Many people pay for their care from their own income or savings. Traditionally, medical insurance has not paid for nursing facility care. However, this is beginning to change. Check with your insurance provider or HMO to inquire about charges they will cover. Other sources sometimes available include Medicare, Medicaid, and the Veterans Administration.

Medicare may be available for those going into a nursing facility after a hospital stay of at least three nights, as well as a skilled care diagnosis (at least one of the following therapies are needed: physical, occupational, speech, or respiratory).
Medicaid may be available for those with modest incomes and assets of $2,000 for an individual and $3,000 for a couple or less. More information about eligibility in Texas may be found here.

Long-term care insurance is similar to other insurance in that it allows people to pay a known and affordable premium that offsets the risk of much larger out-of-pocket expenses. Although long-term care insurance is relatively new, more than 100 companies now offer coverage. Several types of policies are available, but most are indemnity policies. This means that they pay a fixed dollar amount for each day you receive specified care either in a nursing facility or at home.

No policy is guaranteed to cover all expenses fully.
Hospital social workers and nursing facility personnel can tell you the guidelines for these programs. Most nursing facilities have a set daily fee for a specific package of services. The facility staff should go over these fees with you upon your initial tour.

It depends. The daily or monthly fee will generally cover nursing care, room and board, meals and snacks, and activities. Charges could occur for other items such as unique equipment, some laundry services, medications, special diapers, and barber or beauty shop services.

All nursing homes have arrangements with one or more pharmacies to meet resident prescription needs 24-hours a day. Residents may, however, designate their own pharmacy, provided the pharmacy’s services are provided on a 24-hour basis for emergency medications.

All nursing facility residents must have a physician who functions as individual resident’s attending physician. The resident may designate his/her own physician or the NF’s medical director (Medical Director) may become the resident’s attending. However, realize the physician may choose to not make a facility visit. If this is the case, you may be faced with the option of transporting your loved one to his/her physician when such services are needed, or you can choose another physician who makes routine facility visits. You can also request from the nursing facility a list of physicians who practice in that facility.

Talk to the dietary manager or consulting dietician. Ask for menus for the month. Also, ask how special diets are handled. Find out what the facility policy is for providing substitutions if meals are not satisfactory.

Most facilities have a family council, which is a group of individuals who have friends or relatives in the facility. These councils serve as support groups for families, and suggest ideas, activities and changes for the facility to better serve its residents. If the facility you choose does not have a family council, you might talk to the administrator or social worker about starting one. Ask the administrator for a list of other types of support groups.

All residents must have a complete medical history and a physical exam by a physician at or near the time of admission. If the resident is coming straight from the hospital, hospital personnel will need to provide the records to the facility to prevent duplication of tests, expense, and stress to the resident. While at the nursing facility, the resident will have a physical exam at least once a year and at any other time the nursing facility staff believes it is necessary. Because nursing facilities are so extensively regulated – especially if you are relying on Medicare or Medicaid – you may run into some exasperating circumstances. Nursing facilities are required to get many, many forms filled out by either the resident or a responsible party. In addition, Medicare and Medicaid have extensive requirements and may not cover your particular situation. If you have questions concerning the admissions process, the Director of Admissions or other nursing facility staff will be happy to assist you.

Upon admission, the staff members will meet from various departments to formalize a plan of care for your loved one. If at all possible, you and the resident should attend and participate. The “care plan” is updated quarterly, or more frequently if needed. See if the staff is receptive to your loved one’s special problems, such as a daily adjustment to a hearing aid, or making sure that the resident changes clothes each day. But be patient. Staff cannot be expected to learn all the special needs of a new resident overnight.

Call the Texas Health Care Association (THCA) at 800-380-2500 or 512-458-1257.