By JUDD MATSUNAGA, Esq.
After my “Kei-Ai: Most Deadly Nursing Home” article came out (June 12, 2021), I’ve been asked by several members of the Rafu Shimpo community, “What nursing homes are best?”
In a nutshell, I would respond with the following question, “Where do you live?” More specifically, “Where do the family members that will be visiting the most live?”
Let’s face the truth. ALL nursing homes are under-staffed because all of them are trying to make money. The more staff they cut, i.e., the less the overhead, the more profit they make. California nursing homes are famous for “drugging” their residents. If the majority of residents are sleeping all the time, they need less staff to take care of them, and the more profit they make.
If you visit your loved one at a nursing home and they’re always groggy, confused or sleeping, there’s a good chance the nursing home is over-medicating him/her. If so, demand to see their medical chart. Find out if they are administering medications without consent. It is illegal for nursing homes to give drugs without consent.
If you find that they are, you (the family member) must “rock the boat.” You say, “But Judd, I’m Japanese. I was taught ‘don’t rock the boat.’” I understand. I read an old Japanese proverb that said, “It is the nail that sticks out that gets the hammer.” Well, I’m Sansei – I say, to protect your loved one, “It is the squeaky wheel that gets the oil.” Go ahead and “rock the boat.”
However, if it’s just not in your DNA, there are advocating groups that you can go to for help.
The first is the County Ombudsman. There are posters on the hallways of all long-term care facilities giving the number to the local ombudsman office. Long-Term Care Ombudsman representatives assist residents in long-term care facilities with issues related to day-to-day care, health, safety, and personal preferences. Problems can include, but are not limited to:
• Violation of residents’ rights or dignity
• Physical, verbal, mental, or financial abuse
• Poor quality of care
• Dietary concerns
• Medical care, therapy, and rehabilitation issues
• Medicare and Medi-Cal benefit issues
• Improper transfer or discharge of a resident
• Inappropriate use of chemical or physical restraints
Another is the California Advocates of Nursing Home Reform. CANHR has a wealth of information on nursing home residents’ rights and rights of family members on its website, www.canhr.org. You may recall in recent Rafu Shimpo articles that CANHR helped file Senate Bill 279 to stop the evictions and transfers of nursing home residents at Sakura Intermediate Care Facility (ICF) in Boyle Heights.
Sure, you can find the best “rated” nursing home in town; it might even ease your guilt. But if that nursing home is across town, where it’s difficult to get to, sooner or later you’ll stop going as often as you should. Studies have shown that nursing home residents who get visited regularly tend to get better care.
Therefore, the “best” nursing home is the home where family can visit the most often. You, the family member(s), are the best advocate to ensure your loved one gets proper care. The nursing home is getting paid good money to take care of your loved one, but you need to be a good advocate to enure they get the proper care they need.
If you want Medicare or Medi–Cal to help pay for the nursing home care, you must select a facility that is certified by these programs. Medi-Cal will not pay for board and care. Medi-Cal will not pay for assisted living. However, a few assisted living facilities do accept a Medi-Cal waiver program. Due to the extremely high cost of nursing home care – which averages well above $300 per day – most California nursing homes participate in both Medicare and Medi–Cal.
CANHR recently published a FACT SHEET entitled “How to Choose a Nursing Home” (updated July 1, 2021). The following are portions of that Fact Sheet that I thought would be most helpful. The complete Fact Sheet can be found on CANHR’s website listed above.
It is important to select a nursing home that is close and convenient to the person(s) who will be visiting the resident 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. When family members and friends are close enough to visit frequently, they can monitor the resident’s condition, participate in care planning and respond quickly to emergencies.
Despite plummeting rates of COVID infections and deaths in nursing homes due to vaccines, many California nursing homes are still limiting visits from families and friends to 30 minutes per week or less. Other facilities, in stark contrast, are permitting extensive visitation. The state has enabled the wide range of visitation policies among facilities by continued waiver of laws that normally give residents the right to have visitors at any time.
Avoid nursing homes with restrictive visitation policies. All other things being equal, select a nursing home that allows robust visitation. Ask for written copies of each facility’s current visitation policy and for details on how it is implemented. Don’t select a facility that tolerates isolation of residents.
Once you have a list of 4-5 conveniently located nursing homes that accept Medi-Cal, go visit the facility. Nothing substitutes for a personal visit to the facility. Personal visits have always been the most important way to assess the quality of a nursing home, yet this option has not been available during the pandemic while facilities have been closed to visitors.
However, some nursing homes are now allowing potential residents and their representatives to make personal visits on-site to assess their services. All other things being equal, select a nursing home that has allowed you to observe its care and services. Beware of nursing homes that expect you to select them sight unseen.
When visiting facilities under consideration, 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. Resident appearance, use of restraints, residents’ rooms, quality of food and activities are all important factors in evaluating a nursing home. However, nothing is more important than the quality and quantity of nursing home staff.
How do you feel when you visit the facility? How does it compare to others? How did the administrator and staff treat you? Remember that you’ll be depending on these people to take care of your loved one. If you don’t like visiting there, imagine what it would be like living there.
People sometimes overestimate the importance of an attractive building. While a nursing home should be safe, clean and comfortable, it doesn’t do the potential resident any good to choose a “fancy” nursing home if the resident can’t afford it, if it can’t meet the resident’s needs or if it is too far away for family and friends to visit.
In conclusion, Medicare covers up to 100 days of skilled nursing care following a hospital stay of at least three days. 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.
But if your loved one still needs care after the 100 days, you need to qualify for Medi–Cal. 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.
Even if you don’t qualify for Medi–Cal now, it is best to select a Medi–Cal-certified facility. Uncertified facilities can evict you when your money and insurance runs out. Your choice of other facilities at that point may be very limited. Medi–Cal-certified facilities cannot evict residents who qualify for Medi–Cal during their stay.
Finally, here’s some good news. Even if the nursing home told you your loved one doesn’t qualify for Medi-Cal because they have too much money (or property), they are legally allowed to spend down to qualify for Medi-Cal before they become penniless. “But Judd, won’t that trigger a three-year waiting period?” No, not if you seek competent legal advice from an elder law attorney.
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 and Fountain Valley, he can be reached at (800) 411-0546. Opinions expressed in this column are not necessarily those of The Rafu Shimpo.