Section I: General Information About Nursing Homes - Selecting a Nursing Home in New York State
What is a Nursing Home?
Nursing homes are places to live where care is available for people of all ages who need 24-hour nursing care and supervision outside of a hospital. Although all nursing homes must provide certain basic services, some provide specialized care. For example, some nursing homes provide services for people with neurobehavioral disorders, some for those who are ventilator-dependent and some for people with AIDS. Some nursing homes specialize in the care of children.
Exploring the Options
Finding a nursing home that will best meet your needs can be a difficult and time-consuming task. The more information you have, the easier the task will be and the more likely you will find the nursing 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 environment, is important to do.
It is best to have several nursing homes in mind. Before it is time for you to be admitted to a nursing home, you should explore what options are available and research each facility. There are several ways to obtain information. With the help of your doctor and the hospital discharge planning staff (if you are hospitalized), realistically assess your medical, nursing and social needs and seek facilities that can best meet those 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 can be fully explored and your feelings are known. 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 aging and health departments. Contact community groups and advocacy groups. This Guide presents a number of State and voluntary agencies that may be able to help.
Visit the New York State Nursing Home Profile to obtain information on nursing homes in New York State and the quality of care they provide. The care the nursing homes provide can also be compared on the Federal Medicare website (Nursing Home Compare). 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 your doctor if he/she provides care at any nursing homes so that you may be able to continue your relationship with him/her within the nursing home.
Ask questions of key personnel at the facilities you visit -- the nursing home administrator, admissions director, social work director, nursing director and medical director, for example. Make your own judgments. A caring nursing home should welcome both your desire to visit and the questions you ask.
Medical Need and Admission
A medical assessment must be performed before you can be admitted to a nursing home. This assessment is completed by a registered nurse who has been certified to conduct the assessment. The assessment is a two-step process and is specifically designed by NYS DOH to evaluate your functional status, as well as your appropriateness for a nursing home. The assessment is valid for 30 days for individuals who are hospitalized and 90 days for individuals who are in any other setting, including their home.
The nursing home administrator, admissions director or social work director will be able to explain arrangements for your admission to the nursing home. If you are receiving care in a hospital, your doctor and the hospital discharge planning staff 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 who is on Medicaid and no longer needs inpatient hospital care, but requires nursing home 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 your eventual placement.
Each nursing home is required to develop an admission policy and procedure that is in accordance with State and Federal regulations and does not unlawfully discriminate against applicants. However, nursing homes have discretion in making admission decisions and are not required to admit every applicant.
The admissions agreement (also called the financial agreement, admission contract or entrance contract) is a legal agreement between you and the nursing home to outline conditions for admission. The agreement should state the costs, services included and all of your legal responsibilities as the resident. Ideally, it should also include the care to be provided (in accordance with the intensity of need), emergency procedures and standards of food service (e.g., availability of therapeutic diets, kosher diets).
Ask questions about the agreement. Ask your attorney and/or the nursing home administrator, admissions director or social work director to explain anything that is not clear. Call an advocacy group with questions. Resources for helpful information are shown throughout this document.
Paying for Nursing Home Care
Few people can afford to pay for nursing home care out of their own pocket for very long (costs can be $10,000 or more a month). Most nursing home residents are (or become) reliant upon State and Federal subsidies.
Meet with an elder law attorney to get advice on estate planning, Medicare, Medicaid and long-term care insurance before you apply for admission to a nursing home. The New York State Bar Association's Lawyer Referral and Information Service (as well as many local bar associations) can provide you with a list of elder law attorneys. The Lawyer Referral and Information Service can be contacted at 800-342-3661 or firstname.lastname@example.org.
Nursing homes charge a basic daily rate for the services they provide. These rates vary. Some nursing homes have all-inclusive rates; others have a rate for room and board, with additional charges for physician's services, laboratory tests, physical therapy, prescription drugs, etc.
Private pay rates are not regulated. Nursing homes may charge private pay residents whatever they choose. These rates can be expected to increase 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 regulations, 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, general nursing care, personal care, recreation, medical records, housekeeping and linen. There may be extra charges for items that vary from resident to resident, such as physical therapy and medications. Discuss with the nursing home administrator, admissions director or social work director what services are standard and what additional services might be required and what they cost.
Nursing homes are permitted to ask for a pre-payment or security deposit. However, no more than three months' pre-payment can be requested. The nursing home must deposit pre-payment used as a security in an interest-bearing account. If you leave the nursing home or die, any amount paid to the nursing 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 (e.g., for a building fund) from family members to assure placement of a relative.
Most nursing homes require full financial disclosure from residents who will be paying privately. Since many nursing home residents who enter as private pay residents eventually exhaust their funds and go on Medicaid, the nursing home wants to know how long you 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 nursing home accepts Medicaid). When this happens, the nursing home should assist you in completing the necessary paperwork.
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 for your care if you are institutionalized. However, transfer and discharge is permissible if you fail to pay for (or to have paid under Medicare, Medicaid or third party insurance) a stay at the nursing home.
Some nursing homes suggest that funds be placed in a trust that the nursing home controls or that your Social Security checks be made payable directly to the nursing home. The law guarantees you the right to control your own financial affairs as long as you 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 your finances if no one else is willing to handle them.
Private long-term care insurance policies are becoming more widely available. They are advertised as a possible alternative to Medicaid or as a way to avoid exhausting resources when/if nursing home care is needed. Policies vary in the coverage they provide and should be carefully examined before purchasing. In New York State, only a few policies are valid. The New York State Department of Financial Services (DFS) publishes information about long-term care and the long-term care insurance policies available in New York State. For more information, call the DFS Consumer Hotline at 800-342-3736 or visit the DFS website at www.dfs.ny.gov.
The Federal government now permits New York State to authorize Medicaid without an individual exhausting his/her assets if that person first purchases a long-term care insurance policy sponsored by the State. These policies 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 the benefits are exhausted, that person, if income qualified, 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 unique NYS DOH program that combines private long-term care private insurance and Medicaid Extended Coverage to help New Yorkers prepare financially for the possibility of needing nursing home care or assisted living services someday. For more information, call 866-950-7526 or visit the Partnership website at www.nyspltc.org.
Medicare is a Federal health insurance program for people aged 65 and older and disabled people. Medicare covers skilled nursing care in a nursing home under certain conditions for a limited time. However, the program is very specific about what services are included and under what circumstances. You should familiarize yourself with these specifics based on your own personal situation.
For more information, call 800-772-1213 or visit the Social Security website at www.ssa.gov. You may also visit your local Social Security office.
Medicaid was established by Congress in 1965 as 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 home care for as long as the care is required if an individual 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 of the United States, meet New York State income and resource limitations and 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 expenses that are not covered by Medicaid.
Medicaid Managed Care and Managed Long Term Care
As part of New York State's Medicaid reforms, NYS DOH set a goal of having all Medicaid consumers served in care management by April 2018. This effort began in 2011 to improve quality of care and patient outcomes over the full range of health care, including mental health, substance use, and developmental disability services. This includes long term care. Effective February 1, 2015, for New York City, April 1, 2015 for Nassau, Suffolk, and Westchester Counties, and July 1, 2015 for the rest of the State, any Medicaid consumer aged 21 and older placed in a nursing home for a long-term stay must remain in, or join, a Medicaid Managed Care Plan or a Managed Long Term Care Plan. Medicaid consumers who also get Medicare must join a Managed Long Term Care Plan. Medicaid-only consumers must join a Medicaid Managed Care Plan unless they meet certain conditions. Rules of eligibility for long term care are the same.
For more information about Medicaid, including Medicaid Managed Care and Managed Long Term Care, visit the NYS DOH website at http://www.health.ny.gov/health_care/medicaid/ or contact your local Department of Social Services office.
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.
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 nursing home. The governing body meets to set policies and adopt and enforce rules and regulations for the health care and safety of the residents. The type of ownership and management is 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 admissions director, social work director, nursing services director and medical director.
The administrator of the nursing home must be licensed by New York State. The nursing services director must be a registered professional nurse. The medical director must be a New York State licensed physician. Speaking with each of these leaders should give you a good understanding of the nursing home's philosophy and operation.
Health Care Decisions
Illness and 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. 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.
Advance Directives are specific written or verbal instructions about treatment made by an adult. 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 doctor 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. In accordance with the New York Health Care Proxy Law, adults may appoint someone they trust to decide about medical treatment should they become unable to decide on their own.
To complement the use of traditional advance directives and facilitate the communication of medical orders impacting end-of-life care for patients with advanced chronic or serious illness, the Medical Orders for Life-Sustaining Treatment (MOLST) program was created. The MOLST program is based on the belief that you have the right to make you own health care decisions, including decisions about life-sustaining treatment, to describe these wishes to health care providers and to receive comfort care while wishes are being honored.
For more information about Advance Directives and the New York Health Care Proxy Law, visit the NYS DOH website at www.health.ny.gov/professionals/patients/health_care_proxy/.
DNR orders, including your rights under New York State law, can be found at www.health.ny.gov/publications/1449/section_3.htm#DECIDING. Information about the MOLST program can be found at http://www.health.ny.gov/professionals/patients/patient_rights/molst/.
Some nursing homes' moral or religious philosophy may conflict with your wishes about Advance Directives. Ask about the nursing home's policy regarding Advance Directives to determine if a particular nursing home is right for you.
Policies covering the rights of residents are established by State and Federal regulations. The nursing home must implement these policies and explain them to residents. The nursing home must also post 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.
Any person requiring nursing home care should be able to enter any nursing home and receive appropriate care, be treated with courtesy and enjoy continued civil and legal rights. As a nursing home resident, you have the right to:
- Dignity, respect and a comfortable living environment
- Quality of care and treatment without discrimination
- Freedom of choice to make your own, independent decisions
- The safeguard of your property and money
- Safeguards in admission transfer and discharge
- Privacy in communications
- Participate in organizations and activities of your choice
- An easy-to-use and responsive complaint procedure
- Exercise all of your rights without fear of reprisals
Ask the nursing home administrator for policies on residents' rights and for the booklet entitled "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 (LTCOP) is a Federal advocacy program dedicated to protecting people living in long-term care facilities. In New York State, the Office for the Aging operates LTCOP through its Office of the State Long Term Care Ombudsman. LTCOP can help you throughout the nursing home placement process. The Program provides another source of information for selecting a nursing home, understanding the rights of residents and learning about good standards of care. However, the Program does not rate or recommend specific nursing homes and will not select a nursing home for a family or prospective resident.
LTCOP advocates for residents by investigating and resolving complaints made by or on behalf of residents; promoting the development of resident and family councils; and informing government agencies, providers and the general public about issues and concerns impacting residents of long-term care facilities.
For more information, call the New York State Senior Citizens' HelpLine at 800-342- 9871 or visit the New York State Office of Long Term Care Ombudsman at www.ltcombudsman.ny.gov.
Nursing Home Complaints
NYS DOH operates a Nursing Home Complaint Hotline to receive complaints about nursing home care in New York State. The toll-free Hotline can be called 24 hours a day, seven days a week. The Hotline is staffed by clinical professionals who provide specific information about callers' concerns. NYS DOH surveyors then investigate the issue and make a determination on whether State or Federal regulations have been violated.
- New York State Department of Health
Nursing Home Complaint Hotline
875 Central Avenue
Albany, New York 12206
- New York State Office for the Aging
2 Empire State Plaza
Albany, New York 12223
800-342-9871 (General Assistance)
800-342-9871 (Senior Citizens' HelpLine)
- New York State Justice Center for the Protection of People with Special Needs
161 Delaware Avenue
Delmar, New York 12054
518-549-0200 (General Phone)
TTY: Dial 7-1-1 for the NYS Relay and give the operator 1-518-549-0200
855-373-2122 (Report Abuse)
800-624-4143 (Information and Referral)
TTY: Dial 7-1-1 for the NYS Relay and give the operator 1-800-624-4143
Additional information about long-term care services and supports can be obtained from the Aging and Disability Resource Center (ADRC) at http://www.aoa.gov/AoA_programs/HCLTC/ADRC/ADRC_Program.aspx or locally through NY Connects: Choices for Long Term Care at https://www.nyconnects.ny.gov/.
Nursing Home Provider Associations
Nursing home provider associations also have useful information about nursing homes that are members. The following organizations represent and provide assistance to nursing homes in New York State:
- Continuing Care Leadership Coalition
555 West 57th Street, Suite 1500
New York, New York 10019
- Greater New York Health Care Facilities Association
519 Eighth Avenue, 16th Floor
New York, New York 10018
- Healthcare Association of New York State
One Empire Drive
Rensselaer, New York 12144
- Intercounty Health Facilities Association, Inc.
1615 Northern Boulevard, Suite 306
Manhasset, New York 11030
- LeadingAge New York
13 British American Boulevard, Suite 2
Latham, New York 12110
- New York State Association of Counties
540 Broadway, 5th Floor
Albany, New York 12207
- New York State Health Facilities Association
33 Elk Street, Suite 300
Albany, New York 12207
- Southern New York Association
39 Broadway, Suite 1710
New York, New York 10006