In Part 2, we said that Grandma can stay at the retirement home if she is able to walk, bathe, eat and dress without assistance. This article will address what to do with Grandma if she cannot remain at home safely (Part I) and the level of care required is greater than what is offered at the retirement home.

If Grandma has to go to a nursing home, how do you choose the best one? “That’s easy,” you might say, “Keiro Nursing Home.” That might be true if you live in Los Angeles or the South Bay, but it’s not necessarily true if you live too far away to visit regularly. In other words, location is the most important factor to consider.

Try to select a nursing home that is close and convenient to the person(s) who will be visiting Grandma the most often. Residents who have frequent visitors often recover faster, are happier and healthier from the love and attention received and tend to receive a higher quality of care.

“Does that mean that residents who never get visitors tend to get a lower level of care?” Perhaps. When family members and friends are close enough to visit frequently, they can monitor the resident’s condition and file complaints for abuse or neglect with the California Department of Public Health (DPH).

Try to obtain information about facilities from people you trust. Relatives, friends, clergy, local senior groups, ombudsman programs, Alzheimer’s support groups, hospital discharge planners, doctors and others may have recent experiences with nursing homes in your area. If possible, ask the residents and visitors their opinions while making visits.

Always seek a nursing home that can meet any special-care needs your loved one may have. For example, due to behaviors associated with dementia, some residents may need a locked facility. Others may need a ventilator, which is only available at certain facilities. Make sure the facilities under consideration are currently able to provide the necessary care.

Remember, not all nursing homes are the same. Some are better than others. To make sure Grandma will get the best of care, you will need to visit to the facility. Ask to see the entire facility, not just the nicely decorated lobby or a designated unit. Try to get a feel for the quality of care and how residents are treated by the staff.

Over the years, I have visited nursing homes all over L.A. and Orange counties. I can get a general impression of the quality of care using two simple tests. First, if the nursing home is dark and smells bad (like urine), probably not the best choice. The nicer facilities are bright and cheery, and smell clean(er).

Also, if residents are left unattended in the hallways, slumped over in their wheelchairs, also probably not the best choice. In the nicer facilities, if you see a resident in the hallway, they are almost always accompanied by an attendant pushing or assisting them down the hallway.

How do you feel when you visit the facility? How did the administrator and staff treat you? Remember that you’ll be depending on these people to take care of your loved one. Some nursing homes I just don’t like to visit — it’s depressing. Imagine what it would be like to have to live there.

Many people are admitted to nursing homes from hospitals. If your family member or friend is hospitalized, contact the hospital’s discharge planning or social work office as soon as possible to request assistance in arranging nursing home care. Hospitals are required to help patients locate and obtain care and services they will need upon discharge.

Medicare’s short–term skilled nursing facility benefit is very limited, but is often helpful to gain admission to a nursing home, especially when skilled nursing care or therapy are needed after hospitalization due to a stroke, surgery, injury or other medical conditions. Medicare covers up to 100 days of skilled nursing care following a hospital stay of at least three days.

If you want help paying for the nursing home care, make sure that you select a facility that is certified by both Medicare and Medi-Cal. Although most California nursing homes participate in both, some are private-pay only. Due to the extremely high cost of nursing home care – which averages $7,500 per month or more  – few people can afford to pay privately for very long.

Medi–Cal helps pay nursing home care for two of every three residents in California. Due to the high cost of nursing home care, most people in nursing homes will meet Medi-Cal’s financial eligibility requirements sometime during their stay. If you are told that you do not qualify for Medi-Cal since you have too many assets, that may not necessarily be true (see Part 4 coming soon).

Although it is illegal for a certified nursing home to require a resident to pay privately for any set period of time, many nursing homes give preference to applicants who can pay privately. The longer you can pay the private rate, the more options you will have when looking for a facility.

“Say, Judd, are you saying that if I want to place Grandma in a nursing home that has a waiting list, I could get her in faster if I put her application in as ‘private pay’? Then, once she is in, convert her to Medi-Cal?” It has been done. Medi-Cal facilities cannot evict residents who qualify for Medi-Cal during their stay.

Choosing a nursing home for a family member is one of the most difficult decisions in life. It is a stressful, time-consuming task that is often made worse by the fact that a loved one has suffered a medical crisis. You may face great pressure to locate a nursing home and arrange care in a very short period of time.

If you need help finding a list of Medi-Cal licensed nursing homes in your area, there are many websites that can assist you. Some of these sites have in-depth information on all 1,300-plus nursing homes in California. If you don’t have access to the Internet, please feel free to call my office at (310) 348-7272. Any member of my staff would be happy to assist you.

Judd Matsunaga, Esq., is the founding partner of the Law Offices of Matsunaga & Associates, specializing in estate/Medi-Cal planning, probate, personal injury and real estate law. With offices in Torrance, Hollywood, Sherman Oaks, Pasadena Fountain Valley, he can be reached at (800) 411-0546. Opinions expressed in this column are not necessarily those of The Rafu Shimpo.

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