are other kinds of living and care choices available for long-term care. You can get long-term care at home, in senior centers, at community centers, or in special retirement or assisted living facilities. You may need help from family and friends, community services, and professional care agencies. You may wish to talk to your family, doctor, or a social worker to help decide what long-term care you need.

Listed in the next few sections are some of the most common kinds of long-term care. These long-term care choices may be called by other names in different states. The services and costs may vary between facilities as well. Call your local Area Agency on Aging for a list of long-term care choices in your state.

To get their telephone number look at www.aoa.gov on the web. Or, call the Eldercare Locator at 1-800-677-1116 (weekdays 9:00 a.m. to 8:00 p.m. Eastern time) ask them for your local Area Agency on Aging telephone number. Ask your local Area Agency on Aging for a list of long-term choices in your state.

Long-Term Care Choices Include:

Community Services: There are a variety of community services that might help you with your personal activities. Some services, like volunteer groups that help with things like shopping or transportation, may be free. Some services may be available for a cost that can vary depending on where you live and the services you need. Below is a list of some home services and programs that are found in most communities:

          • Adult day care
          • Meal programs (like Meals-on-Wheels)
          • Senior centers
          • Friendly visitor programs
          • Help with shopping and transportation
          • Help with legal questions, bill paying, or other financial matters

For information about community services, call your local Area Agency on Aging. You can get the telephone number of your local Area Agency on Aging by looking at www.aoa.gov on the web. Select “About AOA and the Aging Network.” Then select “Area Agencies on Aging.” Or, you can call the Eldercare Locator at 1-800-677-1116 (weekdays 9:00 a.m. to 8:00 p.m. Eastern time) for your local Area Agency on Aging telephone number.

Home Care: Depending on your needs, you may be able to get help with your personal activities (for example, help with the laundry, shopping, cooking, and cleaning) at home from family members, friends, or volunteer groups. If you think you need home care, talk to your family to see if they can help with your care or help arrange for other care providers.

There are also home health care agencies that give custodial and/or skilled nursing care in your home. Remember, Medicare only pays for home care if you meet certain conditions. To get a free copy of the Medicare booklet Medicare and Home Health Care (CMSPub.No.10969).

Accessory Dwelling Units (ADUs): If you or a loved one owns a single-family home, an accessory dwelling unit (ADU) may help you keep your independence. An ADU, sometimes called an “in-law apartment,” an “accessory apartment,” or a “second unit,” is a second living space within a home or on a lot. It has a separate living and sleeping area, a place to cook, and a bathroom. Space such as an upper floor, basement, attic, or space over a garage may be turned into an ADU. Family members might be interested in living in an ADU in your home, or, you may want to build a separate living space at your family member's home.

Check with your local zoning office to be sure ADUs are allowed in your area, and if there are special rules. The cost for an ADU can vary widely depending on how big it is, and how much it costs for building materials and workers.

Subsidized Senior Housing:There are Federal and State programs that help pay for housing for some older people with low to moderate incomes. Some of these housing programs also offer help with meals and other activities like housekeeping, shopping, and doing the laundry. Residents usually live in their own apartments in the complex. Rent payments are usually a percentage of your income.

Board and Care Homes: Board and care homes are group living arrangements designed to meet the needs of people who cannot live independently but do not need nursing home services. Most board and care homes provide help with some of the activities of daily living such as bathing, dressing, and using the bathroom. Board and care homes are sometimes called “group homes.” Many of these homes do not get payment from Medicare or Medicaid. The monthly charge is usually a percentage of your income.

Assisted Living Facilities: These facilities provide help with activities of daily living like bathing, dressing, and using the bathroom. They may also help with care most people do themselves like taking medicine or using eye drops and additional services like getting to appointments or preparing meals. Residents often live in their own room or apartment within a building or group of buildings and have some or all of their meals together.

Social and recreational activities are usually provided. Some assisted living facilities have health services on site. In most cases, assisted living residents pay a regular monthly rent, and then pay additional fees for the services that they get. The term “Assisted Living” may mean different things in different facilities. Not all assisted living facilities provide the same services. It is important that you contact the facility and make sure they can provide you assistance to meet your needs.

Continuing Care Retirement Communities (CCRCs): CCRCs are retirement communities with more than one kind of housing and different levels of care. Where you live depends on the level of care you need. In the same community, there may be individual homes or apartments for residents who still live on their own, an assisted living facility for people who need some help with daily care, and a nursing home for those who require higher levels of care. Residents move from one level to another based on their needs, but stay within the CCRC.

If you are considering a CCRC, be sure to check the record of its nursing home. Your CCRC contract usually requires you to use the CCRC's nursing home if you need nursing home care. Some CCRC’s will only admit people into their nursing home if they have previously lived in another section of the retirement community, such as their assisted living or an independent area. Also, many CCRCs generally require a large payment before you move in (called an entry fee) and charge monthly fees.

You can also find out if a CCRC is accredited and get advice on selecting this type of community from Continuing Care Accreditation Commission at 1-202-783-7286. Or, you can look at www.ccaconline.org on the web.

Another Type of Care Available

Hospice Care: Hospice is a special way of caring for people who are terminally ill, and for their family. This care includes physical care and counseling. The goal of hospice is to care for you and your family, not to cure your illness. If you qualify for hospice care, you can get medical and support services, including nursing care, medical social services, doctor services, counseling, homemaker services, and other types of services. You will have a team of doctors, nurses, home health aides, social workers, counselors and trained volunteers to help you and your family cope with your illness. In many cases, you and your family can stay together in the comfort of your home. Medicare covers hospice care if you qualify. Medicare does not pay for 24-hour assistance if you get hospice services at home.

Depending on your condition, you may get hospice care in a hospice facility, hospital, or nursing home. Room and board are not covered if you get general hospice services while you are a resident of a nursing home or a hospice’s residential facility. However, room and board are covered for inpatient respite care and during short-term hospital stays. To get a free copy of the booklet Medicare Hospice Benefits (CMS Pub.No.02154).

Some nursing homes may provide respite care. Respite care is inpatient care given to a hospice patient so that the usual caregiver can rest. Medicare covers respite care if you are getting covered hospice care.

Getting More Information

Before you choose the type of long-term care you need, you may want to get more information to help you make the best choice. Some free booklets can be ordered, and some information is available on the web. If you don't have a computer, your local library or senior center may be able to help you find the information on their computer.

For more information on long-term care choices:
•	Look at www.medicare.gov on the web. Select "Publications” to look at or print a copy of the booklet, "Choosing Long-Term Care" (CMS Pub.No.02223).You can also order a free copy by calling 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048. This booklet explains the long-term care choices listed in this section in more detail. It also tells you how to get more information and help with your questions.
For more information on nursing homes:
•	You can get a copy of A Consumer's Guide to Nursing Facilities. This guide has information on the various types of long-term care facilities, how to choose the proper level of care, and what to look for in a long-term care insurance policy. To order your free copy, call 1-800-628-8140 or, write to the American Health Care Association, 1201 L Street NW, Washington, DC 20005. Or, look at www.longtermcareliving.com or www.ahca.org on the web. Select “Consumer Information.”
•	You can get information from the American Association of Homes and Services for the Aging (AAHSA) by calling 1-800-508-9442 or looking at www.aahsa.org on the web. Select “Consumers.” Or, write to AAHSA at 2519 Connecticut Ave., NW, Washington, DC 20008.

There are steps you can take to find the nursing home that is best for you.

It's important to plan ahead. Planning ahead will help you make a nursing home choice that meets your needs and gives you good quality care. Finding the right nursing home is important because it may be your home for a short or long period of time. You want to be comfortable, secure, and cared for properly.

The steps to choosing a nursing home are:
1.	Find out about the nursing homes in your area (see below).
2.	Find out how nursing homes compare in quality.
3.	Visit the nursing homes you are interested in, or have someone visit for you.
4.	Choose the nursing home that best meets your needs.
Step 1: Find out about the nursing homes in your area.
To find out about the nursing homes in your area:
•	Look at www.medicare.gov on the web. Select “Nursing Home Compare.” You can find detailed information on nursing homes in your area.
•	Ask the hospital's discharge planner or social worker for a list of local nursing homes, if you are in the hospital. They may help you find an available bed. Some nursing homes work together with hospitals, and some are independent.
•	Visit or call your local social service agency or hospital. Ask to speak to a social worker or case manager who can help you find a nursing home in your area.
•	Ask people you trust, like your doctor, family, friends, neighbors, or clergy if they have had personal experience with nursing homes. They may be able to give you the name of a nursing home where they had a good experience.
•	Call your Area Agency on Aging. Their telephone number should be listed in your local telephone directory. This agency can give you information about the nursing homes in your area. You can get the telephone number of your local Area Agency on Aging by looking at www.aoa.gov on the web. Select “About AoA and the Aging Network.” Then select “Area Agencies on Aging.”
•	Call the Eldercare Locator at 1-800-677-1116 (weekdays 9:00 a.m. to 8:00 p.m. Eastern time) for information about nursing homes in your area.
Step 2: Find out how nursing homes compare in quality.
Quality care means doing the right thing, at the right time, in the right way for the right person, and having the best possible results. Nursing homes are certified to make sure they meet certain Federal health and safety requirements. To find out how nursing homes compare in quality in your area, look at www.medicare.gov on the web. Select “Nursing Home Compare.” You can compare the State inspection reports of the nursing homes in your area and look at other information, like resident characteristics and staffing levels. As of spring 2002, for each nursing home in the states of Maryland, Ohio, Colorado, Rhode Island, Washington, and Florida, you can see quality information on “Nursing Home Compare,” including:
•	The Percentage of Residents Who Need More Help Doing Daily Activities than when their need for help was last assessed, like; 1) feeding oneself, 2) moving from one chair to another, 3) changing positions while in bed, and 4) going to the bathroom alone.
•	The Percentage of Residents with Pressure (Bed)Sores. These are usually caused by constant pressure such as lying or sitting in one position for a very long time.
•	The Percentage of Residents Who Lost Too Much Weight, which might be unhealthy.
•	The Percentage of Residents with Pain. This is very bad pain that happens everyday, over the last 7 days, and is very bad or moderate.
•	The Percentage of Residents with Infections. These include pneumonia, wound infections, urinary tract or a bladder infection.
•	The Percentage of Residents in Physical Restraints. Physical restraints are any device that keeps a resident from moving freely, like ankle restraints, special types of vests, or chairs with lap trays.
•	The Percentage of Short-Stay Residents (residents who stay for less than 90 days) Who Improved in Walking. Short-stay residents are in the nursing home less than 90 days.Improvement in walking is an increase in a resident ’ s ability to walk with little or no help at all.
•	*The Percentage of Short-Stay Residents with Pain.*
•	The Percentage of Short-Stay Residents with Delirium, which is a mix of short-term problems with focusing or shifting attention, being confused and not being aware of one's surroundings. These symptoms may appear suddenly and can be reversible. (Note that delirium is not “senility,” which is more about learning and memory problems.)
Other ways to find out about nursing home quality:
•	Ask friends and other people you know if they are or were satisfied with the quality of care.
•	Call the local office of consumer affairs for your state. Ask if they have information on the quality of nursing homes (look in the blue pages of your telephone book for their telephone number).
•	Call your State health department. Ask if they have information on the quality of nursing homes (look in the blue pages of your telephone book for their telephone number).
•	Call your Long-Term Care Ombudsman. The Ombudsman program helps residents of nursing homes solve problems by acting on their behalf. Ombudsmen visit nursing homes and speak with residents throughout the year to make sure residents' rights are protected. They are a very good source of general information about nursing homes and can work to solve problems with your nursing home care, including financial issues. They may be able to help you compare the nursing home's strengths and weaknesses. Ask them questions like how many complaints they have gotten about a nursing home, what kind of complaints they were, and if the problems were resolved.
Step 3: Visit the nursing homes you are interested in, or have someone visit for you.
•	Before you make a decision about the nursing home, visit the nursing homes you are interested in. A visit gives you the chance to see the residents, staff, and facility. It also allows you to talk with nursing home staff, with the people who live and get care at the nursing home and their family members. Be sure to call the nursing home office and make an appointment to tour the nursing home before you visit. If you can't visit the nursing home yourself, you may want to get a family member or friend to visit for you. If a family member or friend can't visit for you, you can call for information. However, a visit gives you a better way to see the quality of care and life the residents get.
Listed below are some tips to help you get ready for your visit:
1.	Get Information, see below.
2.	Visit the Nursing Home.
3.	Ask Questions.
Get Information
*Call About Services:*
•	What services does the nursing home provide?
*Call About Fees:*
•	Do they charge a basic fee for room, meals, and personal care?
•	Do they charge extra for other services or care for special medical needs?
*See the Inspection Report:*
•	Get a copy of the nursing home inspection report from “Nursing Home Compare” at www.medicare.gov on the web. The inspection report tells you how well the nursing home meets Federal health and safety requirements.
•	The nursing home must have the results of the most recent survey of the facility done by Federal or State surveyors available for you to look at.
Visit the Nursing Home
	*Review Information:*
•	Before your visit, go over any information you have already gathered.
	*Take a Formal Tour:*
•	Make an appointment with the nursing home before you visit.
•	Take a formal tour with a nursing home staff member.
•	Ask questions during your tour, including questions about the quality measures from “Nursing Home Compare,” at www.medicare.gov on the web.
•	Look around to get a better picture of the services, activities, and quality of care and life for the residents.
	*Visit Again:*
•	Revisit the nursing home a second time, on a different day and at a different time of the day than when you first visited. Staffing can be different at different times of the day, and on weekends.
•	Try to visit during the late morning or midday. This allows you to see the residents when they are out of bed, eating, and going to activities.
	*Go to Council Meetings:*
•	Ask a nursing home staff member if you can get permission from the resident's or family council's participants to attend a meeting of the nursing home's resident council and/or family council meeting. These councils are usually organized and managed by the resident's families to improve the quality of care and life for the residents and address concerns.
Ask Questions
	*Use the Nursing Home Checklist:*
	Ask questions from the Nursing Home Checklist below. The Nursing Home Checklist can help you to know what to look for and what questions to ask so you can compare nursing homes. This checklist has questions about basic information, resident appearance, nursing home living spaces, staff, residents' rooms, hallways, stairs, lounges, bathrooms, menus and food, activities, and safety and care. For example:
	Is the nursing home certified by Medicare and Medicaid?
	Is there a bed available? (Is there a waiting list?)
	Is the nursing home easy to visit for family and friends?
	Ask to see a copy of the nursing home's most recent inspection report. If any deficiencies were found, ask if they have been corrected and ask to see the plan correction.
	*Ask about Satisfaction:*
•	Talk to staff, residents, and family members if you can. Ask them if they are satisfied with the nursing home and its services.
	*Other Questions:*
•	Write down any questions you still have about the nursing home or how the nursing home will meet your needs.
•	Ask the staff about the quality information from “Nursing Home Compare,” at www.medicare.gov on the web. This may help you compare nursing homes.
•	Ask the staff to explain anything you see and hear that you don't understand. For example, a person may be calling out. It may be because they are confused, not because they are being hurt or neglected. Don't be afraid to ask questions.
	Don't go into resident rooms or care areas without checking with the resident and nursing home staff first. Residents have a right to privacy.

This checklist can help you look at and compare the nursing homes that you visit. Look at the checklist before you go on your nursing home visit or tour. This will give you an idea about the kinds of questions to ask and what you should look for as you tour the facility and see the staff and the residents. Some of these questions may be more personally important to you and your family, and some are more important for finding out about the quality of care the residents get. Use a new checklist for each nursing home you visit. You can photocopy the checklist or print out additional copies from Nursing Home Compare at www.medicare.gov on the web.

Use your completed checklist with the quality information on www.medicare.gov at Nursing Home Compare on the web to help you compare the nursing homes you are interested in.

Nursing Home Compare at www.medicare.gov on the web includes information such as:

•	The number of beds at the facility, and how many are being used (occupied).
•	The number of staff working at the facility.
•	Information about the residents (a profile).
•	Nursing home inspection summary results.

If you don't have a computer, your local library or senior center may be able to help you find this information on their computer. Or, call 1-800-MEDICARE (1-800-633-4227) and a Customer Service Representative will read this information to you. TTY users should call 1-877-486-2048.

(For a printable version of this checklist, please visit www.medicare.gov and choose the "Nursing Home Compare" section)

Name of Nursing Home:_________________________ Date of Visit:______________	Yes	No	Comments
Basic Information
The nursing home is Medicare-certified.
The nursing home is Medicaid-certified.
The nursing home has the level of care needed (e.g. skilled, custodial), and a bed is available.
The nursing home has special services if needed in a separate unit (e.g. dementia, ventilator, or rehabilitation), and a bed is available.
The nursing home is located close enough for friends and family to visit.
Resident Appearance
Residents are clean, appropriately dressed for he season or time of day and well-groomed.
Nursing Home Living Spaces
The nursing home is free from overwhelming unpleasant odors.
The nursing home appears clean and well-kept.
The temperature in the nursing home is comfortable for residents.
The nursing home has good lighting.
Noise levels in the dining room and other common areas are comfortable.
Smoking is not allowed or may be restricted to certain areas of the nursing home.
Furnishings are sturdy, yet comfortable and attractive.

	Yes	No	Comments
Staff
The relationship between the staff and the residents appears to be warm, polite, and respectful.
All staff wear name tags.
Staff knock on the door before entering a resident’s room and refer to residents by name.
The nursing home offers a training and continuing education program for all staff.
The nursing home does background checks on all staff.
The guide on your tour knows the residents by name and is recognized by them.
There is a full-time Registered Nurse (RN) in the nursing home at all times, other than the Administrator or Director of Nursing.
The same team of nurses and Certified Nursing Assistants (CNAs) work with the same resident 4 to 5 days per week.
CNAs work with a reasonable number of residents.
CNAs are involved in care planning meetings.
There is a full-time social worker on staff.
There is a licensed doctor on staff. Is he or she there daily? Can he or she be reached at all times?
The nursing home’s management team has worked together for at least one year.

	Yes	No	Comments
Residents’ Rooms
Residents may have personal belongings and/or furniture in their rooms.
Each resident has storage space (closet and drawers) in his or her room.
Each resident has a window in his or her bedroom.
Residents have access to a personal telephone and television.
Residents have a choice of roommates.
Water pitchers can be reached by residents.
There are policies and procedures to protect resident’s possessions.
Hallways, Stairs, Lounges, and Bathrooms
Exits are clearly marked.
There are quiet areas where residents can visit with friends and family.
The nursing home has smoke detectors and sprinklers.
All common areas, resident rooms, and doorways are designed for wheelchair use.
There are handrails in the hallways and grab bars in the bathrooms.
Menus and Food
Residents have a choice of food items at each meal. (Ask if your favorite foods are served.)
Nutritious snacks are available upon request.
Staff help residents eat and drink at mealtimes if help is needed.

	Yes	No	Comments
Activities
Residents, including those who are unable to leave their rooms, may choose to take part in a variety of activities.
The nursing home has outdoor areas for resident use and staff help residents go outside.
The nursing home has an active volunteer program.
Safety and Care
The nursing home has an emergency evacuation plan and holds regular fire drills.
Residents get preventive care, like a yearly flu shot, to help keep them healthy.
Residents may still see their personal doctors.
The nursing home has an arrangement with a nearby hospital for emergencies.
Care plan meetings are held at times that are convenient for residents and family members to attend whenever possible.
The nursing home has corrected all deficiencies (failure to meet one or more Federal or State requirements) on its last state inspection report.

•	Insurance Information: Provide information about health care coverage and/or long-term care insurance you have that pays for nursing home and/or health care. This includes the name of the insurance company and the policy number.

•	Information on Your Medical History: Your doctor may give the staff some of this information. This includes a list of any current or past health problems, past surgeries or treatments you have had, allergies you have to food or medicine, and shots you've had.
•	Information on Your Current Health Status: Your doctor may give the staff some of this information. This includes a list of your current health problems, and any activities of daily living that might be difficult for you to do by yourself.
•	A List of Your Current Medicines: Include the dose, how often you take it, and why you take it.
•	A List of All Your Health Care Providers: Include names, addresses, and telephone numbers.
•	A List of Family Members to Call in Case of an Emergency: Include names, addresses, and telephone numbers.

Health Care Advance Directives

You may be asked if you have a health care advance directive: A health care advance directive is a written document that says how you want medical decisions to be made if you can’t make decisions for yourself. The two most commonly prepared health care advance directives are:

•

A Living Will is a written legal document that says what type of treatments you want or don't want in case you cannot speak for yourself. This document typically only comes into effect if you’re terminally ill (usually if you have six months or less to live) or permanently unconscious and cannot speak for yourself. A Living Will doesn’t let you name someone to make health care decisions for you.

•

A Durable Power of Attorney for Health Care is a legal document that names someone else to make health care decisions for you if you become unable to make your own decisions.

If you don't have a health care advance directive and need help preparing one, or need more information, talk to a social worker, discharge planner, your doctor, or the nursing home staff. You can call your local Area Agency on Aging to find out if your state has any legal services that help with preparing these forms. You will find the telephone number in the blue pages of your local telephone book.

Personal Needs Account

You may wish to open an account managed by the nursing home. You can deposit money into the account for personal use. Check with the nursing home to see how they manage these accounts. You may only have access to the account at certain times.

Nursing home care can be very expensive. Medicare generally does not cover nursing home care. There are many ways people can pay for nursing home care. For example, they can use their own money, may be able to get help from their state, or use long-term care insurance.

Nursing home care is not covered by many types of health insurance. Don't drop your health care coverage if you are in a nursing home. Even if it doesn't cover nursing home care, you will need health coverage for hospital or doctor services or supplies while you are in the nursing home.

Most people who enter nursing homes begin by paying for their care out of their own pocket. As they use up their resources over a period of time, they may eventually become eligible for Medicaid.

Remember, Medicare does cover skilled nursing care after a qualifying hospital stay. For more information on Medicare coverage of skilled nursing facility care, get a free copy of the booklet Medicare Coverage of Skilled Nursing Facility Care (CMS Pub.No.10053).

This section explains some of the ways you can pay for nursing home care, or get help with other health care costs. It includes information about:

	Personal Resources
	Help From Your State
	Medicaid
	Programs of All-inclusive Care for the Elderly
	Home and Community Based Waiver Programs
	Long--Term Care Insurance
	Medicare

Personal Resources

You can use your savings to pay for nursing home care. Some insurance companies let you use your life insurance policy to pay for long-term care. Ask your insurance agent how this works.

Another option for homeowners is a "reverse mortgage." It allows some people to use their home as a source of income without losing ownership. It is a type of loan. Talk to a lawyer or financial advisor about the benefits and risks of a reverse mortgage.

Important: Be sure to get help before using either of these options. There are important issues you need to understand.

Help From Your State

Medicaid
Medicaid is a joint Federal and State program that pays for certain health services and nursing home care for older people with low incomes and limited assets. If you qualify, you may be able to get help to pay for nursing home care, or other health care costs. If you qualify for both Medicare and Medicaid, most health care costs are covered. But remember, not all nursing homes accept Medicaid payment. Check with the nursing home to see if they accept Medicaid, and if they have a Medicaid bed available.

Who is eligible for Medicaid and what services are covered varies from State to State. Most often, eligibility is based on your income and personal resources. Sometimes you must reduce your personal resources before you qualify. Be sure to ask whether State law or nursing home policy will guarantee that are defined on you will be able to stay at that nursing home if your care is covered by Medicaid later. You may be moved to another room or another section of the nursing home when your care is paid by Medicaid.

To get more information on Medicaid eligibility requirements in your State, call your State Medical Assistance Office.

Some important things to know about Medicaid:

•	The State cannot put a lien on your home (to recover benefits correctly paid) while you are living in a nursing home if there is a reasonable chance you will return home after getting nursing home care. Also, the State can't put a lien on your home (to recover benefits correctly paid) if you have a spouse or dependents living there.
•	Most people who get Medicaid have to reduce their assets first. There are rules about what is counted as an asset and what isn ’ t when determining Medicaid eligibility. There are also rules that mandate States to allow married couples separated because one of them is in an institution (like a nursing home) to protect a certain amount of assets and income for the spouse who isn’t in an institution. A spouse may keep one half of the couple's joint assets, up to $89,280 (as of 2002) as well as a monthly income allowance. For more information, call your State Medical Assistance Office. Or, you can call your local Area Agency on Aging to find out if your State has any legal services that would help provide you with more information. You can also get free counseling from your State Health Insurance Assistance Program.
•	You cannot give your assets away to family members or non-family members, rather than use your assets to pay for your nursing home care. If you give assets away within three years before the date you apply for Medicaid or after you apply, the assets given away will be counted as assets that should be used to pay for your nursing home care. Giving away assets can delay when you become eligible for Medicaid. There are some exceptions to this especially if you have a spouse, or a blind or disabled child.
•	After a person who gets Medicaid nursing home benefits dies, in most cases the State must try to get whatever benefits it paid for that person back from their estate. However, they cannot recover this until after the person’s spouse dies, or as long as there is a blind or disabled child or child under the age of 21 in the family.

Note: Federal law protects spouses of nursing home residents from losing all of their income and assets to pay for nursing home care for their spouse. When one member of a couple enters a nursing home and applies for Medicaid, his or her eligibility is determined under what are called the “spousal impoverishment” rules. “Spousal impoverishment” helps make sure that the spouse still at home will have the money needed to pay for living expenses by protecting a certain amount of the couple’s resources, as well as at least a portion of the nursing home resident’s income, for the use of the spouse who is still at home. For more information about this protection, call your State Medical Assistance Office.

To apply for Medicaid, call your State Medical Assistance Office. They can tell you if you qualify for the Medicaid nursing home benefit, or other programs, such as the Programs of All-inclusive Care for the Elderly (PACE), or home and community based waiver programs.

Programs of All-inclusive Care for the Elderly (PACE)
PACE combines medical, social, and long-term care services for frail people. PACE is available only in states that have chosen to offer it under Medicaid. The goal of PACE is to help people stay independent and living in their community as long as possible, while getting the high quality care they need.

To be eligible for PACE, you must be age 55 or older, live in the service area of a PACE program, be certified as eligible for nursing home care by the appropriate State agency, and be able to live safely in the community.

To find out if there is a PACE program in your area, call the State Medical Assistance Office. Or, you can look at www.medicare.gov/nursing/alternatives/pace.asp on the web.

Home and Community Based Waiver Programs
If you are already eligible (or close to being eligible) for Medicaid, you may be able to get help with the costs of some home and community based services. States have home and community based waiver programs to help people keep their independence, while getting the care they need outside of an inpatient facility. You can call the Area Agency on Aging.

You can get the telephone number of your local Area Agency on Aging by looking at www.aoa.gov on the web. Select “About AOA and the Aging Network.” Then select “Area Agencies on Aging.” You can also call the Eldercare Locator at 1-800-677-1116 (weekdays 9:00 a.m. to 8:00 p.m. Eastern time) for your local Area Agency on Aging telephone number. Or, call your State Medical Assistance Office. Both can help with your Medicaid questions, or give you information about other programs to help pay for the costs of nursing home care or community and home services.

Long-Term Care Insurance
This type of private insurance policy can help pay for many types of long-term care, including both skilled and non-skilled care. Long-term care insurance can vary widely.

Some policies may cover only nursing home care. Others may include coverage for a whole range of services like care in an adult day care center, assisted living, medical equipment, and informal home care.

If you have long-term care insurance, check your policy or call the insurance company to find out if the care you need is covered. If you are shopping for long-term care insurance, find out which types of long-term care services and facilities the different policies cover.

Also, check to see if your coverage could be limited because of a pre-existing condition. Make sure you buy from a reliable company that is licensed in your State. For more information about long-term care insurance, get a copy of A Shopper's Guide to Long-Term Care Insurance from the National Association of Insurance Commissioners, 2301 McGee Street, Suite 800, Kansas City, MO 64108-3600.

By fall 2002, there was a chance for Federal employees, members of the Uniformed Services, retirees, their spouses, and other qualified relatives to buy long-term care insurance at discounted group rates. For more information about long-term care insurance for Federal employees, look at www.opm.gov/insure/ltc on the web.

Medicare
Medicare is a health insurance program for:

	People age 65 or older.
	Some people with disabilities under age 65.
	People with End-Stage Renal Disease (ESRD) (permanent kidney failure requiring dialysis or a kidney transplant).
You can get your Medicare health care in two ways:
*1. The Original Medicare Plan*
	The Original Medicare Plan does not pay for most nursing home care. Most nursing home care is custodial care to help with activities of daily living like bathing, dressing, and using the bathroom. Medicare covers very limited and medically- necessary skilled care or home health care if you need skilled care for an illness or injury and you meet certain conditions. For more information on Medicare coverage of skilled nursing facility care or home health care, look at www.medicare.gov on the web. Select “Publications” to look at or print a copy of the booklet Medicare Coverage of Skilled Nursing Facility Care (CMS Pub.No.10153) or Medicare and Home Health Care (CMS Pub.No.10969). You can also order a free copy by calling 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.
*2. Other Medicare Health Plans*
	If you belong to a Medicare managed care plan or Medicare Private-Fee-for-Service plan, check with your plan to see if it covers nursing home care. Usually, plans do not help pay for this care unless the nursing home has a contract with the plan. Ask the health plan about nursing home coverage before you make any arrangements. If the nursing home has a contract with your health plan, ask the health plan if they check the home for quality of care.

Adjusting to Your New Home

New nursing home residents sometimes have difficulty adjusting to their new environment, even if the nursing home is giving good care. Adjusting to the nursing home can be made easier with support and visits from family and friends. Here are some tips to help you become comfortable with your new home, whether you are there for a short or long period of time.

•	Bring some of your special personal belongings, like photographs or a favorite bedspread to make your room feel more familiar. Check with the staff first to see what you can bring.
•	Take part in the activities offered at the nursing home. It is a great way to meet new friends and become a part of your new community.
•	Continue your subscriptions to magazines or newspapers to help you keep in touch with your outside interests.
*Reporting and Resolving Problems*
If you have a problem at the nursing home, talk to the staff involved. For example, if you have a problem with your care, talk to the nurse or Certified Nurse Assistant (CNA). The staff may not know there is a problem unless you tell them. If the problem is not resolved, ask to talk with the supervisor, the social worker, the Director of Nursing, or your doctor. The facility must have a grievance procedure for complaints. If your problem is not resolved, follow the facility's grievance procedure. You may also want to bring the problem to the resident or family council. The nursing home must post the name, address, and telephone number of state advocacy groups, such as the State Survey and Certification Agency, the State Licensure Office, the State Ombudsman Program, the Protection and Advocacy Network, and the Medicaid Fraud Control Unit. If you feel you need outside help to resolve your problem, call the Long-Term Care Ombudsman or State Survey Agency for your area.
*Care Plans*
The nursing home staff will get your health information and review your health condition to prepare your care plan. You (if you are able) or your family with your permission, or someone acting on your behalf, have the right to take part in planning your care together with the nursing home staff. Your care plan is very important. A good care plan can help make sure that you are getting the care you need and help make your stay more pleasant. Health assessments (a review of your health condition) must be done within 14 days of admission. You should expect to get a health assessment at least every 90 days after your first review, and possibly more often if your medical status changes. The nursing home staff will assess your condition periodically to see if your health status has changed. They will adjust your care plan as needed. Depending on your needs, your care plan may include:
•	What kind of personal or health care services you need,
•	What type of staff should give you these services,
•	How often you need the services,
•	What kind of equipment or supplies you need (like a wheelchair or feeding tube),
•	What kind of diet you need (if you need a special one),
•	Your health goal (or goals), and
•	How your care plan will help you reach your goal.