elder-helper

How do I know which homes will accept my relative? Do they and can they refuse an admission?

This is a common source of frustration for many people. You need to place a loved one into a nursing home, either for sub-acute
rehab with plans to discharge them back to their home when the therapy is finished or for them to live there long term. After
weighing your options and doing a little research, you narrow your choice down to one facility. You call the facility to arrange the
admission and are told, "I'm sorry but we aren't taking any new admissions at this time." Or they say, "We don't have any
available beds at this time." Notice they didn't say we don't have any empty beds but available beds. This is code for 'we either
don't want to admit this person or we are not able to.' Reasons for not wanting to admit this person are many…

1. They do not have sufficient funds
2. Their acuity level is too high
3. The family has a history of complaining and threatening law suits
4. The family claims the admission is for sub-acute rehab but the nursing home suspects they are really looking for long term care.
5. The hospital is just 'dumping' this resident because no other facility will take them

How you can solve this problem depends on what the admission is for. I will address the 3 most common reasons for nursing
home admissions - sub-acute rehab, long-term care and end of life comfort care (Hospice)

Sub-acute rehab - The typical scenario goes something like this. Your mom lives independently in her own home and manages
just fine. She is 82 years old, relatively healthy and participates in the Medicare program. One day she unfortunately slips and
falls at home and suffers a broken hip. She is hospitalized and has surgery to repair the hip. After about 4-5 days in the hospital,
the hospital discharge planner will speak to your mom and probably to the family regarding discharge from the hospital. The
physician along with the hospital staff will make recommendations. They will either recommend that your mom discharge back
home and receive 'home therapy' or 'outpatient therapy' or they will recommend she receive more intense 'sub-acute rehab' in a
rehab center or nursing home. The goal regardless of what option she chooses is for her to return to her base line of functioning
and live in her own home again, as she was prior to the fall. Let's say the physician recommends sub-acute rehab. This is usually
the easiest situation to place your mom. It is a slam dunk financially for the nursing home and most would be eager to take her. In
the event that the Nursing home you picked sounds hesitant to take her, remind them of these important facts.

1. She is relatively healthy with no debilitating conditions and is anticipated by her physician to make a quick and full recovery
2. She owns her own home and plans to discharge there asap
3. She fully understands the Medicare guidelines and knows that she must cooperate with therapy in order for Medicare to pay
for her stay
4. Both she and her family are motivated to see her recovery fully and will cooperate in all aspects of her stay.

It would be VERY difficult for a facility to argue against this! In this scenario, a nursing home would be crazy to turn her away.
The only logical reason would be if they were completely full with no planned discharges. If they are still hesitant, you do have the
option of placing her in a private, long-term care room and pay extra. You can offer this if the facility is 'dual certified', meaning
that any bed in the facility may be used for Medicare, not just one certain unit or section that might be full. A good facility can get
very creative when admitting a rehab resident if they want to. The trick is to sell yourself and don't give up. Even though the stay
may be short (3-6 weeks), the difference in the quality of homes can be enormous. Placing your mom in a poor quality home,
even for a few weeks, increases the risk of her obtaining an infection, falling and getting re-injured, being a victim of neglect
and/or abuse and delayed recovery.

Long-term care - This gets a little trickier. There are many factors that effect whether or not a facility will take this admission.
The #1 factor is cost. Is this person going to pay out of pocket or with Medicaid? If they are going to pay out of pocket (known
as 'private pay') convincing the facility to admit them is a little easier. The facility will usually require a financial disclosure form or
application to be filled out. Every facility is different but most require a minimum amount of assets before they will accept an
admission. This minimum can range from $40,000 to $300,000. The #1 question that the family or resident must ask if they are
being admitted under private pay is this. What happens if mom is admitted and in the future, her money runs out? This is critical!
Believe it or not, some facilities will say, "when the funds are exhausted they have 30 days to vacate." This sounds incredibly
cruel but it happens, a lot. Some facilities are all hand shakes and smiles while you still have the ability to pay, but in the fine print
of the contract you signed, it may state, "we do not accept Medicaid as payment at any time." In other words, if grandma is
broke, she gets evicted. Most facilities will allow the resident to stay and convert to Medicaid after their money runs out. If the
resident is accepted after filling out the financial disclosure, they get to live there for life if they choose, they will never be asked to
leave. It's also a good idea to ask if the facility has any kind of benevolence or charity fund. This is money that is donated to the
facility by churches or wealthy donors to assist residents with making their payments. When they no longer qualify for this, they
would then apply for Medicaid. Every state is different regarding Medicaid so you will need to consult an advisor in your
particular state. For more information, see my Medicaid page.

The #2 factor is acuity of the resident. This is defined as the resident's medical diagnoses, diseases and conditions, ability to care
for themselves, mood and behaviors and medication needs. The nursing home will look at the acuity level and ask themselves
several questions

1. Do we have staff qualified to care for this person?
2. Do we have enough staff if they require 2-3 people to care for them at one time?
3. How complex are their medications?
4. will this resident be a good fit for our facility?
5. ultimately, can we safely care for this person?

Sometimes just a medical diagnosis will cause a facility to say no to a potential admission. Some examples are: HIV, AIDS,
Alzheimer's, contagious infections, closed head injuries and cancer that is being treated. Conditions include combative behavior,
morbid obesity, tracheotomies, ventilators, renal dialysis, delusions and hallucinations, large wounds, fractures with traction and
specialty diets. Medications that the facility may say no to are TPN (total parentral nutrition), certain IV medications, expensive
chemo therapy drugs or expensive tube feeding formulas. The facility may have a case when it considers their ability to provide
quality care and to do it safely. If they can't do both, you don't want your loved one to stay there either.

End of life care or Hospice care - Questions of acuity become less of an issue now. Ability to pay is still a factor. The big
question now is bed availability. Some facilities have distinct areas for end of life care like private rooms, Hospice wings or
floors. Some facilities will simply place a resident in any bed in the facility. It is not necessary to have Hospice involved to receive
end of life care in a nursing home but I do recommend it. Some facilities have their own Hospice while others have an outside
Hospice service visit the resident in the nursing home. Hospice is a concept not a particular company or organization. There are
many different "Hospice" groups and not all are the same. Click this link to find a Hospice organization in your area.

The final last hurdle - Do they have an empty bed? Even if they do, is it the kind of room or unit that you are looking for? Things
you should consider. Do you want a private room, semi-private room or a ward? Do you require a bed with a window? Do you
require a room close to a Nurse's station or common area? If you are not looking for a private room, what are your preferences
in a roommate? Does your loved one stay up late at night? Do they prefer a roommate that is able to converse with them? Do
they need to be the same race? Don't be afraid to ask questions regarding the room location, the roommate, the number of
windows, closet space, etc.

Now that we got through the admission acceptance, you need to decide if this home is right for your loved one.

On to item 2 How do I research a facility's reputation? or return to How to choose a Nursing Home.