Who Pays for the Nursing Home Stay?
MEDICARE: If your loved one has spent three midnights at a hospital as an “admitted” (versus “observation”) patient, and has met hospital level criteria during their stay, he/she may be eligible for Medicare coverage as a Skilled Nursing Home. For additional Medicare information, see below under the heading, “What about Medicare Coverage?”
ILLINOIS PUBLIC AID: If your loved one cannot afford out-of-pocket expenses for a nursing home, he/she may be eligible for Illinois Public Aid. If you are an individual or couple, depending on your assets and level of income each month, you may be eligible to receive assistance for your medical bills and nursing home care if your total assets do not exceed required limits. To obtain further information on the asset and income limits, contact your local Department of Human Services (DHS) office, call 1-800-843-6154, or visit the website http://www.dhs.state.il.us
When you request financial assistance from the local DHS office, you will be required to fill out a financial statement listing your assets, income, and verification of your financial statement and supporting documentation. The DHS offices will notify you of needed information. The process can be somewhat confusing. The nursing home may be able to help and answer many questions.
HMOs (PRIVATE INSURANCE): HMOs all have different benefits, eligibilities, etc. Many private insurance companies have a “deductible” for nursing home care; the deductibles vary by the pan. For best results, refer to your insurance booklet or call your insurance company for your “Skilled Care or Long Term Care Benefits.”
Do you have a doctor in the community?
Your doctor may or may not follow your care at the nursing home. If you want your doctor to be aware of your care, you will need to contact his/her office and let he/she know to contact the nursing home. There is a medical director available at Sunset Home. He may, at his discretion, agree to take over primary care of you, or your loved one who is in need of a physician, while staying at Sunset Home.
ADMISSION: Admission documents must be completed at the nursing home prior to admission or day of admission in order for the home to be able to accept your loved one.
CARE PLAN MEETINGS: The nursing home care plan teams consist of: the care plan nurse, dietary staff, activity staff, therapy, and social services. They will invite you and your loved one to meet together within 21 days after admission in order to bring you and your loved one up to date on the progress of your loved one. Along with providing the opportunity to set care goals. This time is also used to answer any questions or concerns you or your loved one may have.
Sunset Home does provide transportation to physician appointments and other locations/events in town, as needed.
What do I bring to the nursing home?
- Social Security Card
- Insurance Card
- Medicare Care
- Power of Attorney/Living Will Documents
- Emergency Contact Name/Phone Numbers
Personal Items (MARK ALL WITH NAME)
- One week’s worth of clothing including underwear and socks
- Nightclothes and robe
- Sweater or sweatshirt
- Non-skid slippers
- Grooming Articles: comb/brush, toothbrush/toothpaste, dentures, comfortable shoes
You May Bring the Following (if desired)
- Favorite Quilt or Blanket
*If you will be doing the laundry, please bring a receptacle with a lid, no air holes, and identify it with your loved one’s name.
*Large pieces of furniture (recliners, etc.) may be permitted, but please discuss FIRST with the nursing home staff.
What Should We Look for in a Nursing Home?
Here are a few things to look for when choosing a nursing home for your loved one:
- Is the home clean?
- Does it have an odor?
- Are the hallways unobstructed?
- Are staff members courteous to residents and their families?
- Does staff respond in a timely manner to the residents’ needs?
- Are the rooms bright and pleasant?
- Is timely assistance provided to patients who need assistance with eating?
- Is food well presented and appetizing?
- May you eat with your loved one?
What about Medicare Coverage?
(DOES NOT INCLUDE MEDICARE HMOS)
When the hospital care team, including your physician, feels that your loved one requires “skilled care” at a nursing care facility, this means the following services may be needed: IV medications, wound care, new tube feeding care, rehabilitative services, (to name a few). When your loved one meets the requirements for “skilled care,” the Medicare benefits are as follows:
Medicare Benefit Medicare Pays
Days 1-20 100%
Days 21-100 All but $157.50/day
Days 101+ $0
Many times residents are not eligible or do not use their total of 100 days in the nursing home. The nursing home will let you know when your loved one no longer meets Medicare criteria. The nursing home will then help you plan for the care of your loved one whether it is long term care or an alternate plan of care.
What if We Choose Hospice at a Nursing Home?
You may choose Hospice care during your loved one’s nursing home stay. Your loved one will receive additional services from Hospice at the nursing home, such as: Volunteers, Nurses, Chaplains, and Social Workers. Medicare does not cover your room & board at a nursing home while on Hospice. Please ask social services for further information.