The Nursing Home Admission Process
Every day hundreds of people throughout Florida are admitted into a nursing home. Whether the nursing home admission comes after a hospital stay or following a family decision, it can unfortunately be an overwhelming process. We have written this guide to explain some key points of the admissions process and to help families be more informed when going through a difficult time.
Requirements for admission
To be admitted to a nursing home, you undergo a “Pre-Admission Screening and Resident Review” by a physician. This is an evaluation of your mental and physical condition to determine the most appropriate and least restrictive level of care you need. This screening is required by federal law, and must be done no matter how the nursing home stay is paid for, or how long you plan on staying.
How is a nursing home stay paid for?
A stay in a nursing home can be paid for in several ways.
Medicare will pay for a nursing home stay following a hospitalization of at least three days, as long as a physician certifies that it is necessary. Medicare has certain time limitations on how long of a stay it will pay for, depending on medical condition.
Medicaid determines who is eligible for its program through the Florida Department of Children and Families. Like Medicare, Medicaid requires certain findings be made by a doctor before it will pay for a nursing home stay.
Long Term Care Insurance
If you have long term care insurance, it will typically pay for nursing home stays up to a certain amount. Contact your insurance agent or company to learn more about the benefits you are entitled to.
Health insurance as well as the VA or TriCare will typically pay for nursing home stays. Each company has its own different requirements, so check with your health insurance representative.
If there is no health insurance available and you are not eligible for Medicare or Medicaid, you can always pay for the nursing home privately. Each nursing home has different rates per day.
For more information on financial resources, check out the Florida Agency for Health Care Administration’s page here.
Paperwork and admission agreements
On admission the nursing home staff will usually have you sign an admission agreement, and sometimes an “arbitration agreement.”
The admission agreement will lay out the services the nursing home is going to provide as well as how much the cost-per-day will be. If you do not understand something in the admission agreement, as the staff to clarify what it means. Make sure you understand what services will be provided as part of your stay.
Many nursing homes ask their residents to sign an “arbitration agreement” along with the admission agreement. Signing an arbitration agreement basically means that, should you want to file a lawsuit against the nursing home you would not be able to do so, but would be forced into binding arbitration. Florida law is clear that the nursing home cannot refuse to admit you for refusing to sign such an agreement. You have the right to speak to an attorney or your family members before deciding whether or not to sign the agreement.
All nursing home residents have the right to make sure the nursing home obeys their advanced directives, such as a “do not resuscitate” directive. Make sure that the nursing home has a copy of any advanced directive documents that you have in place.
Who will your doctor be?
Typically most nursing home residents are seen by the nursing home’s in-house doctor, also known as the “medical director.” However you have the right to choose a different doctor if you want.
Power-of-Attorney or healthcare surrogate
When entering a nursing home, it is generally a good idea to have a Power-of-Attorney or healthcare surrogate in place so that someone can make decisions on your behalf if you are incapacitated.