HOW TO SELECT LONG TERM CARE ASSISTED LIVING AND NURSING HOMES Delaware Cares About Your Well Being Table of Contents QUESTIONS? WE CAN HELP. Whenever you have questions about selecting a nursing home, Delaware has people ready to help you. For a complete listing of phone numbers for specific questions, see page 20 of this guide. General questions can be answered through the organizations listed below. DELAWARE HEALTH AND SOCIAL SERVICES 800.223.9074 FOR QUESTIONS ABOUT NURSING HOME SELECTION Division of Services for Aging and Adults with Physical Disabilities Long Term Care Ombudsman Program 8:00 a.m. to 4:30 p.m. weekdays 302.577.6661 TO CHECK THE STATE INSPECTION RECORD OF A SPECIFIC NURSING HOME Contact the facility directly or call the Division of Long Term Care Residents Protection 8:00 a.m. to 4:30 p.m., weekdays 800.336.9500 FOR INFORMATION ABOUT MEDICARE BENEFITS AND PROGRAMS 302.739.6266 ELDER info State Health Insurance Assistance Program 8:00 a.m. to 4:30 p.m., weekdays 800.372.2022 FOR INFORMATION ON MEDICAID Division of Social Services 8:00 a.m. to 4:30 p.m., weekdays INTRODUCTION 2 Welcome Is a Nursing Home the Right Choice? How does a Nursing Home Help? The Language of Long Term Care FINDING THERIGHTLONGTERMCARE 5 Understanding Your Options Gathering Information Choosing a Nursing Home PREPARING TOENTER ANURSINGHOME 13 Pre-Admission Arrangements PAYING FORCARE 14 Payment Options AFTERADMISSION 17 Adjusting to a Nursing Home Care Plans Resident Rights and Protection Reporting and Resolving Problems HELPFUL PHONE NUMBERS 20 NURSINGHOMECHECKLIST INSERT DELAWARE NURSING HOMES AND ASSISTEDLIVINGHOMES INSERT 1 Delaware Cares About Your Well Being Introduction Finding the right nursing home takes time – so it’s best to plan ahead. Begin your search before admission becomes necessary. If you are a caregiver, involve your loved one in choosing the right nursing home. That will make decisions easier and provide a smoother transition. To see how nursing homes compare to other care options, see page 6. WELCOME: WE’RE HERE TO HELP YOU MAKE INFORMED DECISIONS. You and those you love deserve the best. But, when it comes to choosing a nursing home, it’s hard to know what “best” really means. This guide is designed to make it easier for you to asses needs, review nursing home options, and make choices. In doing so, you may realize that a form of care other than a nursing home may be a better option. That in itself is a major step forward. The nursing home decision may be one of the toughest choices you’ll ever face. Educating yourself before making decisions will lead to a better result for your loved one. ISA NURSING HOME THE RIGHT CHOICE? If you answer “yes” to some or all of the questions below, a nursing home may be the right option: •Has living independently become difficult? •Is 24-hour nursing care and supervision needed? •Is there a need for ongoing care related to a chronic illness or intensive rehabilitation? •Is help needed with most daily living activities, such as getting out of bed, eating, bathing, dressing and using the bathroom? HOW DOES A NURSING HOME HELP? A nursing home is a permanent residence. A room, meals, recreational activities and help with daily activities are provided, along with medical and rehabilitative care if needed. Some people may stay for a short time for rehabilitation after being hospitalized. 2 Delaware Cares About Your Well Being Introduction THE LANGUAGE OF LONG TERM CARE Understanding the terminology of long term care is a good first step to understanding your options. Here’s a guide to important words to know. Activities of Daily Living (ADLs) These are activities most people do during their daily routine – things like getting in and out of bed, bathing, dressing, eating and using the bathroom. Assisted Living Assisted living facilities provide varying levels of care and accommodations. Please refer to page 7 for a full description. These facilities are state licensed. Care Plan A care plan sets out health care goals that are agreed upon by the nursing home staff and the resident, or the resident’s authorized representative. The plan details all of the personal or health care services that will be needed by the resident, the type of staff needed to deliver those services, how often the services are needed, and any necessary equipment or supplies. Certified Nursing Assistant (CNA) A CNA is trained and certified to assist nurses with non-medical duties such as bathing, dressing or using the bathroom. Intermediate Care An intermediate care nursing home is one where residents do not have significant nursing or medical needs. Residents in intermediate care facilities generally need assistance with activities of daily living. These facilities are state licensed. Long Term Care Ombudsman An ombudsman is an independent individual – often a volunteer – who serves as an advocate (supporter) for residents of long term care facilities. Ombudsmen serve as a voice for individuals who cannot speak for themselves, and work to solve problems between residents and the facilities where they receive care. The Long Term Care Ombudsman Program (LTCOP) also investigates complaints made about quality of care. The Ombudsman program is located in the Division of Services for Aging and Adults with Physical Disabilities. If you have a concern or complaint, you can talk with your Long Term Care Ombudsman. 3 Delaware Cares About Your Well Being Introduction Skilled Nursing Facility A skilled nursing facility is a nursing home that provides 24-hour medical nursing care for people with serious illnesses or disabilities. These facilities are state licensed and care is provided by registered nurses, licensed practical nurses, and certified nurse assistants. Who’s Who at a Long Term Care Facility Here are descriptions that will help you know the role each person has in providing care. Administrator – an individual who is charged with and has responsibility for the general administration of a facility. Activities Director – a staff member who provides quality programs to fit the needs of residents’ interests and levels of function. Certified Nursing Assistant (CNA) – Nursing assistants work closely with patients and provide assistance with daily living tasks, such as: dressing, bathing, feeding, toileting and assisting patients with ambulation, when needed. Director of Nursing (DON) – a registered nurse designated by the facility who is responsible for directing the nursing staff. Medical Director – a physician designated by the facility who is responsible for the implementation of resident care policies and the coordination of medical care in the facility. Social Services Director – a social worker who is responsible for providing medically-related social services like making arrangements for clothing, transportation, transfer or discharge from the facility, maintaining contact with families, etc. 4 Delaware Cares About Your Well Being Long Term Care FINDING THE RIGHT LONG TERM CARE Searching for the best care option will be easier if you take it one step at a time. This section will help you do that by providing the information you need to: 1. UNDERSTAND YOUR OPTIONS 2. GATHER INFORMATION 3. CHOOSE A NURSING HOME 1. UNDERSTANDING YOUR OPTIONS Nursing homes are just one of the options available for long term care. What’s right for you? Start by assessing the care needed — then look for the option that best responds to those needs. Caregivers at facilities are familiar with the concerns of residents and families. You should feel free to ask caregivers plenty of questions to help with the decision and transition process. Remember, the best decisions can be made when everyone works together, including caregivers, families, potential residents and family physicians. Nursing Homes Nursing homes care for all facets of a resident’s health and well being, providing residential, personal, medical, nursing and rehabilitative care. Nursing homes become the resident’s home. They are designed to provide a room, meals, recreational activities, and opportunities for social interaction in a safe, secure environment. Residents are supervised 24 hours a day. Assistance is provided for basic, everyday activities. If needed, nursing home residents receive help with daily activities like dressing, eating, walking, personal hygiene, and getting in and out of bed. Medical care is directed by your personal physician. When an individual enters a nursing home, his or her physician will provide directives for medications and a detailed plan for any restorative or rehabilitative care. . 5 Delaware Cares About Your Well Being Long Term Care Delaware nursing homes are certified and licensed by the state to provide different levels of care. With the help of community services and home care, you or your loved one may be able to stay at home. To learn about community care programs in Delaware, call: Division of Services for Aging and Adults with Physical Disabilities at 800.223.9074. If the cost is an issue, subsidized housing may be an appropriate option. Treatments or special diets. Nursing home residents will be visited by a physician on a regular basis. This physician will monitor the overall care being provided. Nursing homes also have a physician on staff to handle emergencies. Daily medical care is provided by registered nurses or licensed practical nurses. Nursing homes are required to have registered nurses or licensed practical nurses on staff. These nurses provide assessments, treatments, and injections, coordinate care and administer medicine. The nursing staff also provides rehabilitative services and therapy. Cost: Most nursing homes charge a basic fee for room, meals and some personal care. There may be extra charges for special medical and other personal needs. Other Long Term Care Options Home Care Sometimes, an older person needs daily care but wants to stay in his or her own home. Community and home health care services may make this a possibility. Many communities provide specific services needed by elderly residents. These can include adult day care, meal programs, senior centers, friendly visitor programs, help with shopping and transportation, and assistance with legal or financial matters. There are also home health care agencies that may provide custodial and/or skilled nursing care in your loved one’s own home. Cost: Costs vary depending upon the number of hours of care and the type of service provided. Subsidized Senior Housing Older individuals in the low-to-moderate income bracket may qualify for federal or state programs that help pay for housing. Subsidized housing includes apartments in complexes designed for elderly residents. Cost: The monthly charge is usually a percentage of the resident’s income. Board and Care Homes Sometimes called “group homes,” board and care homes are designed to meet the needs of seniors who cannot live on their own, but who are not yet ready for nursing home care. Most board and care homes are group living arrangements where help is offered with some activities of daily living such as bathing, dressing and using the bathroom. Cost: The monthly charge is usually a percentage of the resident’s income. 6 Delaware Cares About Your Well Being Assisted Living Facilities Help is provided with daily living activities such as bathing, dressing and using the bathroom. Assistance may also be provided with taking medicine. Some assisted living facilities have health services on site, while others may provide transportation to doctor’s appointments. Residents have their own rooms or apartments, and have some or all of their meals in a central dining area with other residents. Social and recreational services are usually provided. Cost: In most cases residents pay a monthly rent, plus additional fees for services. Continuing Care Retirement Communities (CCRCs) A continuing care retirement community is a single community that offers a variety of care options and living arrangements. This allows residents to continue living in the community, even as their need for care changes. Most CCRCs offer individual homes or apartments for seniors who want to live on their own, an assisted living facility for those who need help with some daily activities, and a nursing home for residents who need around-the-clock care. Cost: Costs will vary depending on the type of residence and level of care you choose. Hospice Care If your loved one is terminally ill, hospice care may be the right answer for your entire family. When there is no longer hope for a cure, hospice care provides hope for a peaceful goodbye by offering physical and emotional care for the individual, and counseling for the immediate family. Those who qualify for hospice care can often stay at home, or in the home of a family member, while receiving medical and support services. A team of doctors, nurses, home health aides, social workers, counselors and trained volunteers will help care for the patient, help the family accomplish daily tasks, and help everyone cope. Depending on the individual’s condition, hospice care may also be provided in a hospital or nursing home. Cost: Costs vary depending upon the condition of the patient and where the patient is receiving medical care. In some cases, hospice is covered by insurance, including Medicare and Medicaid. Contact your insurance carrier for details. 7 Delaware Cares About Your Well Being Long Term Care In Board and Care Homes, residents share living arrangements with a small group. No two Assisted Living communities are alike. Each offers a different level of services and accommodations. If you’re looking for care that changes with your needs, Continuing Care may be the answer. Specially trained Hospice staff provide peace, comfort and care during the most difficult times. Long Term Care 2. GATHERING INFORMATION Want to talk things over? Call the Long Term Care Ombudsman Program Director at 800.223.9074. A list of Delaware Nursing Homes and Assisted Living facilities is provided in the back pocket of this guide. Need help finding a nursing home? The Delaware Eldercare Locator: 800.677.1116 Delaware Long Term Care Ombudsman Program 800.223.9074 302.255.9390 Before choosing your care options, be sure to talk things over with the family doctor currently providing care.If you decide that a nursing home is the right choice for care, you’ll need to gather as much information as possible about the nursing homes in your area. Your Long Term Care Ombudsman Program An advocacy organization with resources for information and assistance. Delaware’s Long Term Care Ombudsman Program can provide excellent information throughout your nursing home selection process. Volunteers visit nursing homes on a regular basis. They spend time with residents, help assure that they are receiving the best possible care, and assist in resolving problems that residents may be experiencing. Ombudsmen provide information about how homes are organized and regulated, as well as the strengths and weaknesses of nursing homes in their area. Ombudsmen can offer a wealth of general information that can help you in your selection process. Make a List of Nursing Homes In your search for information, the first thing you’ll need to do is find nursing homes in your area. There are many sources you can use for information. Ask your loved one’s doctor or health care provider about nursing homes they might recommend. •Talk to hospital discharge planners or social workers. •Ask family members, friends and neighbors. •Talk to your church leaders. •Check your local phone book. •Look on the Internet at: www.medicare.gov Narrow Your List Once you have reviewed the list of possible nursing homes, a few basic questions may help you narrow the list to facilities worth looking into in more detail. Call each nursing home on your list, and ask about: Availability Beds in nursing homes are limited. Ask if a bed is available, how long you might have to wait, and if you can add your name to a waiting list. 8 Delaware Cares About Your Well Being Special Care Needs Is special care needed for Alzheimer’s disease, dementia, or other medical conditions? Ask if the nursing home is capable of meeting these needs and if the answer is “yes,” ask about specifics. Religious and Cultural Preferences Does the nursing home offer an environment that supports religious or cultural preferences? Language Are there any potential language barriers at the nursing home you are considering? Residents who don’t speak the same primary language as the nursing home staff may find it difficult to communicate needs and form bonds with the staff and other residents. Medicare and Medicaid Coverage If you depend on Medicare or Medicaid coverage, make sure the nursing home accepts this as payment and has those types of beds available. Services and Fees Ask for details on the nursing home’s charges and fees to make sure it will be affordable on a long-term basis. It is important to obtain this information, preferably in writing, well before the admissions process. If it is not clear and specific, ask questions. Compare the Quality of the Homes on Your List Now that you’ve narrowed your list to the nursing homes that meet your basic requirements, it’s time to dig deeper to find out about the quality of care provided. Review Nursing Home Quality Measures The Nursing Home Compare section of the www.medicare.gov web site has a whole host of information that you can easily retrieve. The web page has nursing home quality measures that offer information on ten important indicators of the care provided by the facility. This information provides data on quality measures 9 Delaware Cares About Your Well Being Long Term Care The Checklist in the back pocket of this Guide can help you narrow down your choices. To compare nursing home facilities, visit this web site: www.medicare.gov Long Term Care Review the survey reports for each home you are considering. Survey reports should be clearly posted in all nursing homes. You may also obtain them from the Division of Long Term Care Residents Protection at 302.577.6661. You can look at nursing home comparisons online at www.medicare.gov. Click on “Nursing Home Compare.” including the percent of residents with pressure (bed) sores, percent of residents with physical restraints, and more. Review Staffing Compliance The Nursing Home Compare web page also has information on staffing in nursing homes. Several studies have found that there are minimum staffing thresholds that promote high quality of care. Nursing home staffing is an important indicator that can help you make the best choice. In Delaware, we have a minimum staffing law that requires facilities provide at least 3.28 hours of staff time per resident per day. You can see how a particular facility is doing by checking the web site. Review Quality Reports All Delaware nursing homes must be licensed by the State of Delaware, and must meet licensing requirements. Every 12 months, nursing homes are surveyed by Delaware nursing home experts on a “surprise” basis. Nursing homes that accept Medicare and/or Medicaid payments must also meet federal licensing requirements. The State of Delaware conducts the inspection of these homes. Usually, both the state and federal inspection is conducted at the same time. Additional inspections are done when problems arise. The State of Delaware license survey includes: •A review of the care provided by the facility to the residents •A review of the facility staffing •An inspection of the environment •Interviews with the residents, staff and families •A review of personnel records •Observation of the facility’s kitchen and food handling practices •A safety code inspection conducted through the Fire Marshal’s Office 10 Delaware Cares About Your Well Being Long Term Care 3. CHOOSING A NURSING HOME Visit Your Top Choices Multiple personal visits to the nursing homes you’re considering are absolutely essential. Below are some things to look for during your initial and follow-up visits. The First Visit The first time you visit a nursing home, you’ll probably be given a formal tour. This is fine as a general introduction to the nursing home, but may not give you the complete picture. During your initial visit, look for the following: •Did the residents appear happy, well cared for and stimulated? •Is the facility clean? •Did you feel comfortable talking with the staff? •Were nurses and other caregivers friendly and helpful? The facility with the •Ask specific questions about how your loved one will be cared for. beautiful lobby or the best •Who will be responsible for providing care? art work may not be the one with the best care. •What social and recreational activities are provided, how often, and how can your loved one be involved? •What specialists are on staff to attend to special dietary, medical or rehabilitative needs? Make sure that the answers •What special programs or services are available that may help you receive are consistent your loved one to feel more comfortable? with what you observe. Before ending your visit, be sure to ask for a copy of the nursing home’s most recent inspection report. The Follow-up Visit Plan a few follow-up visits to the nursing home at different times of the day and week so you can get a complete picture of life and care at each nursing home. During your follow-up visit(s): •Use the checklist in the back of this Guide. Bring it with you and fill it in during your visit. •Talk to the residents. Ask them how they feel about the nursing home and the care they are receiving. •Talk to other family members who may be visiting and ask them whether they’re satisfied with their loved one’s care. 11 Delaware Cares About Your Well Being Preparing to Enter Long Term Care •Observe meal times. Look at how food is prepared, how staff interact with residents, and how residents interact with each other in the dining area. •Look into social and recreational activities. Are the residents enjoying them? How often are activities offered? Is help available to residents so they can fully participate? Do activities meet individual interests? Additional Help for Making the Final Decision Attend Resident and Family Council Meetings Most nursing homes have resident and/or family councils. These are groups consisting of residents and family members who meet on a regular basis to discuss concerns. These councils are very active in promoting quality of life for nursing home residents. Ask the resident council president if you can attend a meeting, or receive a copy of recent meeting minutes. For questions related Talk to an Ombudsman to the quality of The Delaware Long Term Care Ombudsman Program volunteers nursing home care, visit nursing home residents on a regular basis, and work to help residents with call Quality Insights their concerns. They are an excellent source of information when you have of Delaware at questions about a nursing home’s strengths and weaknesses. 866.475.9669. Contact Quality Insights of Delaware Quality Insights of Delaware is an organization that works to assure the quality of care received by individuals covered by Medicare. A person covered by Medicare has the right to receive good quality health care. Quality Insights of Delaware evaluates medical records to ensure that the care provided is appropriate. They also work with providers to develop better ways of treating the people under their care. 12 Delaware Cares About Your Well Being PREPARING TO ENTER A NURSING HOME When you’ve found the right nursing home, you’ll need to start the ball rolling by taking care of pre-admission requirements, and developing a plan for payment. PRE-ADMISSION ARRANGEMENTS Before you or your loved one is admitted to a nursing home, you will need to provide the nursing home staff with the following information: Payment Information How will you pay for the nursing home care? You will need to provide the nursing home staff with the details. This can include financial records, any health or long term care insurance coverage you have, as well as Medicare or Medicaid information. Medical Information The nursing home staff will need comprehensive health information, including: • Medical History: including current or past health problems, past surgeries or treatments, allergies, and an immunization record. • Current Health Status: including a list of current health problems and any difficulties with activities of daily living. • Current Medications: including the dose, reason for the medicine, and how often the medicine should be taken. Advance Health Care Directives An advance health care directive allows an individual to give instructions about his or her own health care, and to name someone else to make health care decisions on his or her own behalf. The directive also enables the individual to 13 Delaware Cares About Your Well Being Throughout the admissions process, the nursing home staff should be patient, courteous and respectful of your time and consideration. If they are not, you may want to reconsider your decision. Payment express his or her wishes regarding organ donation. If you or your loved one needs help in preparing an advance directive, contact the Long Term Care Ombudsman Program or Community Legal Aid Society, Inc. Important People The nursing staff will also need to know who the important people are in the new resident’s life. • Health Care Providers: including names, addresses and telephone numbers of doctors, therapists, counselors or others who are currently involved in providing healthcare. • Family Members: including names, addresses and telephone numbers of family members who can be called in case of an emergency. PAYING FOR CARE Nursing homes are expensive, so paying for care may be a major concern. The nursing home admissions staff can provide you with details on the various forms of payment, which can include: PAYMENT OPTIONS Medicare Under certain limited conditions, and for a short period of time, Medicare will pay some nursing home costs for Medicare beneficiaries who require skilled nursing or rehabilitative services. To be covered, you must – after a qualifying hospital stay – receive the services from a Medicare-certified skilled nursing home. 14 Delaware Cares About Your Well Being Supplemental Medicare Insurance Often called Medigap, this private insurance pays Medicare’s deductibles and co-pays and may cover services not covered by Medicare. Most Medigap plans will help pay for skilled nursing care, but only when that care is covered by Medicare. Medicaid Medicaid is a state and federal program that will pay most nursing home costs for people with limited income and assets. The Medicaid waiver program can pay for assisted living or care at home. Eligibility varies by state, so you should look into Delaware’s requirements to be sure your loved one is eligible. Personal Resources About half of all nursing home residents pay nursing home costs out of their personal resources. If your loved one chooses to use personal resources, and those resources become depleted, he or she may eventually become eligible for Medicaid. This is known as “spending down.” Long Term Care Insurance Long term care insurance is a private insurance policy usually purchased before long term care becomes necessary. A good long term care policy will cover all levels of care in nursing facilities and other residential care settings, such as assisted living. But no policy guarantees to cover all costs of long term care without a limit. If your loved one has this kind of policy, check the policy or call the insurance company to find out all conditions set forth in the policy and if the needed care is covered. If your loved one does not have a long term care policy but is considering buying one, have them investigate many sources and discuss various policy options with a financial planner or insurance agent. Finding a good policy will take some effort, but it will be worthwhile. You Are Not Required to be Personally Liable for a Nursing Home Resident’s Bill Sometimes a nursing home admission agreement may have a line for a “guarantor” to sign. If you sign as guarantor, that means that you have promised to pay for the resident’s care out of your own funds if the resident cannot pay. Both federal and Delaware laws state that a nursing home cannot require anyone but the resident to be personally liable for the resident’s bill. A nursing home is permitted to give you the choice to volunteer to be a guarantor. However, you 15 Delaware Cares About Your Well Being Payment For a handbook detailing Medicare coverage for nursing home expenses call: 800.638.6833. Questions about Medicaid eligibility? Call your nearest DHSS/DSS Long Term Care Medicaid Office. Wilmington: 302.577-2174 State Medicaid Agency: 302.577.4880 Newark: 302.368.6610 Milford: 302.422.1520 Georgetown: 302.856.5379 Payment should understand that the resident will not receive any better care if you agree to be a guarantor. On the other hand, if you sign as a “responsible party,” that means that you will pay for the resident’s care, but only out of the resident’s own funds, not from your own funds. The nursing home admission agreement should make this clear. If the resident has given you a power of attorney (POA) or if a court has appointed you guardian, you should sign as POA or as guardian. AT THE TIME OF ADMISSION Upon admission to the facility, the resident or representative will review and sign a series of paperwork including: Admission Contract This contract contains all the terms and conditions that the resident is bound by while living at the facility. Nursing homes cannot Resident’s Rights Each resident or representative will receive a copy of the Resident’s require residents to waive Rights under the Delaware Code. The facility shall obtain a written receipt their rights to Medicare or that the resident received this document. This written receipt must be retained Medicaid coverage. in the facility’s files. Statement of Services and Charges Prior to admission or at the time of admission, the facility must provide a Contact the State Insurance written statement of the following: Commissioner’s Office at •Services provided by the facility, including those required 800.282.8611 for a list of to be offered on an “as needed” basis. companies authorized to sell •Related charges for services not covered under Medicare or Medicaid, or not covered by the facility’s basic per diem rate. long-term care insurance. Upon receiving this statement, the resident or representative shall sign a written receipt. This written receipt must be retained in the facility’s files. 16 Delaware Cares About Your Well Being After Admission AFTER ADMISSION When the transition to a nursing home has been made, the tough decisions may be over. But, new beginnings bring new challenges. You will need to stay involved to assure that your loved one continues to be happy and comfortable, and that he or she is receiving the best possible care. ADJUSTING TO A NURSING HOME It’s hard to leave home, and just as hard to begin life in a nursing home. Here are some ideas that can make the adjustment easier. Frequent visits from family and friends can make the transition easier. Some families work out a visiting schedule to assure the resident has at least one visitor every day, or several times a week. Cards and letters help in between visits. You can make a nursing home feel more like “home” by bringing personal items like family photos, a favorite quilt or other small items. These can be placed in the new room. Be sure to label everything with the resident’s name. •Encourage your loved one to take part in recreational activities and social activities offered at the nursing home. Sharing a common interest is the best way to meet friends and feel part of the community. Encourage participation in the resident council if your loved one is able. •Arrange for your loved one to continue receiving familiar magazines or newspapers. •Communicate regularly with the nurses and especially with the certified nursing assistants who provide much of the hands-on care. •If your loved one is affiliated with a religious or cultural group, contact them and ask them to visit your loved one in her new home. •Ask the Long Term Care Ombudsman to visit your loved one. 17 Delaware Cares About Your Well Being After Admission Nursing homes must provide residents with a written description of their legal rights. Ask for a copy. For help in resolving problems with nursing home care, contact the Delaware Long Term Care Ombudsman Program: 800.223.9074. CARE PLANS Upon admission, the nursing home staff will develop an initial care plan. The resident may take part in developing the care plan if he or she is able. Family members or other individuals who have been authorized to act on behalf of the resident may also be involved. Within 14 days, the nursing home will conduct a health assessment to determine the health condition of the new resident. Using this assessment, and input from the resident or other authorized individuals, a care plan will be created. It may include: •Personal or health care services •The type of staff needed to deliver these services •The required frequency of services •Equipment or supplies needed (wheelchairs, walkers, feeding tube, etc.) •A listing or statement of the resident’s health goals •A summary of how the care plan will help the resident achieve those goals RESIDENT RIGHTS AND PROTECTION Nursing home residents have the same rights and protections as all United States citizens. The State of Delaware has developed a specific listing of rights that apply to nursing home residents: •The right to be fully informed •The right to participate in your own care •The right to make independent choices •The right to privacy and confidentiality •The right to dignity, respect and freedom •The right to remain in the facility •The right to raise concerns or complaints without retaliation REPORTING AND RESOLVING CONCERNS OR COMPLAINTS If you notice a problem at a nursing home, talk things over with the nursing care staff. Bring your concerns to the attention of the nursing supervisor, a social worker, the director of nursing or a family doctor If you feel the problem has not been resolved, you can also bring general concerns to the attention of the resident or family council. 18 Delaware Cares About Your Well Being After Admission Neglect and Abuse Nursing home residents have the right to be free from verbal, physical or mental abuse. In fact, in the State of Delaware, abuse and neglect of nursing home residents is a serious crime. The Delaware Attorney General’s Office and the Division of Long Term Care Residents Protection (DLTCRP) have a specialized unit that investigates and prosecutes abuse, neglect, mistreatment, and financial exploitation of nursing home residents. In addition, the DLTCRP maintains and administers the Adult Abuse Registry (AAR). The AAR is a list of individuals who have had a substantiated complaint of abuse, neglect, mistreatment, or financial exploitation against a long term care resident. The Delaware Medicaid Fraud Control Unit (MFCU) has a statewide team of criminal investigators and prosecutors that pursue charges against abusers. For information on warning signs of abuse or to report abuse or neglect, call the Long Term Care Ombudsman Program Director at 800.223.9074. 19 Delaware Cares About Your Well Being Phone Numbers HELPFUL TELEPHONE NUMBERS INFORMATION AND RESOURCES Quality Insights of Delaware 19943, 19946, 19950, 19952, (Medicare Rights and Preventive 19953, 19954, 19955, 19960, Delaware Helpline Health Services covered by Medicare) 19961, 19962, 19963, 19964,For state information and 866.475.9669 community services 19977, 19979, 19980 800.464.4357 MEDICARE, MEDICAID AND Georgetown State Service Center: 302.856.5379 Division of Services for Aging and INSURANCE Adults with Physical Disabilities ELDER info Areas served – by Zip Code: 800.223.9074 State Health Insurance Assistance 19930, 19931, 19933, 19939, Program 19940, 19944, 19945, 19947, Independent Resources, Inc. 19951, 19956,19958, 19966, Resource Center for Persons with 800.336.9500 19968, 19970, 19971, 19973, Disabilities Delaware Insurance Department 19975 New Castle County: 302.765.0191 302.739.4251 Kent County: 302.735.4599 Medicare Sussex County: 302.854.9330 Delaware Medicare Fraud Alert Part A: 800.442.8430 Program Part B: 800.444.4606 Long Term Care Ombudsman 800.223.9074 Program Veterans Affairs 800.223.9074 Medicaid Offices 800.461.8262 Delaware Health and Social QUALITY OF CARE Services Social Security Administration 800.372.2022 800.772.1213 Delaware Board of Examiners For Nursing Home Administrators Thatcher Street Office: LEGAL ISSUES 302.739.4522 302.577.2174 Areas served – by Zip Code: Attorney General’s Office Delaware Nursing Home Residents 19703, 19732, 19735, 19801, Medicaid Fraud Control Unit Quality Assurance Commission 19802, 19803, 19804, 19805, 302.577.8505 302.577.6661 19806, 19810 Board of Medical Practice Office of the Public Guardian Robscott Building: 302.739.4522 302.577.8990 302.368.6610 Board of Nursing Society, Inc. Division of Long Term Care Areas served – by Zip Code: 302.739.4522 Residents Protection Delaware Health 19701, 19702, 19706, 19707, and Social Services Community Legal Aid Society New Castle County: 302.577.6661 19708, 19709, 19710, 19711, Elder Law Program 19713, 19720, 19730, 19731, Kent/Sussex Counties: 19733, 19734, 19736, 19804, Disabilities Law Program 302.424.6377 19808 New Castle County: 302.575.0690 24-hour toll-free number Kent County: 302.674.8503 for complaints: Milford State Service Center: Sussex County: 302.856.3742 877.453.0012 302.422.1520 Areas served – by Zip Code: 19901, 19902, 19904, 19934, 19936, 19938, 19941, 19942, 20 Delaware Cares About Your Well Being 800.223.9074 Long Term Care Ombudsman Program ASSISTED LIVING FACILITIESS & NURSING HOME SURVEY DEMENTIA SERVICES SPECIALIZED SERVICES PS56 $$$ $$$ No No No 101 $ $ No No 24 $ $ No No No 37 $$$$ $$$$ No No No 44 $$ $$$ No No 51 $$ $$$$ No 100 $ $ No No 70 $ No No 35 N/A $$$ No No No No 26 $$ $$$ No No 93 $ 4 N/A $ 15 N/A $$$ No 72 $ (302.283.0540 52 $$ $$$ No 69 $$ $$$$ No 54 $ No No No 57 $ $ No No 71 $ $ No No No 85 $ $ 59 $$$ $$$ No No 96 $ 71 $ $ No No No 66 $$ $$$$$$ 20 N/A No No No No No No No No 19 $ No No No 15 $ $ No No No No No No No No 21 $ $ No No No ASSISTED LIVING FACILITIES SBeds Semi Occupational Medicaid Protection Care NEW CASTLE COUNTY KENT COUNTY SUSSEX COUNTY AYMENT OURCE Arden Courts, 302.762.7800 Yes Yes Yes Yes Yes Yes Captain’s Deck, 302.798.3500 Yes Yes Yes No No Yes Yes Eden Rock, 302.475.9400 Yes Yes Yes Yes Yes Yes Forwood Manor, 302.529.1601 Yes Yes Yes Yes Yes No Foulk Manor North, 302.478.4296 Yes Yes Yes Yes Yes No Yes Foulk Manor South, 302.655.6249 Yes Yes Yes Yes Yes No No Yes Gardens of White Chapel, 302.366.8100 Yes Yes Yes No No No Yes Lorelton, 302.573.3580 $$ No No Yes Yes Yes Yes No Methodist Country House, 302.654.5101 Yes No Yes Yes Yes Millcroft, 302.366.0160 Yes Yes Yes Yes Yes No Yes Rockland Place, 302.777.3099 $$ Yes Yes No No No No No No No Pioneer House, 302.286.0892 No No No No No No No No Yes Shipley Manor, 302.479.0111 Yes Yes Yes Yes Yes No No No Somerford House, 302.266.9255 $$ No No Yes Yes Yes Yes No Yes Yes Somerford Place All Alz. Unit), Yes Yes Yes Yes Yes Yes Yes Yes Sunrise Assisted Living of Wilmington, 302.475.9163 Yes Yes Yes Yes Yes Yes Yes Yes Windsor Place, 302.239.3200 $$ No No Yes Yes Yes Yes Green Meadows, 302.674.4407 Yes Yes Yes Yes Yes Yes Yes Heritage (Dover), 302.735.8800 Yes No Yes Yes Yes Yes State Street (formerly Elderwood) 302.674.2144 Yes Yes Yes Yes Yes No No No Yes Westminster Village, 302.674.8030 Yes No Yes Yes Yes Yes Yes Brandywine AL at Seaside Pointe, 302.226.8750 $$ Yes Yes Yes Yes Yes Yes No No Yes Heritage (Milford), 302.422.8700 Yes No Yes Yes Yes Yes Methodist Manor House, 302.629.4593 Yes Yes Yes Yes Yes No No No No Peach Tree, 302.684.4002 Yes Seaford Center, 302.629.3575 $$ No No Yes Yes Yes Yes Stockley Center, 302.934.8031 Yes The Village at Green Valley, 302.934.7300 ext. 114 Yes Yes Yes No No Yes URVEY Name Private Alzheimers Wandering Physical Speech Language Respiratory Intravenous Wound Wing Therapy Therapy Therapy Therapy Information confirmed as of September, 2004. $ $$ $100 – $125 $$$ $125 – $150 $$$$ $150 – $175 $$$$$ $175 – $200Under $100 $$$$$$ $200 – $250 Key NURSING HOME SURVEY Beds Semi Occupational Medicaid Medicare Protection Care (NEW CASTLE COUNTY) DEMENTIA SERVICES SPECIALIZED SERVICES PS169 $$$$$ $$$$$ No 120 $$$ $$$$ No *** 37 $ N/A No 101 $$$$ $$$$$ No * 114 $$$$ N/A No *** , 302.995.8434 100 N/A N/A No 72 $$$$ $$$$$$ No 46 $$$$ $$$$$ No 57 $$$ $$$ No 114 $$$$$ $$$$$ No *** 94 $$$$$$ N/A No HCR 162 $$$$ $$$$ 106 $$$$ $$$$ No 172 $$$$$ $$$$$ 66 N/A $$$$$ No 106 $$$$$ $$$$$ 90 $$$$$ $$$$$ No No 302.764.0181 138 $$$$ $$$$$ 67 $$$$$ $$$$$ No No No 77 $$$$ $$$$ No No No 60 $$$$ $$$$ No 110 $$$$ $$$$$ No 67 $$$$ $$$$$ No No 150 $$$$$ $$$$$ No NEW CASTLE COUNTY Name Private Alzheimers Wandering Physical Speech Language Respiratory Intravenous Wound Wing Therapy Therapy Therapy Therapy AYMENT OURCE Accord Health Service at Brandywine, 302.998.0101 Yes Yes Yes Yes Yes No Yes Yes Yes Arbors, 302.328.2580 Yes Yes Yes Yes Yes Yes Yes Yes Yes Carvel Bldg/DE Psychiatric Center, 302.255.2700Yes Yes Yes No No No Yes Yes No Churchman Village, 302.998.6900 Yes Yes Yes Yes Yes Yes Yes Yes Yes Cokesbury Village, 302.234.4444 Yes Yes Yes Yes Yes Yes Yes Yes Yes EP BissellYes Yes Yes Yes Yes Yes Yes Yes Yes Forward Manor, 302.529.1600 Yes Yes Yes Yes Yes Yes Yes Yes Yes Foulk Manor North, 302.478.4296 Yes Yes Yes Yes Yes No Yes Yes No Foulk Manor South, 302.655.6249 Yes Yes Yes Yes Yes Yes Yes No No Gilpin Hall, 302.654.4486 Yes Yes Yes Yes Yes Yes Yes Yes Yes Governor Bacon, 302.836.2550 Yes Yes Yes Yes Yes No Yes Yes No (Manor Care Pike Creek), 302.239.8583 Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Hillside Center, 302.652.1181 Yes Yes Yes Yes Yes Yes Yes Yes Yes Hockessin Hills, 302.652.1181 Yes Yes Yes Yes Yes No Yes Yes Yes Yes Jeanne Jugan Residence, 302.368.5886 Yes Yes Yes Yes Yes Yes Yes Yes Yes Kentmere, 302.652.3311 Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Kutz Home, 302.764.7000 Yes Yes Yes Yes Yes Yes Yes Yes Manor Care (Foulk) Yes Yes Yes Yes Yes No Yes Yes Yes Yes Mary Campbell Center, 302.762.6025 Yes Yes Yes No Yes Yes Yes Masonic Home, 302.994.4434 Yes Yes Yes Yes Yes No No Methodist Country House, 302.654.5101 Yes Yes Yes Yes Yes Yes Yes No Yes Millcroft, 302.366.0160 Yes Yes Yes Yes Yes Yes Yes Yes Yes Newark Manor, 302.731.5576 Yes Yes Yes Yes Yes No No Yes Parkview, 302.655.6135 Yes Yes Yes Yes Yes Yes Yes Yes Yes *Massage **Ventilator ***State Owned Facility Information confirmed as of September, 2004. $ $$ $100 – $125 $$$ $125 – $150 $$$$ $150 – $175 $$$$$ $175 – $200Under $100 $$$$$$ $200 – $250 $$$$$$$ $250 and up Key NURSING HOME SURVEY Beds Semi Occupational Medicaid Medicare Protection Care (NEW CASTLE, KENT & SUSSEX COUNTIES) DEMENTIA SERVICES SPECIALIZED SERVICES PS** 108 $$$$$ $$$$$ No 82 $$$$ $$$$$ No 302.234.5420 104 $$$$$ $$$$$$ 47 $$$$$ $$$$$$ No 100 $$$$$$ $$$$$$ No 120 $$$$ $$$$$ 78 $$$$ $$$$$ *** 400 $$$$$ $$$$$ 151 $$$$$ $$$$$ 120 $$$$ $$$ No 61 $$$$ $$$$$ 109 $$$ $$$ No No 56 $ No No No No 161 $$$$$ $$$$$ ** 179 $$$$$ $$$$$ No 109 $$$$ $$$$ 89 $$$$$ $$$$$ No No 110 $$$$$ $$$$$ 60 $$$ $$$$ No 136 $$$$$$$ $$$$ 4 N/A N/A IU124 $$$ $$$ NEW CASTLE COUNTY (CONT.) KENT COUNTY SUSSEX COUNTY Name Private Alzheimers Wandering Physical Speech Language Respiratory Intravenous Wound Wing Therapy Therapy Therapy Therapy AYMENT OURCE Riverside, 302.765.4400 Yes Yes Yes Yes Yes Yes Yes Yes Yes Shipley Manor, 302.479.0111 Yes Yes Yes Yes Yes Yes Yes Yes Yes St. Francis (Brackenville) Yes Yes Yes Yes Yes No Yes Yes Yes Yes Stone Gates, 302.658.6200 Yes Yes Yes Yes Yes Yes Yes No Yes Tilton Terrace 302.652.3861 Yes Yes Yes Yes Yes Yes Yes Yes Yes Capitol Health Care Services, 302.734.1199 Yes Yes Yes Yes Yes No No No Yes Yes Courtland Manor, 302.674.0566 Yes Yes Yes Yes Yes No No Yes Yes Yes DE Hospital/Chronically Ill, 302.653.8556 Yes Yes Yes Yes Yes No Yes Yes Yes Yes Green Valley Pavillion, 302.653.5085 Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Silver Lake Center, 302.734.5990 Yes Yes Yes Yes Yes Yes Yes Yes Yes Westminster Health Center, 302.674.8030 Yes Yes Yes Yes Yes No No Yes Yes Yes Chancellor Care, 302.846.3077 Yes Yes Yes Yes Yes Yes Yes Yes Country Rest Home, 302.349.4114 $$ Yes Yes Yes Yes No Yes Green Valley Terrace, 302.934.7300 Yes Yes Yes Yes Yes No Yes Yes Yes Yes Harbor Healthcare, 302.645.4664 Yes Yes Yes Yes Yes Yes Yes Yes Yes Harrison House, 302.856.4574 Yes Yes Yes Yes Yes No Yes Yes Yes Yes Lewes Convalescent, 302.645.6606 Yes Yes Yes Yes Yes Yes Yes Yes Lifecare at Loftland Park, 302.628.3000 Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Methodist Manor House, 302.629.4593 Yes Yes Yes Yes Yes Yes Yes No Yes Milford Center, 302.422.3303 Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Milford Transitional Care, 302.422.3311 NFORMATION NAVAILABLE Seaford Center, 302.629.3575 Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes *Massage **Ventilator ***State Owned Facility Information confirmed as of September, 2004. $ $$ $100 – $125 $$$ $125 – $150 $$$$ $150 – $175 $$$$$ $175 – $200Under $100 $$$$$$ $200 – $250 $$$$$$$ $250 and up Key Long Term Care Ombudsman Program 800.233.9074 N U R S I N G H O M E C H E C K L I S T With so many things to consider, choosing the right nursing home for your loved one can seem overwhelming. This checklist will help make it easier. Use it to evaluate and compare the nursing homes you are considering. Make several copies of this checklist so you’ll have one for each nursing home you visit. Name of Nursing Home: Date Visited: Facility Information Is this facility.... Capable of meeting your loved one’s special needs? .Yes .No Medicare certified? .Yes .No Medicaid certified? .Yes .No Conveniently located for family and friends? .Yes .No Currently accepting new residents? .Yes .No If no, how long is the waiting period? The Nursing Home and Staff Does the nursing home..... Have the latest survey reports posted? .Yes .No Have a list of Residents Rights posted? .Yes .No Have special services units? .Yes .No Have a full-time Registered Nurse in the home at .Yes .No all times (other than the Director of Nursing)? Have the same team of nurses and certified Nursing .Yes .No Assistants (CNAs) work with the same resident 4-5 days per week? Use CNAs in the development of the Care Plan .Yes .No Does the staff..... Refer to residents by name? .Yes .No Knock on residents’ door before entering? .Yes .No Quality of Life Are residents..... Dressed appropriately and well groomed? .Yes .No Permitted to have personal belongings .Yes .No and/or furniture? Free to make choices about their daily routine .Yes .No (when to get up, when to eat, etc.)? Have a choice of food items at each meal? .Yes .No Treated with warmth and respect by the staff? .Yes .No Does the nursing home.... Provide each resident with a room with a window? .Yes .No Provide comfortable furniture in resident rooms and public areas? .Yes .No Smell and look clean? .Yes .No Have outside volunteer groups? .Yes .No Offer a wide variety of activities? .Yes .No Have a Family and Resident Council? .Yes .No Have an outdoor area for resident use? .Yes .No Quality of Care Does the nursing home...... Involve residents and family in Care Planning? .Yes .No Have a staff that responds quickly to calls for help? .Yes .No Routinely monitor each resident’s weight? .Yes .No Provide nutritious snacks during the day and evening? .Yes .No Have an arrangement with a nearby hospital for .Yes .No emergency situations? Have enough staff at night and on weekends to care .Yes .No for each resident? Allow residents to continue seeing their personal Physician? .Yes .No NURSING HOME CHECKLIST Safety Does the facility..... Have handrails in the hallways and grab bars in the bathrooms? .Yes .No Have exits that are clearly marked? .Yes .No Have smoke detectors and sprinklers? .Yes .No Clean up spills and other accidents quickly? .Yes .No Keep hallways free of clutter, and well lighted? .Yes .No Provide residents with preventive care, such as a .Yes .No yearly flu shot? NEED INFORMATION ABOUT DELAWARE NURSING HOMES? For questions about nursing home selection: Delaware Long Term Care Ombudsman Program: 800.223.9074 To check the state inspection record of a specific nursing home: Division of Long Term Care Residents Protection: 302.577.6666 EAGLE’S LAW Staffing in nursing homes is a critical component in providing quality of care in long term care facilities. Studies conducted by the federal government and experts in long-term care have shown that residents should receive a minimum threshold of care to maintain their health and wellbeing. In a study released by the U.S. Department of Health and Human Services, researchers found that quality of care was maintained when a resident received at least 4.13 hours per patient day or ppd. In 2000, Delaware passed “Eagle’s Law” which established minimum staffing standards in nursing homes. This law phases in three standards of care over time and is subject to approval by the governor and the legislature. Currently, Delaware has implemented Phase II of Eagle’s Law, which requires at least 3.28 hours of care per patient day (ppd). If the law is fully phased in, nursing homes will be eventually required to provide 3.67 hours ppd. On average Delaware is providing 3.7 ppd to residents in private/non-profit nursing facilities and 4.6 ppd to publicly owned and operated facilities (Source: DLTCRP, August 1, 2004). In addition to specifying the number of hours per day, Eagle’s Law also established staff-to-resident ratios by shift. A nursing home runs on three shifts per day: days-evenings-nights. Each shift is approximately 7.5 to 8 hours in length. The staffing law calls for minimum staffing of nurses (LPN/RN – licensed practical nurses, registered nurses) and certified nurse assistants (C.N.A.) per shift. A nursing facility may opt to comply with one of two standards: 1. Minimum Alternative Staffing Ratio (MASR); or 2. Phase II Staffing Standard. It’s important to ask the facility administrator which standard the nursing home has selected to comply with. Either way, a facility must provide at least 3.28 hours ppd. Listed below are the minimum ratios required by each standard. MINIMUM ALTERNATIVE STAFFING RATIO (MASR) C.N.A. LPN/RN Day 1:9 1:20 Evening 1:10 1:25 Night 1:22 1:40 PHASE II OF EAGLE’S LAW STAFFING RATIOS C.N.A. LPN/RN Day 1:8 1:15 Evening 1:10 1:23 Night 1:20 1:40 TO CALCULATE THE NUMBER OF NURSES AND C.N.A.’S PER SHIFT TURN TO THE BACK. YOU CAN CALCULATE THE NUMBER OF NURSES AND C.N.A.’S PER SHIFT BY USING A SIMPLE FORMULA. 1. Determine the standard the nursing home is using (MASR or Phase II) 2. Convert the ratio listed on the front into a decimal equivalent (see conversion chart below) 3. Multiply the decimal equivalent of the ratio by number of residents in facility SAMPLE CALCULATION Calculate the number of C.N.A’s needed on the day shift for 100 bed facility using the Phase II standard. Step I Check Phase II Chart 1:8 Step II Convert to Decimal 1/8 = 0.125 (See conversion chart below) Step III 0.125 x 100 = 12.5Multiply converted ratio by number of residents in facility Staff Ratio x Number of Beds = Required Staff In this example, the minimum number of CNAs needed for the day shift is 13. Remember to round up to the nearest whole person. RATIO TO DECIMAL CONVERSION CHART 1:8 = 0.125 1:9 = 0.111 1:10 = 0.100 1:15 = 0.066 1:20 = 0.050 1:22 = 0.045 1:23 = 0.043 1:25 = 0.040 1:40 = 0.025 If you need more information on staffing standards you can contact your local Long Term Care Ombudsman to assist you further. Delaware Long Term Care Ombudsman Program 800.223.9074