Selecting a Nursing Home in New York State

Section I: Information about Nursing Homes

What is a Nursing Home?

Nursing homes are places to live where care is available for people who need 24-hour nursing care and supervision outside of a hospital. Although all nursing homes must provide certain basic services, some homes provide special care for certain types of clients. For example, some homes provide services for individuals with head injuries, some for those who are ventilator-dependent, some for people with AIDS and some specialize in the care of children.

Table of Contents

Admission

Finding the nursing home that will best meet your needs can be a difficult and time-consuming task. The more information you have, the easier this task will be and the more likely that you will find the home that is right for you. Making the decision that a nursing home is the right place for you and looking at different homes to identify those that best meet your needs from the services they offer to their cultural environments is important to do.

It is best to have several nursing homes in mind should the need arise. Before it is time for you to be admitted to a nursing home, you should explore what nursing home options are available and research each facility. There are several ways to get information. With the help of your doctor and the hospital discharge planning staff, realistically assess your medical, nursing and social needs and seek facilities that can best meet these needs. For example, a facility with a strong physical therapy department might be important if you are recovering from a stroke.

Discuss nursing home placement with your family so that all possibilities will be fully explored and your feelings known before a crisis occurs.

Watch for articles in newspapers and magazines and for television programs that discuss nursing homes. Pick up information on nursing homes from social service agencies or local offices for the aging and local health departments. Contact community groups and advocacy groups. This Guide lists a number of state and voluntary agencies that may be able to help.

Ask family and friends about their own experiences. If you know someone who is in a nursing home, visit that person and ask questions. Ask questions of key personnel at the facilities you visit: the administrator, social work director, nursing director, and medical director, for example. Make your own judgements. A caring home should welcome both your desire to visit and the questions you ask.

Medical Need

Medical need and method of payment play a large part in admission.

A medical assessment must be performed before you can be admitted to a nursing home. This assessment is done by a registered nurse, who has been certified to perform the assessment. The assessment is a two-step process and is specifically designed by the State Health Department to evaluate your functional status as well as your appropriateness for a nursing home. The Department of Health requires that assessment forms be completed for everyone who applies for residence in a nursing home in New York State. The forms are valid for 30 days for hospitalized individuals and 90 days for those who are in any other setting, including their home.

The nursing home administrator, admissions director or director of social services will be able to explain arrangements for your admission to the facility. If you are receiving care in a hospital, your doctor and the hospital social worker/discharge planner will assist in making arrangements for your placement, hopefully in the nursing home of your choice.

New York State regulations require that a hospitalized patient on Medicaid who no longer needs inpatient hospital care be placed in the first available bed within 50 miles of the patient's home. By telling the hospital which nursing homes to apply to, you or your family can influence the location of the eventual placement.

Admissions Agreement

The admissions agreement (also called the financial agreement, admission contract, entrance contract or some other term) is a legal agreement between the nursing home and the resident to spell out conditions for admission. The contract should state the costs, services included, and all legal responsibilities of the resident. Ideally, it should also include care (in accordance with intensity of need), emergency procedures and standards of food service (for example, availability of therapeutic diets, kosher diets, etc.).

Ask questions about the contract. Ask your attorney, the nursing home administrator or admissions director to explain anything that is not clear. Call an advocacy group with questions. See pages 9 – 12 for a list of organizations that may provide helpful information.

Paying for Nursing Home Care

Few people can afford to pay for nursing home care out of their own pocket for very long (costs range from $3,000 to $10,000 or more a month). Ninety percent of New York State nursing home residents are or become reliant upon state and federal subsidies.

Meet with an elder law attorney to get advice on estate planning, Medicaid, Medicare and long-term care insurance before you apply to a nursing home. The New York State Bar Association Referral Service at 800-342-3661 (LRS@nysba.org), as well as many local bar associations will provide you with a list of elder law attorneys.

Private Payment

Nursing homes charge a basic daily rate for the services they provide and these vary from home to home. Some homes have all-inclusive rates; others have a rate for room and board and add additional charges for physician's services, laboratory tests, physical therapy, prescription drugs, etc.

Private pay rates are not regulated. Homes may charge their private pay residents whatever they wish. These rates can be expected to go up at least once a year. If you are planning to pay for nursing home care out of your own pocket, ask for a list of services that are covered by the basic daily rate. Also ask how the rates are adjusted and how residents are notified of adjustments. (Under current regulation, this notification must occur in writing 30 days prior to any upward adjustment in the daily rate for a service being implemented.)

The basic daily rate must cover room and meals, housekeeping, linen, general nursing care, medical records and services, recreation and personal care. There may be extra charges for items that vary from resident to resident, such as physical therapy and medications. Discuss with the home's admissions director, administrator or social worker what services are standard and what additional services might be required and what they cost.

Homes are permitted to ask for a prepayment or a security deposit. The home can ask for no more than three months' prepayment. Prepayment used as security must be deposited by the home in an interest-bearing account. If you leave the home or die, any amount paid to the home over and above the cost of services already provided must be refunded.

It is illegal for a nursing home to demand or accept donations (to a building fund, for example) from family members to assure placement of a relative.

Most homes require full financial disclosure from residents who will be paying privately. Since many nursing home residents who enter as private pay residents eventually use up their funds and go on Medicaid, the homes want to know how long the resident will be able to pay privately and when to apply for Medicaid. Once you are eligible for Medicaid, you have the right to have Medicaid pay for your care (if the home accepts Medicaid). When this happens, the nursing home should assist in completing the necessary forms.

In New York State, you may not be moved out of a nursing home because you have exhausted your personal resources. Also, your spouse need not spend all of his/her personal resources on your care if you are institutionalized.

Some homes suggest that funds be placed in a trust that the home controls, or that the resident's Social Security checks be made payable directly to the home. The law guarantees residents the right to control their own financial affairs as long as they are willing and able to do so, or to assign that responsibility to a friend or family member. The nursing home may be given control over a resident's finances if no one else is willing to handle them.

Private Insurance

Private long-term care insurance policies are becoming more and more available. They are advertised as a possible alternative to Medicaid or as a way to avoid exhausting resources when nursing home care is needed. They vary in the coverage they provide and should be carefully examined before purchasing. In New York State, only a few policies are valid. The State Insurance Department (SID) publishes materials comparing long-term care policies offered by different companies. Call 1-800-342-3736 or contact the SID at www.dfs.ny.gov for more information.

The federal government is now permitting New York State to authorize Medicaid without someone exhausting his/her assets if that person first purchases a long-term care insurance policy sponsored by the state. Such a policy must cover at least three years of long-term care, six years of home care or an equivalent combination of both. Once an individual purchases such a policy and once the benefits for such a policy are exhausted, that person, if income eligible, will be eligible for Medicaid payment for long-term care for the remainder of his/her life without consideration of his/her assets. Most importantly, however, whatever assets that person has will be protected and will not have to be used to meet long-term care costs. You may hear this type of insurance referred to as a "partnership" long-term care policy.

The New York State Partnership for Long-term Care is a program that combines long-term care private insurance and Medicaid to help New Yorkers prepare financially for the possibilities of needing nursing home or home care. Information on the Partnership can be obtained by calling 1-888-697-7582 or from its website at www.nyspltc.org.

Medicaid

Medicaid, established by Congress in 1965, is a government health insurance program for people of all ages whose income is too low to provide for routine health care costs, or whose health care costs are too high to be covered by their income. This health insurance covers the cost of nursing care for as long as the care is required if a resident is eligible.

A comprehensive application process is used to determine eligibility for the Medicaid program. This process requires that applicants provide detailed information and documentation regarding income and assets. A Medicaid applicant must be a citizen or permanent resident in the United States, must meet New York State income and resource limitations and must show medical need.

Currently, a Medicaid recipient in a nursing home is allowed to retain $50 of monthly income as a personal needs allowance to meet personal expenses that are not covered by Medicaid. Call your local Department of Social Services office for additional information on Medicaid.

Medicare

Medicare is a federal health insurance program for disabled people and people over age 65. Skilled nursing services must be needed on a daily basis to be eligible for Medicare. Medicare will pay a maximum of 100 days of care in an approved nursing facility for patients in need of skilled care following a hospitalization of at least three full days. To qualify, the patient must be admitted to the nursing home within 30 days of discharge from the hospital.

Many people leave a hospital and enter a nursing home expecting Medicare to continue to pay for health services. This is not the case. Medicare will not pay for a nursing home stay if it is determined that only custodial care is required, or if skilled nursing home care and/or rehabilitative services are needed only on a periodic basis. Under Medicare rules, the need for skilled nursing care must be daily. The program has a number of specifics about what services are included and requires that you be responsible for a co-payment. For further information, contact your local Social Security office or call 1-800-772-1213 for a copy of the Medicare Handbook.

Nursing Home Administration

Nursing homes may be owned by state/local governments (public nursing homes), individuals, corporations and religious or charitable organizations. Most nursing homes are not-for-profit businesses (voluntary nursing homes) or businesses operated for profit (proprietary nursing homes). An individual or a nonprofit organization may own or operate more than one nursing home.

Final responsibility for the operation of a nursing home lies with its governing body (voluntary nursing home) or owner (proprietary nursing home). The governing body (the board of directors or trustees) is legally responsible for the home. The governing body meets to set policies and to adopt and enforce rules and regulations for the health care and safety of the residents. The type of ownership and management are not necessarily an indication of the quality of service that you would receive.

The person in charge of the day-to-day management of a nursing home is called the administrator; the administrator is appointed by the governing body or owner. Other key personnel include the director of nursing services, the medical director, the director of social services and the director of admissions.

The administrator of the nursing home must be licensed by New York State, the director of nursing services must be a registered nurse and licensed by New York State and the medical director must be a licensed New York State physician.

Speaking with each of these leaders should give you a good understanding of the home's philosophy and operation.

Health Care Decisions

Illness and the possibility of death are subjects few people find easy to discuss. Yet, these issues deserve consideration by both you and your family because they often involve decisions that may have to be made if life-sustaining procedures become necessary. This kind of decision does not have to be left to the family to decide. Decide in advance with the help of your family. Any course of treatment for you will be much easier to determine if your wishes are known in advance (see Appendix B).

Under the New York State Health Care Proxy Law, adults may appoint someone they trust to decide about medical treatment should they become unable to decide on their own. See Appendix C for a copy of the Health Care Proxy form and information about the Health Care Proxy Law. This form can be duplicated and does not have to be executed by an attorney. Additional copies are available from the nursing home administrator or from the New York State Department of Health. Most attorneys in New York State also have these forms.

Adults can also give specific instructions about treatment in advance. Those instructions can be verbal or written, and are referred to as Advance Directives. The right to decide about treatment also includes the right to decide about cardiopulmonary resuscitation (an emergency treatment to restart the heart and lungs when breathing or circulation stops). You and your doctors should decide in advance whether or not you want resuscitation measures taken. If you wish, the doctor will give the medical staff a "do-not-resuscitate" (DNR) order. An explanation of DNR, including your rights under New York State law, is included as Appendix D.

Some nursing homes' moral or religious philosophy may conflict with your wishes about advance directives. Ask about the home's policy regarding advance directives to determine if a particular home is right for you.

Residents' Rights

Policies covering the rights of residents are established by state and federal regulations. The nursing home must implement and explain these policies to its residents and must post a summary of residents' rights (a residents' bill of rights) in the building for easy reading. Be sure to notice it and ask any questions you have about its provisions.

Every resident in a nursing home should receive appropriate care, be treated with courtesy and enjoy continued civil and legal rights. The Residents' Bill of Rights is as follows:

In New York State, nursing home residents have the right to:

  • Dignity, respect and a comfortable living environment;
  • Quality of care and treatment without discrimination;
  • Freedom of choice to make independent decisions;
  • Safeguard of money and property;
  • Safeguards in admission, transfer and discharge;
  • Privacy in communications;
  • Participate in organizations and activities of their choice;
  • An easy-to-use and responsive complaint procedure; and
  • Exercise all rights without fear of reprisals.

For a more thorough explanation of nursing home residents' rights, ask the nursing home administrator for policies on residents' rights and for the booklet "Your Rights as a Nursing Home Resident in New York State and Nursing Home Responsibilities".

Long-Term Care Ombudsman Program

The Long-Term Care Ombudsman Program in the State Office for the Aging (SOFA) can help you throughout the nursing home placement process. It provides another source of information about how to go about choosing a facility, understanding the rights of residents and learning about good standards of care. However, the program does not rate or recommend specific facilities and will not choose a facility for a family or a prospective resident.

The State Ombudsman also investigates and resolves complaints made by, or on behalf of, nursing home residents, and monitors the development and implementation of laws, regulations and policies that affect nursing homes.

You may find a phone number and e-mail address for your local Ombudsman through the following listing:

Listing of New York State Office for the Aging Long Term Care Ombudsmen

Further Information

For further information, you may access the following websites:

Or, contact the following agencies:

Nursing Home Complaint Hotline

The New York State Department of Health operates a toll-free hotline to receive complaints about nursing home care in New York State. The hotline can be called 24 hours per day. Clinical professionals speak with all individuals who call the hotline to get specific information about the individual's concerns. The Department's surveyors then investigate the issue and make a determination. To contact the hotline, use the following:

  • Nursing Home Complaint Hotline
    875 Central Ave.
    Albany, New York 12206
    1-(888)-201-4563
    Fax: (518) 408-1157

You can also contact the following advocacy organizations. They may be able to help you if your questions or concerns about a nursing home cannot be resolved by speaking with nursing home staff and administrators.

Coalition of Institutionalized Aged & Disability

  • 425 E. 25th St., Room 910W
    New York, New York 10010
    212-481-7572

CIAD was founded in 1973 to protect the rights of nursing home residents and provide them with the information and skills they need to advocate for themselves. The coalition educates residents about their rights, provides technical assistance to resident councils to make them more effective and promotes residents' participation in public issues. Its board consists of nursing home and adult home residents.

Friends and Relatives of Institutionalized Aged, Inc. (FRIA)

  • 18 John St., Suite 905
    New York, New York 10038
    212-732-4455

FRIA is an independent nonprofit advocacy group organized in 1976 to speak on behalf of the families and friends of adult home and nursing home residents in the New York City area. Through a telephone hotline, FRIA helps families in the selection of a facility and in understanding financial arrangements and admission contracts. It supports families and family councils seeking to safeguard resident rights, responds to problems of care and advances the independence of all residents.

Medicare Rights Center

  • 1460 Broadway, 17th Floor
    New York, New York 10036-7393
    212-869-3850

The center is exclusively devoted to promoting and protecting Medicare beneficiaries' rights through education, advocacy and representation. The center assists Medicare recipients to recover funds by teaching them how to assert their Medicare rights, and assists recipients with appealing their Medicare determinations, distributing self-help literature and enforcing federal and state physician charge limits for Medicare beneficiaries.

National Citizens' Coalition for Nursing Home Reform

  • 1828 L. Street, N.W., Suite 801
    Washington, D.C. 20036-2211
    202-332-2275

The coalition provides information (through a clearinghouse and a bimonthly newsletter) and leadership on federal and state regulatory and legislative policy development, and models and strategies to improve nursing home care and life for residents. Established in 1975, the coalition promotes community involvement in nursing homes; assists in resolving individual complaints and problems; collaborates with health care workers to improve care in nursing homes; monitors regulatory activities to generate effective government enforcement of standards; and supports resident and family council and other forms of consumer empowerment.

New York Statewide Senior Action Council, Inc.

  • 275 State St.
    Albany, New York 12210
    518-436-1006
    Patient's Rights Hotline: 800-333-4374 (in New York City: 212-316-9393)

Formed in 1972, Statewide Senior Action Council is a grassroots nonprofit advocacy organization for senior citizens. The Albany office maintains regular contact with state agencies and legislative leaders on important issues for seniors and has been instrumental in establishing a prescription drug assistance program in the state known as EPIC, maintaining quality care in the Medicare program and establishing the patients' bill of rights. The Statewide hotline is for anyone who has a problem with hospital admissions or discharges, unwanted transfers between hospitals, an unsafe transfer to another hospital, poor quality care, poor discharge planning or lack of post hospital services.

Long Term Care Community Coalition of New York State

  • 242 W. 30th Street Suite 306
    New York, New York 10001
    212-385-0355

This organization provides leadership for its 33-member statewide consumer advocacy organizations. The coalition works to upgrade state regulations, and the state's surveillance and enforcement of existing regulations. The group also educates consumers on key nursing home problems and issues.

Nursing Home Provider Associations

Nursing home provider associations also have useful information about nursing homes that are their members. The following organizations represent and provide assistance to nursing homes:

County Nursing Facilities of New York

  • 111 Pine Street
    Albany, New York 12207
    Phone: 518-465-1473

Greater NY Healthcare Facilities Association

  • 360 W. 31st St., Ste. 303
    New York, New York 10001
    212-643-2828

Greater NY Hospital Association

  • 555 West 57th Street
    New York, New York 10019
    212-246-7100

Healthcare Association of NYS

  • 1 Empire Drive
    Rensselaer, New York 12144
    518-431-7600

Intercounty Health Facilities Assoc.

  • 1615 Northern Blvd. Suite 306
    Manhasset, New York 11030
    516-627-3131

NY Association of Homes and Services for the Aging

  • 150 State Street, Suite 301
    Albany, New York 12207-1698
    518-449-2707

NYS Health Facilities Association

  • 33 Elk Street, Suite 300
    Albany, New York 12207-1010
    518-462-4800

Southern New York Association, Inc.

  • 39 Broadway, Room 2805
    New York, New York 10006
    212-425-5050

Section II provides information on what to look for when you visit a nursing home.

Return to Selecting a Nursing Home