How do you determine if a client is eligible for a nursing home?
We examine an elder's medical records, any information available from community
agencies such as visiting nurses or Adult Day Health programs, any information that
our agency may have regarding the elder's status and the results of any assessment
visits for elders who require one. We look at medical needs, risk of injury or illness,
level of the elder's need for care and compare that to the services available in the
community. Eligibility for nursing home is then based on guidelines and regulations
established by the Division of Medical Assistance, otherwise known as MassHealth (or
What is a nursing home or nursing facility?
These facilities provide 24 hour nursing care, rehabilitation care including physical,
occupational, and speech therapy, assistance with personal care tasks, toileting program,
eating, transfers and mobility. Many facilities also offer specialized services for
clients with middle to late stage Alzheimer's disease. Some have respite programs
that provide short-term care for an elder so that caregivers can have a few days away
from their daily routine.
How is a nursing home paid for?
Many insurance plans, including Medicare, provide nursing facility placement for
a short period of time, usually after a set number of days is spent in an acute care
facility or hospital. Often the client is responsible for a co-payment depending on
the number of days they spend at the nursing facility. For clients who meet the income
eligibility guidelines and qualify for MassHealth or Medicaid, nursing home placement
may be covered for both long and short-term placement, once a nursing home screening
is completed. Social workers in nursing homes, hospitals, home care agencies, and
Aging Service Access Points such as Elder Services of Worcester Area, often assist
in completing the Mass Health application process. Private long-term care insurance
may also cover nursing facility placement depending on the policy.
What is a nursing home screening?
A nursing home screening must be completed for all candidates who are both over
22 years of age and Medicaid recipients, prior to admission to a nursing facility.
This is a screening that involves an Elder Services of Worcester Area nurse, the client,
family members, and doctor. In cases of mental retardation or long standing mental
illness, an additional screening from the appropriate state agency may be required
for approval to take place. During the screening process, our nurses will make referrals
for additional screenings once the client's diagnosis has been confirmed. Please refer
to the Our Nursing Department
section and see How to Request a Nursing Home Screening.
How do I find a good nursing home?
Some basic steps to follow in deciding upon a facility are:
- Discuss needs and services available, particularly with the doctor.
- Decide on a location, taking into consideration who will be visiting the resident
most often and communities nearest those persons.
- Identify facilities in that area that have services that the resident will require.
- Ask if the elder's doctor will be following the elder at a certain facility.
- Visit, observe and ask questions. Contact the admissions department of each facility
to schedule a tour and ask about waiting lists, bed availability, and services.
- Talk to staff, other residents, and especially the family members who visit them.
- Narrow your choices, revisit and check state survey performances. The best web
site for this is the Massachusetts
Department of Health and Human Services and simply enter the town in which you
are searching, or the name of the facility. For additional information you can contact
Elder Services of Worcester Area at 508 756-1545 or complete
an inquiry form.
What can I do if I have a complaint or a concern about a Nursing Home?
Ombudsman Programs are available to address concerns or problems that arise during
an elder’s placement. For more information on the Nursing Home Ombudsman Program
call our office at 508-756-1545.