Nursing Home Admissions Process: What to Expect - Cona Elder Law

Nursing Home Admissions Process: What to Expect

The nursing home admission process can be overwhelming, especially when juggling the emotional impact of placing a loved one in a nursing home.  Knowing what to expect can help alleviate some of the stress.

When a hospital is ready to discharge a patient who needs rehabilitation or residential health care services, a nurse will complete a Patient Review Instrument (PRI).  This assessment is required for admission to any nursing home in New York State.  Family members and loved ones will be asked to identify six skilled nursing facilities of their choosing for their loved one’s admission.  The PRI will be sent to the selected facilities which will determine if the individual is suitable for admission to their facility.

When an individual has a three-day hospital stay immediately prior to being transferred to a skilled nursing facility or rehabilitation center, s/he will be entitled to a maximum of 100 days of Medicare coverage if all eligibility criteria are met and so long as the individual is making progress and/or maintaining their skill level due to the therapy or rehabilitation services provided. The first 20 days in the facility will be paid for in full by Medicare and days 21-100 will be subject to a co-pay, which can be covered by supplemental Medicare insurance (i.e. Medigap coverage) or other private health insurance.  If the individual is no longer progressing and/or maintaining their skill level with therapy or rehabilitation, their Medicare coverage will end and another payment source will be required.

The cost of nursing home care is extremely high, averaging tens of thousands of dollars per month.  As noted above, Medicare covers a maximum of 100 days of nursing home care and regular health insurance plans do not cover long-term health care needs such as care in a nursing home.  Accordingly, there are only three ways to pay for nursing home care:  payment from your own assets and savings, long-term care insurance or Medicaid. 

When you are admitted to a nursing home, you will be asked to sign an Admission Agreement.  If you cannot do so, an agent under a Power of Attorney or other designated representative can sign the agreement for you.   If you have assets, you will be asked to pay a security deposit.  For those applying for Medicaid benefits, your monthly income (Social Security benefits, pension, etc.) must be paid to the nursing home each month (which income is called Net Available Monthly Income or “NAMI”).

It is important to plan ahead and prepare for the costs of such care.  Your Elder Law Attorney can review your asset protection options but keep in mind that the earlier you plan, the more assets you can save.