We usually think of nursing homes as the last stop for very sick, very frail people who need others to take care of them. Nursing homes do offer services for people who need this type of care, but they also offer sub-acute care, rehabilitation, respite care, and long term-care.

Nursing homes are administered by professionals under the supervision of a physician. They are regulated by state departments of health. Nursing home residents are represented by ombudsmen who make regular visits, advocate on behalf of residents, and follow up on complaints.

Choosing a nursing home isn’t a sign of failure. Sometimes your loved would be safer and more comfortable with expert care and professionals looking after him or her around the clock. Nursing homes welcome caregivers for visits with their loved ones. Many homes have special areas for private visits and offer ice cream or a special snack when children come to visit. If your loved one is well enough to go on “day trips” or just a movie in town, you can arrange to take him or her away from the nursing home for a period of time (be sure to check with your physician).  

Preparing for the Search

Involve your loved one and all family members in any decision to move him or her to a nursing home or another type of facility. Talk to your family doctor to find out what services, particularly health care and medication scheduling, are needed from any facility.

Ask around for recommendations on nursing homes. Your doctor, lawyer, clergyman, or next-door neighbor may all have experience with choosing nursing homes for their loved ones. You may also want to get a list from your local state health department and check the local area agency on aging (AAA).  Your AAA can also direct you to the nursing home ombudsman that services your area. You may also want to get a list from your local or state health department and check the Eldercare Locator at www.eldercare.gov.   

Involve Your Loved One in the Search

Take your loved one along when you make visits to prospective nursinghomes. If he isn’t well enough to travel, you can take photos and bring back brochures so you can review them together at home. Get a floor plan or give a detailed description of the room and other areas of the nursing home so your loved one is prepared for his new home. Remind your loved one that you will continue to visit.

In addition to the basic services, be sure to look for social and recreational opportunities. How well do staff interact with one another and with residents, and how well do they communicate with you?

Costs & Fees

Nursing homes are expensive; AARP estimates the cost to be about $50,000 a year per resident. Here’s how that breaks down: 

1. Daily rate: This includes services such as food, laundry, rent, housekeeping, and basic nursing services.  Amenities such as a phone or TV cost extra.
   
2. Basic nursing services: The definition of “basic nursing” varies from facility to facility. Sometimes rates will even vary within a chain. A good rule of thumb is that any service that requires individual time and attention will not be included in basic nursing services.  
   
3. Extra fees: Medication management, cost of medications, hand-feeding, glucose monitoring, and services such as physical therapy are considered supplemental. That means you’ll pay extra for these services. Be sure to get a breakdown of the specifics before you sign up.  

Estimating Costs

Have a detailed list of the services your loved one needs when you start researching facilities. Work with your physician to make a comprehensive list, and go over it several times to make sure you’ve covered every possible daily need. Keep in mind any “extra care” that may be required for a specific health condition. For example, if your loved one is diabetic, you will be charged for nurse time, glucose monitoring, insulin injection, and even the after-care bandaging.

Resident Assessment

Nursing homes are required to provide a written resident assessment that lists all the services the resident requires along with its fee. The assessment is a care-management tool but you can also use it to estimate the total costs of care. Review it with the nursing home representative to make sure you agree to all services and fees.

Paying for Nursing Home Care

At $50,000 a year (on average), it won’t take long to exhaust available funds.  Some residents have long-term-care insurance but most rely on federally financed programs such as Medicare and Medicaid. 

1. Medicare: Seniors over the age of 65 and younger people with chronic diseases are covered by Medicare. However, Medicare has strict requirements and limits on nursing home stays. Discuss the Medicare rules in your state with the nursing home representative. When Medicare benefits are exhausted, most nursing home residents turn to Medicaid to pay their bills.
   
2. Medicaid: About two-thirds of nursing home residents rely on Medicaid. Medicaid is the federal program designed to assist people over the age of 65, or those with low incomes or high medical expenses. Eligibility requirements vary from state to state but the recipient’s spouse is allowed to maintain assets. Enrollment processes also vary, but it usually takes a minimum of three months to get the application approved. Start to work on the Medicaid application as soon as it is indicated; the nursing home representative will help you.  

Your New Role as Caregiver

Choosing to move your loved one into a nursing home may be difficult for both of you. Prepare to spend the first day at the nursing home with your loved one, and be sure to visit often and send care packages (be sure to check with the facility and your loved one’s physician for appropriate gifts).

AARP reminds caregivers that your involvement doesn't end when a loved one enters a nursing home. The family simply takes on a new role making sure others are providing good care. 

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