F.A.Q.s (Frequently Asked Questions)
1. My loved one is in a nursing home and I have concerns about
their care, what can an ombudsman do for me and my loved one?
An Ombudsman can assist by educating you and/or your
loved one of their rights as well as give information in regards to
State/Federal Regulations that nursing homes are required to follow – This will
empower you and/or your loved one to speak up for yourself in a calm manner
because you have the knowledge of what is required in providing care. We will advise you on who to speak with at
the nursing home. We can also speak on your behalf and/or meet with you and
Administration in order to resolve the concerns.
2. Is there a fee for ombudsman services?
No, absolutely not.
3. Is there a fee for resources and information for placement
All services are free of charge.
4. How do I pay for long term care? Are there options?
Private insurance policies usually cover skilled,
intermediate and custodial nursing home services. You need to review the policy with your agent
and define, in writing, exactly what is covered. Many times a nursing home insurance policy
will only cover skilled or intermediate care, leaving custodial care
uncovered. Custodial care is usually the
type of coverage needed when one is planning a long term stay in a nursing
Skilled Nursing Benefits
Under Medicare you may be entitled to limited nursing
home coverage if you are in a Medicare certified bed, have spent three days in
the hospital within the last 30 days and need skilled nursing care. Coverage under Medicare is for a maximum of
100 days with the average being 28 days.
Medicare Part A will pay in full for the first 20 days. After the first 20 days a co-pay will be
required. Most Medicare supplemental
insurance and Medicaid will cover the co-pay.
Medicare Advantage plans such as Secure Horizons have different rules
regarding required hospital stays, schedules of co-payments, etc. However, they still offer full or partial
coverage for up to 100 days.
Coverage is limited to those residents who require daily
skilled nursing care and is assessed on an individual basis. Services such as IV therapy, tube feedings,
ventilators and intensive physical, occupational or speech therapy are among
the items covered. Custodial care is not
of Mental Health
Certain nursing homes and residential care facilities
contract with the Department of Mental Health for direct placement of a
resident under the care of the State Hospital Community Placement Program. Included in this coverage is also clothing
and personal allowance.
This often overlooked source of aid is available by
filling out an application for VA medical services. All veterans are entitled to apply for
residence at one of the state veterans homes.
Often there is a waiting list for admission. The length of the wait will depend on the
individual’s condition and the priority category assigned to him/her.
Aid and Attendance payments are available to veterans and
their spouses who are over 65 and suffering from a disability requiring nursing
care. The veteran must have served
during “war time” as defined by the VA.
There is also an income test.
5. How do I qualify for Medicaid?
An individual qualifies for Vendor Medicaid if he or she
meets the following criteria:
individual must be residing in a licensed nursing facility in a Medicaid
individual must meet the standard for medical disability in federal and state
3) The individual
cannot have countable assets of more than $999.99.
For more information, please refer to our Information
Center section on Financing Care.
6. How does LTCOP address confidentiality?
All of our Ombudsman receive 12 hours of training and
part of their training is spent on the importance of confidentiality. All sign a confidentiality agreement as well.
We are only allowed to discuss issues with the permission
of the resident or the resident’s Guardian/DPA issues concerning the residents
may only be discussed with those whom are directly responsible for their care.
i.e., Administrator, Director of Nursing, Assistant Director of Nursing, Nurses
on duty, Social Worker.
7. How do I choose the right long term care facility for my
Choosing a long term care facility for you, a relative or
a friend is a difficult and agonizing decision.
Often there is not enough notice to evaluate all the information available. This information should enable you to quickly
determine which facilities are conveniently located, within your price range,
offer required services and supervision and are capable of accepting Medicaid
and / or Medicare.
After choosing four or five facilities which meet your
needs, telephone each to discuss financial, medical and placement
arrangements. If placement seems
possible, set up an appointment with the admissions staff. Take a friend or relative with you if at all
During this initial meeting discuss specific items such
as costs, extra charges for services that are not covered under the basic cost,
and policies pertaining to doctors, medication/pharmacies caring for specific
problems, bed holds, discharge, etc.
Make sure you understand the basic policies of the facility. Obtain a
written copy of the bed hold policy.
You should also ask to see the latest survey
results. This should be posted in the
facility, if not, ask to see it.
After you have toured the facility and met with the
necessary people, plan on making two or more visits, unannounced, during
regular visiting hours. Make these
visits at different times from your original, for instance, if your first visit
was at 10 a.m., return for a visit during mealtime and another in the
evening. This will provide you with a
broader view of the facility.
For more information, please refer to our Information
Center section on Choosing A Facility.
8. What should I look for on an admissions agreement for a LTC
Incidentals that are chargeable items
Form that requires a family member to be the RP should
the resident’s money run out.
Form that states they are not responsible for falls,
injuries, etc… to a resident