Alternatives to Traditional Nursing Home Placement

Potential Resources for Obtaining Long-Term and Elder Care, Financial Assistance, General Information and Other Suggestions.

          A  list of guidelines and suggestions compiled by medical professionals at L D H P Medical Review Services Corp.  These suggestions were designed for the public to use in making their personal evaluations of specific resources within their communities.  These suggestions are compiled from the experiences of our medical professionals and are geared toward nationally available programs. Specific communities may have other resources in addition to these.

This is in two parts. Continue scrolling down to the "List of Potential Resources."

PART ONE:  GENERAL INFORMATION AND SUGGESTIONS REGARDING FACILITIES

1.  ALL AGENCIES THROUGH WHICH AN EMPLOYEE IS HIRED OR FACILITIES IN WHICH SOMEONE IS ADMITTED SHOULD CARRY LIABILITY/ MALPRACTICE INSURANCE, BE BONDED, AND HAVE APPROPRIATE STATE AND LOCAL LICENSES. VERIFIABLE REFERENCES SHOULD ALSO BE SUPPLIED, AND THESE REFERENCES SHOULD BE CHECKED BY THE INDIVIDUAL AND/OR HIS/HER FAMILY PRIOR TO UTILIZING THE SERVICE.

2.  DOING A LITTLE INVESTIGATION OF RESOURCES, AGENCIES, AND INSTITUTIONS NOW SAVES A LOT OF FUTURE HEART-ACHE !

3.  MOST FACILITIES DESCRIBE CARE AS SKILLED VS. NON-SKILLED CARE.  THIS IS NOT A REFLECTION ON THE LEVEL OF SKILL OF THE STAFF, BUT RATHER A CLASSIFICATION OF LICENSED VS. NON-LICENSED STAFF. [LICENSED NURSES VS. NON-LICENSED NURSING ASSISTANTS.]

The decision to utilize a nursing home and the situations that make it necessary are never easy for the ill or physically dependent person nor their family to cope with. This information is meant to help in the decision-making process by providing alternative areas to explore. Each situation is individually unique. No recommendations are made as to the advisability of one form of care over another. This information is meant to serve as a guide to help a family generate and explore more ideas and options on their own and thus help formulate their own plan of care for their own unique situation. Specific questions and issues should be discussed with Social Services personnel of the various institutions and entities named in this article and not L D H P Medical Review Services Corp.

Considering the enormous cost of traditional nursing homes, two avenues should be explored prior to committing to a particular institution.

First, will a lesser-skilled institution provide the needed service?
Most facilities describe care as skilled vs. non-skilled care. This is not a reflection on the level of skill of the staff, but rather a classification of licensed vs. non-licensed staff (licensed nurses vs. non-licensed nursing assistants). Traditional Nursing homes are generally "skilled care," but there are other options. Skilled vs. non-skilled is the major distinction in facilities as to the level of care being provided. A non-skilled facility is not necessarily an inferior facility. Not all elderly people require around-the-clock licensed nursing care.

Second, contact Social Services personnel for review of financial alternatives and resources within a local area. (Social Services personnel are employed by nursing homes, hospitals, visiting nurse organizations, and local senior citizen government agencies.)

There are various levels of care that can be tailored to an individual's needs. The individual's personal physician should always be consulted in regard to placement and as to what level of placement would be appropriate.

A LIST OF POTENTIAL RESOURCES

  1. Local Community Resources ---
Many communities have offices of senior affairs or some type of service to assist senior citizens with available community resources. Often these groups also maintain lists of people that provide in-home help to the elderly. This may be anything from home repair, meal preparation, and shopping to a nurse's aid for personal care. If these potential employees are not with an agency, the appropriate insurance, liability bonding, and references should be explored prior to hiring the employee.

  2. Veterans Benefits as a Resource ---
Don’t forget that there may be alternatives if someone was ever a member of the military. In many areas of the country, the Veterans Administration (VA) maintains its own skilled nursing home facilities. In some situations, the VA will assist with financial aid to a resident in a private institution other than a VA facility. In some situations, help with financial aid for the individual to remain in their home with private paid help and financial assistance to the family, especially the spouse, is possible. Women who have served in the military are also eligible for Veterans benefits; this is often overlooked in planning for their care. Veterans' benefits vary greatly with the time of service (peace time or war) and with the illness/disability (military service or non-military service connected). Veterans' benefits are appointed by Congress in specific blocks of time. This creates a great deal of variation in veteran's benefits depending upon the date of the actual appointment of benefits. It would be wise to investigate if the veteran is eligible for benefits even if the veteran is not sure he/she is entitled to these benefits as there is so great a variation in benefits. The Veterans Administration also offers visiting nurse and Hospice care. (See explanations of these services below.) Specific questions should be discussed with the Veterans Administration or a veterans service organization and not L D H P Medical Review Services Corp.

  3. Resources for Remaining in One’s Own Home as an Option ----
Many people can remain in their own home with a minimum of in-home hired help. Often the situation that might make placement in an institution necessary is of a short duration, and with in-home help the crisis passes and the ill person will be able to remain in his/her own home. (The individual's physician can advise the individual and the family on the feasibility of this situation.) Many local private duty nursing companies also have personnel who provide homemaker, shopping, meal preparation, and nursing assistant services by non-licensed staff who are supervised by licensed staff. Some of these companies also have personnel who can assist with finding community resources and financial aid. The VA has visiting nurse programs in many areas. Some in-home services are VA, Medicare, Medicaid, and Private insurance covered expenses if the illness or disability is expected to be of a short duration. All non-licensed, in-home help such as nursing assistants and homemakers should be supervised regularly by licensed medical personnel. Medicare/Medicaid licensed agencies are required to do this regularly.

  4. Home Health Care as a Resource ---
There are home health care agencies which provide both licensed and non-licensed nursing care in the home. Homemakers, nurse’s aids, LPNs, RNs, and various Therapists are provided according to the level of need. Hospice programs often work hand in hand with home health care/visiting nurse agencies. Many services are covered by insurance, but you should investigate that possibility with the specific service. Contact your local hospitals or physician for the agencies in your area.

  5. National Hospice Organization as a Resource ---
Hospice care is for the terminally ill and may or may not be associated with a home healthcare agency. It allows the individual to remain with the family and still receive medical care. There are also hospital-based Hospice services. Hospice care also provides excellent family support and bereavement care. Hospice care is designed to keep the terminally ill as pain free as possible. Contact your local hospitals, home health care agency, physician, or the National Hospice Organization, Inc. The National Hospice Organization, Inc., can be contacted at 1901 North Moore Street, Arlington, Virginia 22209, 1-(703)-243-5900. Request the '96 - '97 Guide to the Nation's Hospices for the facilities near you.

  6. Local Hospice Care as a Resource ---
Local Hospice groups, either through a hospital or as a private entity, offer service similar to those of private duty nursing agencies. The Veterans Administration maintains its own Hospice programs in many areas. In addition, many Hospice groups often have volunteers that are a tremendous resource. Contacting a Hospice service will provide you with many valuable local resource people and a much needed support system.

  7. Shelter Care, Group Homes or Private Homes as a Resource --- Group homes or shelter care homes are for residents who are able to manage their own affairs, but need minimal supervision and assistance in minor areas as well as assistance with laundry and meal preparations. Often these are private homes with a home-like environment and less than 10 residents. They are very family-like, but should have a 24-hour staff and not be solely dependent upon the owner of the home for all of the care. The staff should be sufficient to provide 24-hour care and supervision in case an emergency or illness occurs. These shelter homes should have a state license and be state inspected. They do not usually have a medical staff member and rely on outside medical staff when needed, for example a visiting nurse service. HOWEVER, the residents are medically stable and do not need skilled medical care, but only need assistance with daily activities. The staff needs to have some knowledge of elderly care and have basic emergency and CPR (Cardiopulmonary Resuscitation) training. The cost of these facilities is generally much less than a traditional nursing home, but these fees are also often not insurance covered.

  8. Semi-Skilled Nursing Homes as a Resource ---
There are a few semi-skilled facilities which may have a licensed nurse for one shift for supervision and a very few treatments and unlicensed staff members for other shifts. These facilities are also often in a home with very few residents. Semi-skilled facilities are able to provide a very few medical services for residents who require only a little assistance.

  9. Skilled Nursing Homes as a Resource ---
This is the traditional Nursing Home that most people associate with the term "Nursing Home." This facility offers the highest level of nursing and medical care and is staffed by licensed nurses on each shift, but usually has several nurse's aids or nursing assistants also. These facilities usually are insurance covered, but that should be determined in each case. This is appropriate for the individual requiring a high degree of care on a daily basis. Often nursing homes have social service personnel to assist with financial and insurance questions.

  10. Personal Physician as a Resource ---
The individual's personal physician is generally familiar with the local community and its resources as well as the physically dependent person's condition and can make a recommendation.

  11. Individuals in the Community as Resources ---
If you are not familiar with your local community, you are not alone! Other people in your community have been in similar situations. Use local people as resources and references. Evaluate their level of satisfaction of a particular institution. Don't forget local religious leaders. Rabbis, priests, and ministers visit members in institutions and have a good "feel" for a particular institution.

  12. Insurance Companies as Resources ---
Some insurance companies have referral services and even complete rehabilitation referral programs and are a good resource to explore. Do not forget secondary or supplemental insurance providers either.

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Specific questions and issues should be discussed with Social Services personnel of the various institutions and entities named in this article and not L D H P Medical Review Services Corp.

L D H P Medical Review Services Corp. does not recommend any specific type of care or institution as this is a very personal matter. We hope this brief overview of services will be helpful to you.

Though our business deals with the negative side of institutional placement, many, many families have had positive and satisfying experiences, including those of us at L D H P Medical Review Services Corp. We anticipate your experience will be a positive one.

These guidelines are offered free to the general public and any interested Attorney or insurance professional for assessing the quality of a long-term care facility or for their client’s information and use in planning care for a family member. Feel free to contact us for a free publication-ready copy of this information.   Feel free to copy and distribute this information to any interested party. We encourage the distribution of any information that will assist the public in caring for the elderly. We believe that an informed general public is an essential safeguard for the elderly. Our only stipulation is that these pages be reproduced in their entirety, including our name and address. This information was compiled by L D H P Medical Review Services Corp., and we prefer that it remain as one document for purposes of accuracy and as a representation of this firm. Thank you.

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