Family & Caregiver Resources
Using Informed Decision Making to Determine Your Skilled Nursing Facility and Rehabilitation Care Provider
Deciding what type of care you or a loved one needs is not easy. When skilled nursing and round-the-clock care is required, it’s important to make an informed decision about the right facility. Our family and caregiver resources will help you do just that.
You may be making a decision quickly based on a recent event such as surgery or a hospital stay that required additional care before you could go back home.
You may be seeing a loved one’s disease progress, like Alzheimer’s or a recent stroke. This can make it hard to do basic activities, like dressing or bathing. You may need to make a life transition.
Activities of Daily Living
Activities of daily living are activities that people do every day to take care of themselves. These activities include bathing or showering, dressing, getting in and out of bed or a chair, walking, using the toilet, and eating.
A person is deemed to have a limitation in an activity if they have difficulty performing it by themselves and without special equipment, or if they do not perform the activity at all because of health problems.
It is important to define how much help you or a loved one needs with activities of daily living, to ensure you receive the appropriate level of care. This can be done through a variety of resources, including the ADL checklist. This will help to balance medical and financial options and make the best decision for you and your family.
DOWNLOAD THE ADL CHECKLIST
Make Sure Your Loved One Participates in the Transition to a Skilled Nursing Facility and the Selection of the Care Team
When you can, try to have your loved one involved in the decision-making process with you. Have them join you when you are visiting potential new residences and meeting the care team. Help them choose what items they would like in their room, such as photographs, special blankets, or other objects that will make them feel comfortable and at home.
Does My Loved One Need Assisted Living, Skilled Nursing and/or Rehabilitation?
There are several differences between skilled nursing facility care and assisted living care. It’s important to understand these differences so that you or your loved one can get the appropriate level of care. Examples include:
Important Questions when Considering a Skilled Nursing Facility and Rehabilitation Care
Have you received a medical assessment determining you or a loved one require skilled nursing facility care and/or rehabilitation services?
If you recently had a hospital stay or surgery requiring continued care before you are able to return home— you’ve more than likely received a medical assessment determining additional care is needed and you’re considering skilled nursing and rehabilitation services as the next step. However, if you’re considering a life transition for a loved one who is no longer able to live independently, a medical assessment by your family physician can help clarify your needs and determine if a skilled nursing facility is the right option (also referred to as long term care and nursing home).
Do you or a loved one require 24-hour supervision?
If care is required round the clock, it may be time to seek a medical assessment from your physician determining if skilled nursing care is appropriate. Some things to consider when determining a life transition to long term care include a loved one who:
- Needs assistance with most adult daily living tasks such as dressing, preparing meals and shopping safely, taking medications, bathing or has incontinence and there’s no one at home to help them.
- Needs assistance swallowing and nutrition is being compromised
- If they need supervision or a controlled environment to reduce falls— or they are at risk for wandering
Who pays for skilled nursing facility care (short & long term care)?
Insurance coverage for skilled nursing facility care can be complex. We are here to help alleviate the administrative burden for you and your family and have resources to help you navigate the payor landscape. Insurance plans that cover skilled nursing facility care vary and are plan specific.
Medicaid—A joint federal and state program that helps with medical costs for some people with limited incomes and resources. Medicaid programs vary from state to state, but most health care costs are covered if you qualify for both Medicare and Medicaid.
Original Medicare (or Federal Medicare)—Original Medicare is a fee-for-service health plan that has 2 parts: Part A (Hospital Insurance) and Part B (Medical Insurance). After you pay a deductible, Medicare pays its share of the Medicare-approved amount, and you pay your share (coinsurance and deductibles).
Medicare Part A (Hospital Insurance)—Part A covers inpatient hospital stays, care in a SNF, hospice care, and some home health care. Medicare Summary Notice (MSN)—A notice you get after the doctor, other health care provider, or supplier files a claim for Part A and Part B services in Original Medicare. It explains what the doctor, other health care provider, or supplier billed for, the Medicare-approved amount, how much Medicare paid, and what you must pay.
Medicare Advantage Plan (Part C)—A type of Medicare health plan offered by a private company that contracts with Medicare to provide you with all your Medicare Part A and Part B benefits.
Medicare Advantage Plans include Health Maintenance Organizations, Preferred Provider Organizations, Private Fee-for-Service Plans, Special Needs Plans, and Medicare Medical Savings Account Plans. If you’re enrolled in a Medicare Advantage Plan, most Medicare services are covered through the plan, and aren’t paid for under Original Medicare. Most Medicare Advantage Plans offer prescription drug coverage.
Medigap policy—Medicare Supplement Insurance sold by private insurance companies to fill “gaps” in Original Medicare coverage.
medicaiddoneright.com Medicaid Done Right wants to help residents and their families apply for Medicaid benefits. We use our experience and technology to make it easier for patients and families to focus on their well-being.
ncoa.org The National Council on Aging is a non-profit that helps older Americans get access to services, resources, and initiatives that improve their lives.
alz.org The Alzheimer’s Association was founded in 1980 by a group of family caregivers and people who recognized the need for a place where caregivers could come together and find support. This national resource also provides information about local chapters.
apdaparkinson.org The American Parkinson’s Disease Association (APDA) is a large group of people who are fighting PD. This disease affects about one million people in the United States. The APDA helps these people to have the best life possible, even though they have a chronic neurological disorder.
diabetes.org The American Diabetes Association (ADA) is a nonprofit that educates the public about diabetes and helps people affected by it by funding research to manage, cure, and prevent diabetes.
heart.org The American Heart Association has been around for a long time and is the biggest volunteer organization in the country that helps fight heart disease and stroke.
cancer.org The American Cancer Society is a nationwide, community-based organization that focuses on cancer prevention and helping people who have cancer.
cardinalhospicecare.com Hospice provides care to people who are very ill and may be nearing the end of their lives. The staff at Cardinal Hospice Care are highly skilled and compassionate, and they will work with you to provide care that is tailored to your individual needs. This includes medical care, support for psychological and spiritual needs, and help with bereavement after a loved one has passed away—Hospice helps.
neilmedical.com Neil Medical Group provides pharmacy services and medical supplies for residents in skilled nursing facilities and their care teams.
Take The Next Step
Visit Wilson Pines Nursing & Rehabilitation Center