Q. My mother has dementia and seems to be declining rapidly. Her needs are becoming more than my father and I, and a nurse’s aide, can handle at home. We’ve decided the time has come to consider nursing home care. All of the news stories I have read about long-term care facilities during the coronavirus pandemic make me worry about placing her in a nursing home at this time. What should we look for in a nursing home for it to be a safe place for my mother? Thanks for your help!
A. For the past four months, COVID-19 has been uprooting many areas of life. For families considering nursing home care for a loved one, it has become a valid concern. COVID-19 outbreaks in nursing homes are certainly a reason for worry, but does that mean you should stop looking into nursing homes altogether? Not necessarily.
People are understandably very concerned about how to provide long-term care for their loved ones that need it, or even for themselves. Fortunately, no matter what the concerns are, there are some things families can do to search for and find a safe nursing home for a loved one, even during a nationwide pandemic.
Actions to Take if You or Someone You Love Needs Nursing Home Care at This Time
More than 1.3 million people live in nursing homes nationwide, according to the Kaiser Family Foundation. And many more, similar to your mother, will need long-term care in the not so distant future. These are some suggestions for things you can do if a loved one needs nursing home care during the pandemic:
- Visit the CMS site: Nursing homes are licensed, regulated, and inspected by states and the U.S. Department of Health and Human Services’ Centers for Medicare and Medicaid Services (CMS). A visit to the CMS website page on nursing homes is a good place to begin.
- Access the Nursing Home Compare tool to find a list of local nursing homes. Nursing Home Compare gives facilities individual ratings on health inspections, staffing and quality measures, as well as an overall rating, using a 5-star rating system. The star ratings are no guarantee of quality, but are a useful research tool. Not surprisingly, CMS Administrator Seema Verna says her agency has found that nursing homes with one-star ratings have generally had more cases of the coronavirus than ones with four or five stars. The Nursing Home Compare site has one notable limitation, though — it doesn’t tell you whether any staff has been infected with the coronavirus. So, you will need to dig deeper and take actions such as talking to nursing home administrators and asking pointed questions.
- Get connected to your local ombudsman program, which can often connect you to support groups and resources. The federal government mandates states have these programs and you can look up yours here.
- Gather information on the facility’s coronavirus plans and any cases they’ve had. Not all states are releasing names of nursing homes with cases. You can find out how many coronavirus cases a nursing home has reported by going to CMS’s COVID-19 Nursing Home Data site. There, you enter the name of a nursing home to track the number of new admissions previously treated for the virus. You can also find the total number of residents who’ve either tested positive for COVID-19 or have been treated for it. CMS updates these numbers regularly.
Ask the Right Questions When Considering Nursing Home Facilities During the Pandemic
The following are topics to guide you in making a decision about a nursing home during the coronavirus pandemic:
- Find out the level of personal protection equipment (PPE) they have and how it’s being used. CMS data shows that many states still have numerous nursing homes without enough N95 masks, surgical masks, and gowns.
- Inquire about their testing regime.
- Ask about their staffing levels.
- Find out if any staffer has been treated for the virus and how often staffers are being tested for it.
- Ask what kind of infection-control procedures the nursing home has for residents.
- Ask if new admissions are being isolated. Do residents receive therapy in their rooms?
- Ask if patients receive healthcare visits through telehealth or in their rooms.
- Find out if visitors are allowed and, if so, what safety protocols are in place.
- Find out if the nursing home you’re considering provides cell phones to let residents talk to family members. Also, does it provide laptops or tablets, allowing them to FaceTime, Zoom, or Skype with loved ones?
- Find out if the nursing home is offering virtual tours. If you can’t tour the actual nursing home, taking a virtual tour gives you a chance to see the size of resident rooms; how social distancing is being practiced and how clean the overall facility appears (bearing in mind that the nursing home is choosing what you can see).
How is the Nursing Home Countering Isolation?
Measures to help residents avoid getting COVID-19 are essential. But so are strategies to help counter isolation. Find out if the nursing home is:
- Re-introducing activities that allow distancing (such as book clubs, art classes, or bingo).
- Encouraging outdoor activities, including ones that used to be held indoors (such as art or music classes).
- Enabling frequent video or telephone contact with family, which staff may be helpful in setting up. Some nursing homes purchased iPads for residents to allow them to have virtual visits, take virtual walks, or watch a movie with family.
- Allowing “window visits” from family and friends and enabling them to bring in favorite meals if allowed.
- Establishing small groups of residents who have quarantined and can socialize.
Planning to Pay for Long-Term Care
When you look at potential nursing homes, you will notice they all have one thing in common—the outrageously high costs. In fact, according to the 2019 Genworth Cost of Care Survey, the cost of nursing home care in our area is around $12,000- $14,000 a month. With long-term care services being so costly, how can anyone afford them without going broke or depleting their assets?
Medicare will pay for short-term rehabilitation that takes place in a nursing care or rehab center following a three-day hospital inpatient stay. But, otherwise, Medicare does not pay for long-term care!
Medicaid, on the other hand, is the single largest payor of nursing home care costs because so many people can’t afford to cover the costs themselves. However, Medicaid eligibility is the most complex area of law in existence, and has complex income and asset and functional capacity requirements, making it extremely difficult to qualify, so the help of an experienced elder law attorney, such as myself, is absolutely essential.
Planning for Long-term Care
When it comes to planning for long-term care, Medicaid Asset Protection Planning can be started while your loved one is still able to make legal and financial decisions, or can be initiated by an adult child acting as agent under a properly-drafted Power of Attorney, even if your loved one is already in a nursing home or receiving other long-term care. In fact, the majority of our Lifecare Planning and Medicaid Asset Protection Planning clients come to us when nursing home care is already in place or is imminent.
Generally, the earlier someone plans for long-term care needs, the better. But, fortunately, it is never too late to begin your planning. To afford the catastrophic costs of long-term care without depleting all of your loved one’s hard-earned assets, your mother should begin her Long-Term Care Planning as soon as possible. You should also do Incapacity Planning and Estate Planning, if you haven’t done so already. Please call us to make an appointment for an initial consultation:
Elder Care Fairfax: 703-691-1888
Elder Care Fredericksburg: 540-479-1435
Elder Care Rockville: 301-519-8041
Elder Care DC: 202-587-2797
About Evan H Farr, CELA, CAP
