Considering a Move

If you are considering a move to an assisted living facility (ALF) or nursing home, include your care receiver in the decision if he or she is competent.

The term "long term care" is often used to describe care in a residential facility, but the term can refer to on-going care needed by frail persons living at home. "Long term care" is one of many confusing terms you may encounter. See the "Glossary" of terms in the Introduction of this Handbook.

It helps to learn as much as possible about your long-term care choices and how to evaluate residential facilities. Assisted Living Facilities and nursing homes in Florida are licensed by the Agency for Health Care Administration (AHCA). Always ask to see the AHCA inspection report when you visit a facility. Their web site is www.fdhc.state.fl.us. There is also a web site that provides information on facilities in each county of Florida. Click on "Facility locator" at www.floridahealthstat.com.

There are several free booklets published which provide information on housing and care options:

Florida's West Coast Senior Living Guide includes information about continuing care retirement communities, other retirement communities, senior apartments, assisted living facilities, nursing homes, rehabilitation centers and home health services. It is available free at Eckerd Drug Stores, Albertsons Grocery Stores, Wal-Mart stores and other community locations in Pinellas and surrounding counties of Florida. This guide, published twice a year, is called the Yellow Book of senior living options. It includes comparisons of options in each category and a one-page information directory with telephone numbers for commonly requested services.

Another small book with address listings of various options for housing with care is New Lifestyles, Western Florida, and one that has advertising for various housing choices is Mature Living Choices, Florida's Gulf Coast.

Note: while you are picking up copies of these free housing guides, look for Senior Connection, a free magazine with articles of general interest to seniors and caregivers. Also look for Seniority, a special section of the St. Petersburg Times Newspaper, for up-to-date articles on subjects of interest to seniors and caregivers. Extra copies of Seniority and Senior Connection are often available at senior centers.

Several types of housing provide facility-based long-term care:

Continuing Care Retirement Communities

Continuing Care Retirement Communities (CCRCs), also called life-care facilities, provide residents with shelter and health care in return for an entrance fee and periodic monthly fees. Only properly licensed facilities may use the term "Continuing Care Retirement Community" or "life-care" in marketing efforts. CCRC's may appeal to those who can afford them because of having several levels of care ranging from independent living to nursing home on the same grounds. Residents who need nursing care just move to another part of the facility. There are several different payment plans. Some retirement communities that are not CCRC's offer several levels of care. Be sure to compare various communities before making a choice.

For more about CCRC's and a listing of those in Pinellas County, Florida, ask for the Department of Insurance booklet, Options for Lifelong Care, available by calling the Florida Department of Insurance Helpline, 1-800-640-0886.

Adult Family Care Homes

Adult Family Care Homes (AFCH's) are family-type living arrangements in private homes. These are an option for housing and supportive services for no more than five disabled adults or frail elders. Persons choosing to live in an AFCH must not require 24-hour nursing supervision. These homes must be licensed by the Agency for Health Care Administration as Adult Family-Care Homes unless room, board, and personal care is provided for relatives or no more than two adults who do not receive a state supplement. For more information, see the resources for Assisted Living Facilities listed below.

Assisted Living Facilities

Assisted Living Facilities (ALF's) provide housing, meals, personal care services and supportive services to older persons and disabled persons unable to live independently. They are called Board and Care Homes in some states. Residents in ALF's cannot have conditions that require 24-hour nursing supervision unless receiving licensed hospice services. Some ALF's have specialty licenses to provide limited nursing services or mental health services, and some specialize in providing services to persons with Alzheimer's Disease. If you are looking for a facility to care for someone with Alzheimer's, there are special questions that you need to ask. See "Residential Care Facilities" in the Alzheimer's and Related Disorders section (purple edged pages) of the Senior Resource Directory. Find this article on the Area Agency on Aging of Pasco-Pinellas's web site, www.agingcarefl.org/caregiver/alzheimers/facilities.

According to the National Center for Assisted Living Survey done in 2000, the typical assisted living resident is a woman between 75 and 85 years of age who is mobile but needs help with two activities of daily living (ADL's), which include bathing, dressing, transferring, toileting, and eating. For more Survey results, select "About Assisted Living" on the National Center for Assisted Living (NCAL) web site, www.ncal.org. Select "Consumer Information" followed by "Consumer Guide" to find a "Checklist for Consumers and Prospective Residents".

Assistive living facilities charge an average of $1,873 per month, with prices ranging from below $1,000 to more than $3,000 per month. More than two-thirds of residents pay with their own or family funds. Other funding sources are the Medicaid Waiver program, Nursing Home Diversion program, and Long Term Care (LTC) insurance. In Florida, Medicaid Waiver funding covers costs of community care or care in an assisted living facility for those who qualify. Nursing Home Diversion is a new type of managed care program that can cover care for Medicaid-eligible persons in their home or in a facility. For more about Medicaid Waiver and Nursing Home Diversion, see Stage Two, section 5.

Eleven of the leading insurance companies that sell long term care insurance offer assisted living coverage. However, most of the people who are sixty or over today do not carry long term care insurance. If your care receiver does have a policy, be sure to read it carefully. One caregiver thought that when his wife went into a nursing home under the couple's long term care insurance policy, the policy would pay for the husband to live in the assisted living facility next door because he himself had some physical handicaps. He did not meet the policy's requirements for coverage but he resolved his problem by moving into a less expensive senior apartment that offers one meal a day.

General information about ALF's and the Assisted Living for Seniors Medicaid Waiver is available online at www.state.fl.us/doea, the Florida Department of Elder Affairs (DOEA) web site. A new web site, www.floridaaffordableassistedliving.org, was developed as part of DOEA's Coming Home Project to be a clearinghouse of information for developers, operators, and consumers. Ask about several new facilities that were built as part of this project.

If you are a caregiver (especially a long distance caregiver) for someone who needs help in making the transition to a residential facility, you may want to hire a care manager or placement service. For more about care managers, see Stage One, section 4.

Nursing Homes

Nursing Homes provide more care than assisted living facilities. There are two levels of nursing homes, Skilled Nursing Facilities (SNF) and Intermediate Care Facilities (ICF).

• Skilled Nursing Facilities provide nursing care on a 24-hour basis. Also included are therapy, diet supervision, activities, and medication management. An RN Supervisor is on-site and a physician is accessible. Medicare may pay for skilled nursing care in a facility if the patient meets the necessary criteria. Medicaid may pay for this type of care for persons who meet the income and asset eligibility. For more information about Medicare, call 1-800-Medicare (1-800-633-4227) or visit the Medicare web site, www.medicare.gov.

• Intermediate Care Facilities provide personal care and supervision of dressing, bathing, diet, and self-administered medications. This level of care may be covered by Medicaid for those who financially qualify, but Medicare only pays for skilled nursing and will not pay for what it calls "custodial care" or intermediate care. If a person is on Medicaid, it is illegal for the facility to request more money from the family.

Persons applying for Medicaid coverage of nursing home care in Florida must be assessed by the Florida Department of Elder Affairs (DOEA) CARES (Comprehensive Assessment Review and Evaluation Services) office. See page 47 of this Handbook. The DOEA web site www.state.fl.us/doea also contains information on the CARES Unit. Select "Caring for an Elder" followed by "CARES". Note: the DOEA CARES Unit is not to be confused with CARES, Inc. (Community Aging and Retirement Services), a "lead agency" for case managed programs and provider of services for older persons in Pasco County, Florida.

For up-to-date information about Medicaid income and asset limits and planning for Medicaid eligibility for long-term care, visit the Florida Medicaid.com web site, www.floridamedicaid.com. This commercial site by a number of Florida Medicaid and elder law attorneys explains things like Qualified Income Trust (QIT), which allows persons whose income is too high for Medicaid but too low to afford nursing home care to qualify for Medicaid.

Choosing a nursing home can be complicated and emotional. Sometimes a choice is dictated by what homes have beds available that day. However, if time allows, it is good to learn what to look for in a nursing home and to compare various local nursing homes.

The Florida Agency for Health Care Administration (AHCA), the agency that licenses and inspects nursing homes, publishes regional Nursing Home Guides and provides the same information on its web site. There are several ways to obtain a copy:

• Call AHCA toll-free at 1-888-419-3456 and ask for the Nursing Home Guide for Central Florida, which includes Pasco and Pinellas Counties.

• Write AHCA at the following address: Agency for Health Care Administration, Bureau of Consumer Protection, MS #27, 2727 Mahan Drive, Tallahassee, FL 32308.

• Visit the AHCA web site, www.fdhc.state.fl.us or visit www.floridahealthstat.com. You may want to read How to Select a Nursing Home and Alternatives to Nursing Homes. Select "Search by Region" and choose Region 5 (Pasco and Pinellas) on the Florida map to pull up a list of local facilities. Click on each one for the same information and rating found in the printed version of the Nursing Home Guide. You can search by characteristics you are looking for in a nursing home if you prefer. There is also a link from the AHCA home page to Nursing Home Watch, which lists nursing homes with particularly bad AHCA inspection reports.

Inside The Nursing Home Guide is general information ranging from choosing a nursing home to planning enjoyable activities when visiting someone in a nursing home. There is a glossary of nursing home terms and a comparison of nursing homes in the region. A rating system is used to evaluate the facilities.

Additional information provided in the Nursing Home Guide includes number of beds, minimum costs, payment forms accepted, affiliations, languages spoken, whether for profit or non-profit, and availability of special services such as respite care, pet therapy, and hospice. While looking for a home that will meet your care receiver's needs and that gets a good review is important, other factors such as whether the home is close enough for family to visit frequently should also be considered.

AHCA recommends one or more visits after making comparisons using the Nursing Home Guide. One of these should be scheduled with an opportunity to talk with staff and take a tour. Drop in another time without scheduling an appointment to make certain that the facility still seems attractive and treatment of residents seems the same. Be sure to look at floors above the first floor.

Things to observe when visiting a nursing home include:

• Do residents appear happy, comfortable, and at home?
• Is the facility clean, odor free, and well-staffed?
• Are residents being taken care of in a timely manner?
• Are the rooms decorated with personal furnishings and belongings?
• Do the residents have adequate privacy?

Among the questions you should ask when visiting are:

• What deficiencies, if any, were cited during the last inspection? (Ask to see the survey, which is AHCA's inspection report.)
• How many residents does each nurse and nurse's aid care for during each shift?
• What do they do about medical services and special therapies?
• What transportation arrangements for residents are available?
• What special training does the staff have?
• What are the policies regarding deposits, refunds, and bed holds?
• How much advance notice is provided before increasing charges?
• How are personal possessions safeguarded?
• What activities are available? (Ask to see calendar.)
• What are the designated visiting hours, and are exceptions allowed?
• Does the nursing home have a program to limit the use of physical restraints?

Information about how nursing homes compare anywhere in the country is available in print by calling 1-800-MEDICARE toll-free. It is also posted on Medicare's web site, www.medicare.gov. Select Nursing Home Compare.

The AARP organization has information to help consumers with long term care decisions. According to AARP, location is an important factor to consider when choosing a nursing home because nursing home residents who have regular visitors get better care. For brochures on choosing a nursing home and protecting a resident's rights, call AARP's toll-free line, 1-800-424-3410. The caregiving section of AARP's web site is found at www.aarp.org/caregiving.

When considering legal and financial issues involved in long-term care decisions, many people find it helpful to consult an elder law attorney, an expert in counseling, educating, and advocating for seniors regarding illness, incapacity, and death. Learning what financial decisions to make and avoid if Medicaid will be needed for nursing home care is just one of many reasons to visit an elder law attorney. See more information on elder law attorneys.

Veterans may want to include a U. S. Veterans Administration (VA) nursing home as one of the choices they consider. The Baldomero Lopez Veterans' Nursing Home is located in Land o' Lakes in Pasco County, Florida. This is a 120-bed facility with 60 beds dedicated to serving mobile Alzheimer's patients. To be eligible, a veteran must have been a Florida resident for at least one year, honorably discharged, and need nursing care. Costs vary depending on income.

To locate a VA nursing home anywhere in Florida, visit the Florida Department of Veterans Affairs web site, www.floridavets.org. For more about several types of VA benefits often overlooked by older veterans, see ?Benefits for Veterans? in the More Tips and Resources section and visit the national Veterans Administration (VA) web site, www.va.gov.

Next: Coping with Placing Someone.