Skilled Nursing Facilities
In order to begin selecting a facility, you first need to consider what level of care the resident requires and how you are going to pay for this care. To help you determine what level of care is required you can contact your physician or a social worker/discharge planner if the prospective resident is now hospitalized. All persons interesting in entering a facility must have a physician’s written statement stating they require this level of care.
Definitions of "Level of Care"
SKILLED NURSING FACILITIES (SNF) are licensed to provide twenty-four hour nursing care. Skilled nursing facilities are required to provide medical, rehabilitative and personal care.SKILLED NURSING FACILITIES - DISTINCT PART (SNF-DP) are skilled nursing facilities, which are a distinct part of an acute care hospital. In general, persons are admitted to these units from the acute care units of hospitals.
SKILLED NURSING FACILITIES-SPECIAL TREATMENT PROGRAM (SNF-STP) are skilled nursing facilities with a special treatment program such as providing treatment to the mentally ill.
INTERMEDIATE CARE FACILITIES (ICF) are very similar to skilled nursing facilities but their license only requires them to provide eight hours of licensed nursing care each day. They must offer medical, intermittent nursing, dietary, pharmacy and activity services.
Note that a facility needs to be certified for either/both Medicare/MediCal if the prospective resident plans to use these programs to pay for care immediately or in the future.
We make every effort to keep our information current. However, changes are made without our knowledge, so please be sure to call the facility for the most up-to-date information.
The following are some very simple guidelines, which may be followed as you go about choosing a facility. In addition, a checklist is included to assist you in your selection.
- Know
the level of care you need. Skilled nursing homes provide 24 hours
of skilled care while residential care facilities for the elderly
provide supervision and assistance with personal care, such as
bathing and dressing. The level of care is determined by the
physician.
- Will the nursing home or the residential care home be a permanent placement or used for a short time stay only?
- Understand your financial situation and your ability (or the resident’s ability) to pay for care. Will you be paying for care through private pay, Medicare, private insurance policy or MediCal?
- List the medical needs of the resident.
- List the personal needs of the resident: large facility or small home-like facility, religious and social activities needed.
- List the positive attributes of the resident so that you may provide the administrator with a complete profile of the resident.
- Visit several facilities at different times of the day and let your instincts guide you. Could you live there? Use our checklist.
Admission Agreements
Both skilled nursing and intermediate care facilities are required to make a copy of their admission agreement readily available to any potential resident and/or their family member.Upon admission, each facility should make a reasonable effort to communicate the entire content of the contract (the admission agreement) to the resident and/or their family member and obtain the signature of the person being admitted. In case the resident is unable to sign the contract, the reason should be documented in the medical record by the admitting physician.
The practice of requiring a responsible party is no longer allowed under federal law, whether you are a private-pay resident or already on MediCal when you enter. It is illegal for any facility that participates in MediCal or Medicare to require a resident to have a personally liable responsible party. Federal law (OBRA) prohibits nursing homes from requiring a third party to guarantee payment as a condition of admission or continued stay.
An agent is the person who manages, uses or controls the resident’s funds or assets. The facility may require a resident’s authorized representative or agent to agree to apply the resident’s money to the nursing home charges.
The facility may ask for a security deposit only from private pay residents. The security deposit shall be returned to the resident if and when he/she converts to MediCal.
NO FACILITY MAY REQUIRE A PROSPECTIVE RESIDENT OR HIS/HER FAMILY TO PAY PRIVATELY FOR ANY SPECIFIC PERIOD OF TIME BEFORE CONVERTING TO MEDICAL.
The contract must inform residents at admission and throughout their stay of the services and supplies included in the basic rate. The contract must also inform residents of optional services and the charges for those services.
A facility cannot claim that they are not responsible when the resident has suffered a loss or an injury due to the facility’s negligence (failure to use adequate care). NOTE: Facilities are not responsible for clothing and valuable items that are not listed on the inventory list. The inventory list must be constantly updated as items are brought into or removed from the facility.
Each resident has rights stated under the Federal and California Nursing Home Regulations. A list of these rights must accompany the admission agreement. Familiarize yourself with Resident Rights. They are the lifeline of the resident.
READ AND RE-READ THE ADMISSION AGREEMENT TO AVOID FUTURE PROBLEMS. BE SURE ALL YOUR QUESTIONS ARE ANSWERED.
DIETARY - Are fresh fruits and vegetables used in season?
OTHER - Is the mandatory Ombudsman poster displayed where residents and visitors can easily read it?
Is linen (sheets, blankets, patient gowns, etc.) in good condition?
How is the Personal Needs Allowance made available to patients?
Are administrative personnel available to discuss and resolve concern/problems/ complaints?
THEFT AND LOSS - The loss of personal property is a prevalent problem for the residents and relatives of persons in long term care facilities. Taking precautions to prevent loss or theft of personal property is a shared obligation of the resident, the resident’s family, the administration of the facility, the facility staff and the Ombudsman program. Following are some suggestions for the security and the retention of personal property while in long term care.
In selecting a facility, you may review the facility’s records for a history of theft and loss. Each facility is required to have a theft and loss policy readily available.
It is best to mark or tag your items before admission. Marking clothing with sewn in tags is preferred or use indelible ink to withstand frequent washings. Be careful when marking clothing to be sure that the resident’s name does not show through when the item isbeing worn. This will help protect the dignity of the individual.
Retaining and the having the use of personal possessions is most helpful in making the transition to long term care placement. However, it is best to limit the number of personal belongings that are kept at the facility.
At the time of admission to a facility, an inventory will be prepared and copy given to the resident or responsible party. This inventory should be updated at least twice a year. Any time new items are brought into or taken out of the facility, they should be added to or deleted from the inventory list. Personal items that are frequently taken in and out of the facility (for example, laundry and clothing) do not need to be removed from the inventory list each time. The facility can assist you with hard to mark items such as eyeglasses, dentures and prosthetic devices. For items with great value, a detailed description should be included and it is advised that these items be formally appraised. NOTE: The facility is only responsible for those items on the inventory list and when reasonable efforts have not been made to safeguard resident property.
The facility must maintain a protected area for safekeeping of residents’ personal belongings. The facility must provide a lock for a resident’s bedside drawer or cabinet, if requested. This is at the expense of the resident.
Report any missing items to the facility staff immediately. If you are not satisfied with the response or results of the facility’s investigation, please contact the Ombudsman office to assist you.
Facility staff, residents and their families should all take responsibility for protection of personal property of long term care residents. Be observant and report any unusual activity to the facility administrator. Feel free to call the Ombudsman office if you have any questions or problems regarding theft and loss.
