Selecting a Nursing Home or Long-Term Care Facility

Please use the questions below as a guide in selecting a nursing home or another long-term care facility for you or a loved one. It's also a good idea to ask the home for a copy of its latest inspection and whether a volunteer ombudsman visits regularly. An ombudsman will advocate for your loved one and other residents. And remember, if you have a complaint about a home, or suspect an elderly or disabled person who lives there is being abused or neglected, call the Adult Abuse and Neglect Hotline, 1-800-392-0210.

Do all facilities provide the same services and care?
What questions should I ask to choose an appropriate facility?
What should I look for when signing a long-term care facility contract?
What happens if I run out of money?
What is the cost of facility care?
Do all facilities take Medicare and/or Medicaid reimbursement for care?
What are my rights as a long-term care facility resident?

Do all facilities provide the same services and care?

No, there are different levels of care provided. Missouri's long term care facilities provide different levels of care depending upon a person's needs. Click here to view the different levels of care.

What questions should I ask to choose an appropriate facility?

• Can the facility meet my or my loved one's needs?
• Does it have a current state license?
• Does it accept Medicare and/or Medicaid?
• What problems were identified during the last survey or inspection? (A copy of the home's last inspection should be posted or available in the home.)
• Are the residents treated with dignity?
• Is the home clean and odor free?
• Is there an ombudsman who visits regularly?
• Talk to residents and family members. What comments do they have?

Try to visit several homes or facilities, more than once if possible, and at different times. You'll be able to see how staff interacts with residents at meal times and during afternoon or evening hours.

For a more complete checklist, contact your local Area Agency on Aging or the Missouri Long-Term Care Ombudsman Program at 1-800-309-3282.

What should I look for when signing a long-term care facility contract?

Residents have rights secured by both state and federal laws (these rights are listed at the end of these questions). The admission agreement is also very important in defining a resident's rights and obligations.

Carefully read the admission agreement and ask questions when you don't understand something. The agreement must specify items and services included in the daily rate, and items and services not included.

It should also state how the facility handles emergency situations and when a resident may be transferred.

Each facility also has a "bed-hold policy" that specifies how residents can secure their bed, or a bed in the facility, if they have to go to the hospital.

The agreement must not require family members to be responsible for their loved one's bills if their loved ones receive Medicaid.

What happens if I run out of money?

Many people enter a skilled nursing or an intermediate care facility as private pay residents and turn to Medicaid when their money runs out. If the home is Medicaid-certified, it must continue to care for a resident who eventually requires Medicaid if a Medicaid bed is available. To ensure continued coverage, request a Medicaid-certified bed upon admission. If there is a suspected diagnosis of mental illness, mental retardation, or related disorder, a special screening process may be required.

Placement in a Medicaid bed allows a person to take advantage of the "division of assets" program. The program helps ensure residents' spouses who live in the community are not impoverished because of their loved one's facility bills. A person can apply for Medicaid at his or her local Division of Family Services office.

In some instances, residents are eligible for a cash grant to help cover the costs of their care. The grant, funded by Missouri tax dollars, is available to eligible low-income persons through application at their local Division of Family Services office.

What is the cost of facility care?

Nationwide, the cost is around is $64,000 per year for a skilled nursing home. The average cost in a residential care facility is around $24,000. When selecting a facility, find out which services are included in the basic daily charge and which are not covered. Ask whether a deposit is required and the procedure for return of the deposit. (Medicaid residents do not have to give a deposit).

Do all facilities accept Medicare and/or Medicaid reimbursement for care?

Many skilled nursing and intermediate care facilities accept Medicare and/or Medicaid reimbursement, but residential care facilities do not. However, residential care facility residents may be eligible for state assistance through the Supplemental Nursing Care grant. In addition residential care facilities may participate in the Medicaid Personal Care Program. The Personal Care Program offers Medicaid-eligible residents assistance with activities of daily living. This program provides residential care residents an alternative to nursing facility care.

What are my rights as a long-term care facility resident?

Missourians who live in a long-term care facility licensed by the state are guaranteed certain rights under the Missouri Omnibus Nursing Home Act of 1979 and the federal Omnibus Budget Reconciliation Act of 1987. The rights are:

• You will be informed (at the time of admission to the facility and periodically during your stay) orally and in writing of your rights and responsibilities as a resident.
• You will be informed of the services available and related charges, including protection of personal funds if held by the facility, and all services not covered in the facility's daily rate.
• You may purchase or rent goods or services not included in the facility rate from a provider of your choice.
• You will receive notice before room or roommate changes are made.
• You may examine results of facility inspections including plans of correction.
• You have the right to receive service with reasonable accommodation of your individual needs and preferences except when your health and safety or that of other residents would be endangered.
• You have the right to not have your life regulated beyond what is necessary in providing resident services.
• You have the right to retain your personal possessions as space permits.
• You have the right to be informed of all aspects of your care, to choose your own personal physician, to participate in planning your care and treatment, including any changes in care and treatment. You have the right to refuse treatment and to be informed of the consequences of such refusal.
• You shall be encouraged and assisted throughout your stay to exercise your rights. You have the right to voice complaints and recommend changes regarding personal care, behavior of other residents, conditions in the facility, or other unmet needs or expectations and to expect prompt efforts will be made to address complaints.
• You have a right to privacy for visits with your spouse and may share a room with your spouse if you are both residents and both agree to the cohabitation.
• You have the right to privacy and respect regarding accommodations, personal care, medical treatment, written and telephone communications and visits with other individuals.
• All information related to your medical, personal, social, or financial affairs will be kept confidential.
• You may be discharged or transferred only for medical reasons, for your own welfare or that of others, or for nonpayment. Pre-transfer and pre-discharge notices must be made at least 30 days in advance. Written notices must go to the resident, family member or legal representative or long-term care ombudsman if there is no family and include reasons for the action, the right to appeal and information on how to contact the State Long-Term Care Ombudsman. The facility must assist you in arranging other accommodations.
• You have the right to participate in resident councils and your family has the right to meet together in the facility with families of other residents.
• You may associate and communicate privately with persons of your choice. You may have free access to an ombudsman, your individual physician, or any representative of the state or federal government.
• You have the right to have appropriate activities for your participation and may engage in social, religious and community activities of your choice.
• You have the right to be free from physical or mental abuse, corporal punishment, involuntary seclusion and any physical or chemical restraints imposed for purposes of discipline or for convenience of the staff. Restraints may not be used except under the direction of a physician and only to treat your medical symptoms.