Nursing Facility Selection
There are three common ways that an individual gets placed into a care facility in Minnesota.
First, voluntary admission with the intent of paying privately for the care received at the facility.
Second, admission by Doctor’s order into a facility. The level of care needed and the perceived financial resources of the patient will affect where the person is admitted.
Third, admission as the result of a Long-Term Care Evaluation by a County’s LTC evaluators (also called a MNChoices assessment). This evaluation is a necessary part of the eligibility process for benefits through the MN Medical Assistance program. Following the completion of the evaluation process, a report is issued identifying the care needs of the subject individual and the particular MA program(s) that are allowed to provide the care subsidy. The report establishes the type of facility that is suitable and where the individual will receive MA subsidies should they meet the other eligibility requirements for the benefits.
Finding The Right Place
Many aspects of finding the right “place” are the same as if you were buying a house or renting an apartment: location, amenities, and cost. Add to those issues the care requirements that you are told are required or that you believe are required and you have your work cut out for you. Let’s break apart these requirements and see what needs to be considered.
Location – The person that requires facility care may say. “I have lived in “insert city name” for the last 40 years. I don’t want to go “ABC Care Center” in “insert city name.” This is not an uncommon statement to hear from the person needing care.
Questions about location:
- Does the person have a well-developed social support network in the city that they want to stay in?
- How likely is it that people in that network will be able or willing to regularly come to a care center to see the person?
- Is the facility in the desired city convenient for the family member(s) that are likely to be regular helpers for the person – doctor’s appointments, hair, banking, visiting and the like?
Answers to these questions will give everyone a better perspective on the matter of “location.”
Amenities – There is a wide range of facilities in the marketplace. Some are brand new, with all the bells and whistles of design and technology, and some not so much. Here are several ways that may work for you to adequately sort through these “apples and oranges.” First, make a list of some of the creature comforts that your loved one enjoys and still uses. Second, which types of activities will your loved one likely include in their weekly routines. Third, honestly evaluate your answers for #1 & #2 and ask yourself, “Did this answer result from what I hope happens rather than what my loved one would really like or want?” Nothing is perfect, but try the best you can to make this part of the decision about them. Remember, quality of care always trumps amenities, ALWAYS!
Cost – Private payment for nursing facility care places a huge demand upon anyone’s budget and resources. You have to be honest with your parent, spouse, or sibling(s) about how fast the resources will deplete. You also have to realize that charges for care WILL go up as the person’s health declines. We are not advocating that private pay is not a wise thing for you to do; what we are saying is that you need to have your eyes wide open to the costs and your resource pool.
Evaluating cost when approaching the prospective facility costs through the lens of MA benefits requires a different perspective than private pay. First, once your loved one is in a facility that has accepted them as a MA beneficiary, the law prohibits the facility from treating them differently than those residents that are privately paying for care. Second, once your loved one is on MA benefits, the cost to them does not change regardless of what the costs are for care or the costs of the facility. This is because your loved one contributes their income to the facility, less $102 (this number is set annually and subject to change), and then MA pays the facility the difference between the income contribution and the facility costs. If the difference is $3000 or $10,000, it does not impact your loved one’s contribution to payment for care.
Private pay requirements and waiting lists – What do they really mean? Assisted Living and Assisted Living Memory Care facilities are allowed to do two significant things, if they choose to. First, they can decide how many of their beds will be eligible for MA Elderly Waiver (EW) subsidy. Most of the newer facilities have a limited number, if any. Second, they can require that new residents privately pay for “x” number of months before they can be eligible for one of their MA EW beds, if available. This situation is fraught with risk and potential upheaval for you and your loved one. The only way to combat this problem is to find a facility that does not have private pay requirements, and before you even ask – Yes, there are good facilities that do not have private pay requirements.
Facilities that provide skilled level of care (nursing homes) are prohibited from imposing private pay requirementsprior to being eligible for a MA-LTC bed.
Care requirements – You need to have a list of the various care needs that your loved one requires on a daily and weekly basis. You need to ask whether the facility is set up to handle what your loved one requires. When you get to the point where you decide on a facility, they will have one of their nursing staff come to see your loved one and do their own evaluation of care needs. (This does not replace the evaluation from the County.)
The Place To Start
First, ask your acquaintances what they know about care facilities in the area in which you are looking. Remember that their opinion is their opinion. However, when you hear the same thing from several sources there is a better chance that what you are hearing is true.
Second, if you are in the Minneapolis/St. Paul area, go to careoptionsnetwork.org. They have an online vacancy list for facilities in the Metro area. Make calls, ask your questions and the places that get past your phone screening are the ones that you need to physically visit.
To Learn More, Contact Us At Elder Law Services 763-213-0714