“Why in the world is a nursing home placement for my dad so difficult?” Bill from Smyrna

Thank you so much for your question! This is a question we hear quite a bit – and yes, you are completely correct for a variety of reasons. Nursing home placement for residential care (when someone goes to live at the nursing home and this becomes their primary residence) is one of the most difficult tasks we, as Aging Life Care Managers, face when assisting families with this process.

Unfortunately there is no “magic wand” to make the process easier. However, we have found that knowing a bit more about the internal mechanisms of “the system” can allow you to have a greater understanding of why the difficulties exist and for you in order to have the best results in nursing home placement.

According to Medicare.gov (which is our recommended search engine for nursing homes in your area), there are 92 nursing homes within 50 miles of Atlanta, GA. So, with the wealth of properties in the area – why would it be tough to find one to care for dad?

Here are a few of the factors in nursing home placement that can contribute to the challenges…

• The facility’s reimbursement – In Georgia, nursing home stays are reimbursed in one of 3 primary ways – each allowing for different reimbursement levels to the facility (Medicare rehab stays being the highest reimbursement). Due to the lower level of reimbursement of Medicaid, many facilities have opted to increase the number of beds specifically for rehab and, thus, reducing the number of residential beds available overall.
  • Medicare – A federally funded SNF (skilled nursing facility) benefit that will pay for up to a 100 day rehab stay in a nursing home. For more information on this benefit – https://www.medicare.gov/coverage/skilled-nursing-facility-care.html
  • Private pay – Funds are paid directly by the resident (or their family) monthly for the residential care received.
  • Medicaid – A joint federal and state program that helps pay for the costs related to residential nursing home placement (or Medicare SNF copay) for some people with low income and limited resources. One must meet eligibility requirements of low income and limited assets. A person’s income is generally used first in the month of care needed – then Medicaid pays for what the person cannot afford involving the placement. We find that Medicaid planning is best coordinated through Elder Law services.
• Your funds – Often facilities require private pay status (or current active nursing home Medicaid status if transferring from another in-state facility) to initiate placement. Nursing home Medicaid requires an application be made following placement – which makes someone “Medicaid Pending”. This can be a difficult financial liability for facilities to take on because it requires action on the part of the person’s support system to fulfill the necessary obligations for the application. Thus, many facilities are now requiring families to pay privately for placement until the Medicaid application is completed and approved – thus, shifting the liability back onto the resident and their family.
• Bed availability – Although there are many options for facility placement, many of the residential beds are held for a number of years by the occupants. Thus, beds within facilities typically only become available when someone passes away. This is the harsh reality. Male beds are more difficult to find due to the long life expectancy of women (thus, taking the majority of the bed space in facilities). The majority of bedrooms (and often bathrooms) are shared within nursing homes with a minimum of one other person and possibly as many as six. Thus, when a bed becomes available for whatever reason – the bed availability has to match the gender needed. Also, if your loved one requires memory care within a secured unit, this is not offered at every facility.
• Cognitive/Psych Issues – If your loved one presents with cognitive difficulties or psychiatric issues/behaviors, this could also limit the beds that are offered. It is important to insure that your loved one is as medically stable as possible to ensure best opportunities in placement. The nursing home admissions’ department has the right to choose the residents that enter their building according to their own wishes or abilities to provide care. Since availability is so incredibly limited, they will often choose someone who will likely be the least disruptive or problematic to their current environments. Also, some facilities have age requirements (such as they are unwilling/unable to provide care for someone under the age of 60).

Now that you know a few insider tips – it does not mean all hope is lost. It just requires strategy and active planning. The logistical needs surrounding nursing home residential placement can be guided by Elder Law and/or Aging Life Care Management to assist in the easiest facilitation of the process.

Wishing the best to you and yours!   Lisa