Ask the Lawyer: Senior Care

Robert J. Fogg is chairman of the health-care group of Archer & Greiner, a law firm based in Haddonfield and Princeton, where he concentrates on representing healthcare providers, including hospitals, nursing homes, physicians and other healthcare facilities. He can be reached at 609-580-3702 or rfogg@archerlaw.com.  

Q. My mother lives alone and is now 90. She needs 24-hour supervision, which we can no longer manage at home. What are her choices?

A. Selecting a nursing home or assisted living facility can be a challenging process, but there are many resources to help you find one that may match your needs. First, it may be useful to get advice from either the attending physician, social worker, or a geriatrician to determine what level of care is most appropriate for your loved one. The choices include skilled nursing care, assisted living services, and an independent living community for seniors.

If there are skilled nursing needs that must be addressed, or your parent is being discharged from a hospital for post-acute rehabilitation and needs 24/7 supervision, a skilled nursing facility is your best option. To the extent your parent can live somewhat independently, and needs only limited nursing services and some assistance with activities of daily care or personal care, assisted living may be the best choice. If your parent is independent but their health is declining, or dementia is beginning, a continuing care retirement community may be a good option.

Q. How do we know which facilities provide the best quality of care?

A. One of the value-added services government regulators have actually brought to consumers are quality ratings for nursing homes. You can check the federal “Nursing Home Compare” service created by the Centers for Medicare and Medicaid Services (CMS) at www.medicare.gov/NHCompare. Here, you will find a five-star rating service similar to the “Zagat” ratings for restaurants or hotels. CMS uses measures such as health survey and inspection results, quality indicators like the percentage of residents who have pressure sores, weight loss, or urinary tract infections, and nursing home staffing levels. You can choose nursing homes based on name, state, or county, and then select from that list a number of facilities to compare side-by-side. There’s also a 72-page booklet called “Your Guide to Choosing a Nursing Home,” which may be of assistance to you in making these choices.

The New Jersey Department of Health and Senior Services is also developing a similar rating system to Nursing Home Compare for assisted living facilities in New Jersey. The Health Care Association of New Jersey provides helpful consumer information on choosing various levels of long-term care on its website. Other information, such as facility report cards, can be found on the New Jersey Department of Health and Senior Services website. This agency is also responsible for surveying nursing homes and assisted living facilities and maintains a complaint line in the event a problem develops after admission.

Q. How is nursing home and assisted living care financed?

A. Long-term care services are, of course, expensive. To the extent your parent has remaining financial resources, they will need to be used, or “spent down,” before they may qualify for governmental assistance through Medicaid. There are ways to plan for Medicaid eligibility, for which you should receive advice from a qualified elder law attorney. If your parent is being discharged from an acute-care hospital, Medicare will typically pay for at least 20 days of care in a skilled nursing facility for rehabilitation purposes. Assisted living is mostly paid for privately, although Medicaid may be available to cover a limited portion of the cost of assisted living once the person has spent down their resources to qualify. Continuing care retirement communities have all three levels of care, but typically have large entrance fees and monthly maintenance charges.  

Q. What about long-term care insurance?

A. Long-term care insurance will typically pay a specified dollar amount toward the per diem cost of a nursing home. Long-term care insurance purchased earlier in life can be a good investment, but often costs may exceed potential benefits. Be sure to choose carefully to compare plans and benefits, as these can vary significantly by use of co-pays, eligibility thresholds, and availability of home care benefits. Adult medical day care services may be a valuable option for a senior to keep them at home, so it’s important to ensure it’s available under a long-term care insurance policy.  

DISCLAIMER: Information provided in “Ask the Lawyer” is for general informational and educational purposes only. It does not constitute legal advice, and may not be used and relied upon as a substitute for legal advice regarding a specific legal issue or problem. Transmission of the information is not intended to create, and receipt does not constitute, a lawyer-client relationship. Legal advice should be obtained from a qualified attorney licensed to practice in the jurisdiction where that legal advice is sought.