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Work Life

The Handbook of Elder Care Resources for the Federal Workplace

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Housing Options

Nursing Homes

Nursing homes are for people who need extensive and extended health or personal care. Many people live in nursing homes unnecessarily because they thought they had no other alternatives. Nursing homes are intended only for those who are seriously ill--not for people who feel they have no other options.

There are two levels of care:

Skilled Nursing--is for persons who need intensive care, 24 hour-a-day supervision, and treatment by a registered nurse under the direction of a physician.

Nursing Facility--is for persons who need 24 hour-a-day supervision under the direction of a registered nurse and a physician.

The level of care required is determined by a person`s physician. In addition, many States require and conduct pre-screening of potential nursing home residents to determine the level of care needed. Your parent`s local social service agency or the admissions person at any nursing home can direct you to the agency that makes this determination.

There are about 20,000 nursing homes in the United States, serving about 5 percent of the older population. The chances are about one in four that an individual will need to reside in a nursing home at some time in his or her life. The cost for staying for one year in a nursing home generally ranges between $20,000 and $48,000. Medicare and private medigap insurance plans reimburse very little of the cost. An extended stay in a nursing home can wipe out a family`s savings, so advance planning for this eventuality is critical. Only when a nursing home patient becomes impoverished, does Medicaid begin to pay the cost of nursing home care.

Before entering a nursing home, ask yourself:

  • Have you explored thoroughly with your parent the home and community-based options described in this book?
  • How will your parent meet the expenses?
  • How will your parent cope with the institutional atmosphere? The loss of independence?
  • Is the home convenient for visiting by family and friends?
  • Is the home clean and odor free?
  • Can the home ensure the security of your parent's possessions?
  • What levels of care are available? Are they appropriate to your parent's needs?


To help you in selecting the right nursing home for your parent, consider contacting the local ombudsman. The ombudsman program is a significant part of the nursing home system. Federal law requires each State Agency on Aging to have an Office of the Long-Term Care Ombudsman, and more than 500 local ombudsman programs now exist nationwide.

These offices provide help and information to older Americans, their families, and friends regarding long-term care facilities. The local ombudsman also can help to ensure that your parent receives good care throughout his or her stay. Keep in mind that the ombudsman cannot advise you on one particular nursing home, but will supply current information regarding nursing homes near you or your parent.

Ombudsman functions include:

Visiting nursing homes on a regular basis;

  • Receiving and investigating complaints made by or on behalf of nursing home residents and working to resolve the problems;
  • Referring un-resolvable problems or findings of serious violations of standards in a nursing home facility to State Health Departments for action; and
  • Providing information on licensed long-term care facilities in the State or local area including the number and nature of complaints against a facility, results and conclusions of the investigation into these complaints, and advice on what to look for as tell-tale signs of good care in facilities.

Refer to Resource and Referral Services for a list of State long-term care ombudsman offices.

Refer to Practical Tips for Elder Care for a list of helpful suggestions and a checklist that can be used when you visit nursing homes.

Nursing Home Telephone Interview

Once you identify what you want and need in a home, simply telephoning some of the nursing homes on your list may eliminate the need to visit them. Some of the key questions that you may ask over the phone to facilities are:

  • Is the nursing home certified for participation in the Medicare or Medicaid programs?
  • What are the facility`s admissions requirements for residents?
  • What is the "typical profile" of a resident in the facility? For example,Telephoneif a family member requires temporary rehabilitation services and the nursing home specializes in Alzheimer`s disease care, it`s probably not a good match.
  • Does the nursing home require that a resident sign over personal property or real estate in exchange for care?
  • Does the facility have vacancies, or is there a waiting list?

People To Talk To

  • Your family (or a trusted advisor) about their reactions to the plans your parent is making;
  • At least one person who lives in the type of facility your parent is contemplating;people talking
  • The Better Business Bureau and Consumer Protection Office in the area where the facility or service is located, to check on its reputation;
  • An attorney if your parent will be required to sign a contract; and
  • State and local Long-Term Care Ombudsman Programs that are set up to investigate complaints and mediate disputes between residents and/or their families and nursing home facilities. You can find them through your State Agency on Aging.

Housing and Nursing Home Resources

A number of resources are available that may be of help when considering housing options.

Write to AARP to obtain a free copy of the following publications. Include the title and publication number.

AARP Fulfillment
601 E Street, NW.
Washington, DC 20049

  • Staying at Home: A Guide to Long-Term Care and Housing -- Publication No. D14986
  • Tomorrow`s Choices: Preparing Now for Future Legal, Financial, and Health Care Decisions -- Publication No. D13479
  • Nursing Home Life: A Guide for Residents and Families -- Publication No. D13063

AARP Fact Sheets on Nursing Homes:

Title Publication No.
New Protections of Nursing Home Residents' Rights D13713
Encountering Problems in Nursing Homes D13714
Medicaid Discrimination and Consumer Rights D13715
The Nursing Home Regulatory System D13716
Long-Term Care Ombudsman Program D13717

Write to the American Association of Homes for the Aging to receive a copy of the following publications:

American Association of Homes for
the Aging (AAHA) Publications
901 E Street, NW., Suite 500
Washington, DC 20004-2037

  • Continuing Care Retirement Community: A Guidebook for Consumers
  • The Continuing Care Consumer Brochure: A Life Style Offering Security and Independence
  • Living Independently: Housing Choices for Older People (brochure)
  • Choosing a Nursing Home: A Guide to Quality Care (brochure) -- Publication No. CF015
  • The Nursing Home and You: Partners in Caring for a Relative with Alzheimer`s Disease

Write to Department of Health and Human Services at:

HHS - Centers for Medicare and Medicaid Services
6325 Security Boulevard
Baltimore, MD 21207

For a free copy of

  • Guide to Choosing a Nursing Home -- Publication No. HCFA-02174

With the exception of the Nursing Home Telephone Interview information, the housing alternative information was borrowed from two AARP publications, Tomorrow`s Choices and Nursing Home Life: A Guide For Residents and Families, and is reprinted here with permission from AARP.

NOTE: Under Federal Law, the U.S. Office of Personnel Management (OPM) is prohibited from ranking, endorsing, or promoting agencies or organizations listed on its website.

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