Definitions of Services for Consumers
Assisted Living Facilities: A residential facility which stresses the social needs of the residents and provides room, board, recreation and social activities, housekeeping, personal services, and supervision to residents. Health monitoring services may be provided to residents, at their request, by a doctor’s order through licensed nurses, or a certified home health agency, which may or may not be owned by the operator. These facilities may be licensed to receive Medicaid payment for services.
Continuing Care Retirement Community: A facility or facilities approved by the Life Care Community Council to provide, pursuant to a contract, a comprehensive cohesive living arrangement for the elderly which provides independent living units through equity and non-equity models, board, a range of health care and social services, including home care, nursing care and at least 60 days of on-site or affiliated nursing facility care and provides access to health services, prescription drugs and rehabilitation services.
Hospice Care (through a Certified Hospice): The provision of short-term inpatient services for pain control and management of symptoms related to terminal illness. Such services shall be provided by a hospice possessing a valid state-issued certificate of approval.
ICF/IID: A licensed facility whose primary purpose is to provide health or rehabilitative services for mentally retarded individuals or persons with related conditions.
Intermediate and Skilled Care: Nursing care facilities provide 24-hour nursing services for convalescent and long-term care patients. They provide regular medical, nursing, social, and rehabilitative services in addition to room and board. Registered nurses, licensed practical nurses, and nurse aides provide services prescribed by the patient’s physician. Emphasis is on medical nursing care with restorative, physical, occupational and other therapies. These facilities are eligible to participate in both Medicare and Medicaid.
Medical Care: Each patient in a nursing home is under the care of a physician who visits periodically, and who is responsible for the patient’s overall plan of care. In most cases, the patient’s personal physician refers the patient to the facility and certifies the need for admission. Once the patient is admitted, the physician writes orders for medication and develops the patient care plan, including restorative and rehabilitative procedures, special diets, and other treatments. Every nursing home usually has at least one physician on staff or on call to handle emergencies.
Nursing Care: Nursing procedures require the professional skills of a registered or licensed practical nurse. These include administering medications, injections, catheterization, and similar procedures ordered by the attending physician. Post-hospital stroke, heart, or orthopedic care is available with related services such as physical therapy, occupational therapy, dental services, dietary consultation, laboratory and x-ray services, and pharmaceutical dispensary.
Sub-Acute Care: Skilled nursing facility sub-acute care units offer a wide variety of medical, rehabilitative, and therapeutic services once provided only by hospitals. Common conditions treated in sub-acute units include brain and spinal cord injuries, neurological and respiratory problems, cancer, stroke, AIDS, and head trauma. Because nursing facility sub-acute care costs are 40 to 60 percent less than hospital costs, HMOs and other managed care entities have begun moving hospital patients to nursing facilities for their sub-acute care.
Rehabilitation: All nursing facilities are required to provide services to enable the resident to meet the highest practicable level of functioning. Nursing care facilities provide intensive rehabilitative services. These services are designed to enhance the resident’s highest functional abilities and encourage discharge to the community at a lower level of care. Nursing facilities are demonstrating enormous success at providing these services at a lower cost to the consumer.
Respite Care: Respite care is scheduled short-term nursing home care provided on a temporary basis to an individual who needs this level of care but who is normally cared for in the community. The goal of scheduled short-term care is to provide relief for the caregivers while providing nursing home care for the individual. Short-term stay beds must be distinct from general nursing facility beds.
Consumer Guide to Long-Term Care Services
Choosing a Long-Term Care Facility for Your Loved One
DHCFA members are committed to providing you with all the assistance and information you need, without obligation to help you and your loved one make the best decision for your situation. The process can be stressful, and today’s long-term care options are many.
Downloadable Guidebooks
Planning Ahead
The best way to ease the emotional distress of selecting a long-term care facility is to plan ahead. Beginning the process early reduces stress and gives your loved one more time to prepare for the transition to their new home when and if the time ever comes that these services are needed. Visiting facilities before there is a need takes much apprehension out of the process.
Who Pays?
It is important to note that the government provides little financial assistance for long-term care unless a resident is impoverished and qualifies for Medicaid. Most health insurance plans do not cover the costs for long term care, including Medicare. It is important that you consult a financial consultant to determine how you and or your loved one will cover the cost of long-term care if and when it becomes necessary.
Options for paying for long-term care costs are:
- Personal funds
- Medicare
- Medicaid
- Long-term care insurance
Medicare is the federal health insurance program for the elderly, disabled, and those with chronic kidney disease which is administered by the U.S. Department of Health and Social Services. Under certain conditions, Medicare covers the first 20 days of care in a skilled nursing facility. From day 21-100 the beneficiary must share the cost of care by paying a nationally set co-payment amount. For more information on Medicare, please call: (800) 633-4227 or visit: www.medicare.gov.
Medicaid is the federal and state financed assistance program for needy and low-income individuals of all ages. Medicaid programs vary from state to state. In Delaware, in order to be eligible an individual must meet both medical and financial eligibility. To find out what the current limits are, or for general information on Delaware Medicaid, please call: (302) 368-6610.
Long-term care insurance offers a viable solution to paying long-term care costs while preserving personal savings. This type of insurance tends to become more expensive the older you are when you acquire it, so it is important to plan ahead. All policies sold in Delaware must be approved by the Insurance Department. To obtain a list of plans approved in Delaware call ElderInfo at: 800-336-9500.
Selecting a Facility
Making the selection of a long-term care facility a family affair empowers your loved one and gives him/her control of the situation. If your loved one is capable of participating and having his/her wishes considered, the selection, decision, and ultimately the transition to the facility, will be much easier for all parties involved. This approach minimizes the guilt many family members often feel.
Do Your Homework
To begin the process, you may want to call your facilities of choice and request as much information as possible to assist you. Some families choose facilities which are close to their home making it easier to visit often, yet others choose facilities that offer special amenities which they know are important to the potential resident. You may want to review the facilities last state inspection report which facilities have readily available for public viewing. If you feel you need further clarification, feel free to speak to the administrator.
Visiting Facilities
Perhaps the most important part of the entire process is to personally visit facilities with your loved one if this is possible. During the pandemic, facilities are using alternate means such as virtual tours that allows you to see each facility’s own personality and amenities that make it special. During your tour, observe the interaction between staff and residents or talk directly to the residents. By following these simple steps, you will get a good feel for the atmosphere of the center and whether it is compatible to your loved one’s personality and customary way of life.
Complete a Checklist for Each Facility You Visit
The best way to record your and your loved one’s impression is to keep notes on each facility you visit. Completing a checklist and making notes offers an opportunity for further discussion regarding this important decision with your loved one.
Your Involvement is Essential
- Initiate open dialog with your loved one to prepare them for the eventuality of the need to transition into a long-term care facility. Also discuss their personal wishes and whether their legal affairs are in order.
- Ask your loved one to participate in the facility selection.
- Once placement occurs, visit frequently and encourage others to visit too.
- Learn all you can about the rights and responsibilities of residents, families and the facility.
- Recognize that open communication is the most effective tool to a positive experience for all involved.
- Preplan with advanced medical directives and medical and financial powers of attorney, including an individual who is otherwise authorized under applicable law to make the health-care decisions by execution of the DMOST form on the patient’s behalf. Learn more about DMOST – Delaware Medical Orders For Scope of Treatment www.delawaremost.org. DMOST forms are uploaded to the Delaware Health Information Network at www.dhin.org.
Despite What You Have Read or May Have Heard
While our profession faces a growing demand for quality while receiving less funding from Medicare and Medicaid to accomplish this, we are also struggling with the impact of a critical nursing and allied professionals shortage. We recognize the need for quality care and are committed to continuous quality improvement in every aspect of operation in our facilities.
Additionally, we understand that many negative feelings regarding long-term care often stem from a family’s fear regarding their loved one’s future well-being and guilt about the placement decision. Today’s long-term care facilities are monitored very closely and follow over 1,000 state and federal regulations. In Delaware, the Division of Health Care Quality oversees the licensing and inspection process and they make frequent inspections, including surprise inspections of long-term care facilities to ensure that quality standards are met. If any problem areas are discovered, they are documented, and plans to correct these are immediately developed and implemented. Moreover, the Division of Services for Aging and Adults with Physical Disabilities oversees the state’s Ombudsman Program. Every facility has an Ombudsman Representative assigned to them who will confidentially assist a resident or family member to develop solutions to any problem they feel they have not been able to resolve with the facility’s administration.
To reach the Division of Health Care Quality (DHCQ) call (302) 421-7400 and to reach the Delaware Aging & Disability Resource Center call (800) 223-9074 or go to www.DelawareADRC.com.
Today’s long-term care facilities provide a valuable service and level of care that families can depend on. The decision to place a loved one in a long-term care setting is a very emotional and complex. The process becomes less overwhelming when you are prepared. Every provider of long-term care services has dedicated their lives to helping families and their loved ones during these difficult times. We are here to help you.
Need Help?
Need Help? Consider using professionals who can help you identify appropriate services and communities that are a best fit for your situation. Check out these DHCFA associate members:
Placement Help
Elder Law Services