Image reads: A Guide for Alzheimer's Disease and Related Disorders

" A nursing home is not a place where people go to die. It is a place where people go to live and enjoy the rest of their life."

Eric Haider,
CEO Crestview Home, Inc.
Bethany, Missouri

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Nursing Home Care

There is no perfectly "right" time for placing the person with Alzheimer's disease in an adult care facility. The timing depends upon the needs of the individual and the ability of the caregiver to meet those needs. It is a good idea to begin considering a choice for placement well in advance of the need. This will give you adequate time to research your decision.

Since adult care facilities often have waiting lists, you need to have an idea of when placement might be needed. Ask the nursing facility admission person how they manage their waiting lists. Can a person be on the list and say no to a call for placement? Do they lose their spot on the list or will they get a call the next time? Also, it is important to determine how much time you will need to get the individuals finances in order to pay for the placement.

You will need to assess if the facility can meet any special needs the person may have. It is very important to find out how behavior problems will be managed.

Dementia Special Care Unit

A dementia special care unit is a unit or wing of an adult care facility that has been specifically designed to meet the needs of persons with dementia related disorders. These units may provide a specifically designed environment, activities and specially trained staff members.

When choosing a special care unit, the family should examine several facilities at various times of the day. They should question the staff about their philosophy, policies, management, daily resident care, activities, staff-to-resident ratio throughout a 24-hour day, staff dementia specific training and the cost of care.

Many persons with dementia are provided quality care within adult care facilities that do not have special care units.

CARE Assessment

Before admission to a Kansas nursing home, a person is required to receive a CARE evaluation. The name "CARE" stands for Client Assessment, Referral and Evaluation. The assessment is a personal interview with the client that includes the caregiver. It usually takes about an hour to complete.

The purpose of CARE is to assist you in finding the most appropriate long-term care service and to collect the data on the need for home and community based services. The care assessor will be knowledgeable about services in your area.

If the person is in the hospital awaiting discharge, a hospital staff member will complete the care assessment. If the person is residing at home and plan to go to a nursing facility, the local Area Agency on Aging staff will coordinate the assessment. If you would like to request an assessment or would like additional information about the CARE program, call your local Area Agency on Aging (page 58).

Upon completion of the assessment a CARE certificate will be issued. This certificate should be taken to the nursing facility at the time of admission.

If the person is in the hospital awaiting discharge, a hospital staff member may complete the care assessment. If the person is residing at home and plans to go to a nursing home, the local Area Agency on Aging staff will coordinate the assessment. If you would like to request an assessment or would like additional information about the CARE program, call your local Area Agency on Aging.

State Survey

A state survey completed by the Kansas Department of Health and Environment is an inspection report that shows how well a nursing home meets state regulations for long term care facilities. It also shows how the nursing home plans to correct the violations that were found. Every nursing home must have the latest survey report available to the general public. Ask to look at the report when you visit a nursing home.

Nursing Home Physician

Every nursing home has a medical director who is a medical doctor, but every person has the right to have their own physician to direct the care provided at the nursing home. Many doctors do not visit residents in the nursing facility. You will need to ask the doctor of your choice if they will make nursing home visits. Many aspects of nursing home care require an order signed by the doctor.

Inform the physician and nursing home staff that you expect to be fully consulted on care decisions concerning the person with dementia. Because you have a wealth of information about the person, you will be a valuable resource to them.

Plan of Care

In nursing homes, the care each resident receives is directed by a "care plan." The plan is based on an assessment of the person's needs and problem areas. The plan sets care and management goals and identifies how nursing, dietary, social service and other staff will handle each of the problem areas.

Once the person is admitted, you are part of the team. Plan to attend regularly scheduled care plan meetings. As a caregiver, you are familiar with the best techniques for working with the person. These techniques need to be shared with the nursing home staff.

Financial Arrangements

Financial arrangements must be completed with the nursing home prior to admission of the person with dementia. The person admitted to the nursing home is required to pay for their care. It is very important to examine your written agreement in detail on behalf of the person with dementia.

Make sure you understand what services the basic monthly fee covers and what services must be paid for separately. All financial arrangements should be in place by the day of the move.

The selection of a nursing home and the arrangements you make to finance the cost will affect you and the person in your care. If you are the person's spouse, keep in mind during your financial planning that you must provide for the financial needs of the person with dementia and yourself.

Some facilities owned and operated by religious or fraternal organizations may offer free or low cost care to members. As a military veteran, the person may be eligible for free or low cost care at a Veterans Administration (VA) facility. A veteran should contact the local VA Benefit Counselor to discuss possible benefits.

Medicare and Medicaid Payment

Medicaid financial assistance for nursing home care is for people who have limited monthly income and resources. The Kansas Department of Social and Rehabilitation Services manages the program. The difference between a person's income and the cost of nursing home care are paid by Medicaid funds. Contact the Kansas Department on Aging or the Kansas Department of Social and Rehabilitation Services with questions on Medicaid.

Medicare is a federal health insurance plan. There are two parts of the Medicare program. Part A pays for in-hospital care, some skilled nursing home costs, hospice and home health care services. Part B pays for doctors' fees and some outpatient hospital and rehabilitation services. However, Medicare does not pay for long term nursing home care.

For information about Medicare Part A, call (800) 445-7170. Part B information is available by calling (800) 432-3531.

Spousal Impoverishment Law

There is a federal law called Spousal Impoverishment, also known as Division of Assets, that allows the spouse remaining at home to protect a substantial portion of assets and income. This program allows the ill spouse to receive Medicaid sponsored nursing home care without impoverishing the spouse who stays at home. Contact your county Social and Rehabilitation Services office for information on the Spousal Impoverishment benefit. For a "Questions & Answers on Spousal Impoverishment" brochure contact your local Area Agency on Aging or the Kansas Department on Aging.

Resident Rights

Residents of nursing homes are protected by federal law that has established important legal rights. Nursing homes are required to provide care that promotes the quality of life of each resident. They must provide services and activities designed to attain the highest practical physical, mental, and psychosocial well being of each resident.

Residents have the right to be treated with respect, dignity and full recognition of their individuality.

Residents and their families have freedom of choice to select a personal physician and to be fully informed and participate in planning care and treatment or refusing care or treatment. Residents also have the right of privacy with regard to accommodations, medical treatment, written and phone communications, visits, and meeting with family and resident groups. Married couples can choose to share a room, if both agree.

The rules also protect against abuse and restraint. Each resident has the right to be free from physical or mental abuse, corporal punishment, involuntary seclusion, and any physical or chemical restraints.

The resident's right to have visitors is protected. Relatives, with the resident's consent, may visit at any time. Visits from friends may only be subjected to "reasonable hours." The personal physician, health department representative, or state ombudsman also has the right to visit anytime.

The federal rules also protect the right of the resident to remain in the nursing home and limit the conditions under which the care facility may transfer or discharge the resident.

Contact the Kansas Department of Health and Environment at (800) 842-0078 if you believe the person with dementia is being discharged inappropriately or if you have concerns about their health care and safety.

Conditions that must be met for transfer or discharge of a nursing home resident

Another level of care is needed based on a physician recommendation. Such as, the resident's health has improved and services are no longer needed or a resident is demonstrating care needs that would best be served by a higher level of care such as in a Dementia Special Care Unit.
The resident, after reasonable notice, has failed to pay agreed upon nursing home charges. (Note: Use of Medicaid funding cannot be considered as non-payment).
The resident's presence threatened either the health or safety of other residents and the resident or legally responsible representative rejects recommendations for hospitalizations and treatment. It is common for a person with dementia to become combative at some time during the illness. If this happens a thorough medical and psychiatric evaluation should occur. This would be considered therapeutic leave and would not be justification for eviction.
The facility ceases to operate.

The Kansas Long Term Care Ombudsman Program at (877) 662-8362, through its trained professional and volunteer staff, also serves as an advocate for the long term care resident.

The Kansas Advocates for Better Care at (800) 525-1782 works to protect the rights of people who live in Kansas long-term care homes and to improve the quality of care and quality of life for those people.

Protection against Medicaid discrimination

Residents using Medicaid are protected from discriminatory practices. The nursing home accepting Medicaid payment must maintain identical policies and practices regarding transfer, discharge and provision of services for all residents.

A nursing home in Kansas participating in the Medicaid program cannot ask what the payor source would be as a determinant in accepting a person into their facility.

The facility must inform residents about how to apply for Medicaid and may not require residents to waive their Medicaid benefit. Finally, the nursing home is not allowed to require that a third party guarantee payment as a condition of an admission or continued stay. It cannot accept money or other consideration as a precondition for a continued stay for persons eligible for Medicaid.

Nursing Home Information

Staff at the nursing facility, your local Area Agency on Aging or Kansas Department of Social and Rehabilitative Services office can provide information regarding nursing facility placement or payment options.

There are two professional associations representing Kansas nursing facilities. These are the Kansas Association of Homes & Services for the Aging at (785) 233-7443 or Kansas Health Care Association at (785) 267-6003.

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