Taking Stock: What Kind of Care Is Needed?
It is impossible to choose a nursing facility without first
determining the type of care your loved one needs. Not only will
that information assist you in finding a home that provides the
proper level of care, it will also be a major factor in determining
what, if any, government aid (Medicare or Medicaid) your care
recipient will be eligible for.
The three most common types of care are: custodial, intermediate
and skilled nursing. Custodial care means that residents need help
with personal activities such as dressing, bathing, and eating.
This type of care is essentially non-medical and is administered by
aides rather than trained medical personnel. Residents who need
rehabilitative therapy and medications in addition to personal
custodial care are candidates for intermediate care. Intermediate
care is delivered by licensed therapists as well as registered and
licensed practical nurses. When the level of disability is such
that the resident is not able to care for him or herself and may
even be bedridden, skilled nursing care is needed. It is
administered on the orders of an attending physician by licensed
medical personnel.
A good starting point for evaluating your care recipient’s
health status is the list of activities of daily living (ADLs)
which include bathing, dressing, eating, going to the toilet and
getting in or out of bed. An additional list, the instrumental
activities of daily living (IADLs) which include cooking, cleaning,
shopping, taking medicine and paying bills can also help give you
an overall picture of your loved one’s abilities. And of
course, consultation with the doctor, who will most likely have had
considerable experience in nursing home placements, can prove
invaluable.
Finances - What Can We Afford?
Nursing homes are expensive and your choice may well be dictated
by what financial resources are available. First, it is important
to realize that Medicare does not cover intermediate or custodial
care, the most common types of care needed. Even for skilled
nursing care, there are a number of conditions that apply before
Medicare will pay, and the coverage period is quite limited.
Medicare covers only 100 days in a skilled nursing facility; the
first 20 are fully paid but you must contribute a high co-payment
for the remaining 80 days. If your care recipient’s stay is
covered by Medicare, the facility you choose must be Medicare
approved.
