How to Evaluate Alternatives to Nursing Home Care

The notion of a nursing home is very frightening to many people, largely because it feels like the surrender of independence. If you or a loved one is faced with the likelihood of nursing home care, you should evaluate all the alternatives before making the final decision, if time and circumstances permit.

Instructions

Difficulty: Moderate

Things You’ll Need:

• Information from Medicare on available alternative programs, including P.A.C.E. and the Social Managed Care Plan
• Contact with a local seniors advocacy center, if available
• Information from home healthcare providers

1. When circumstances dictate that a person requires permanent or temporary nursing home level of care, giving up one's independence and comforts of home is extremely difficult. There are alternatives that may not require leaving home. One such possible alternative offered under Medicare and Medicaid is P.A.C.E. (Program of All-Inclusive Care for the Elderly).
2. First, since P.A.C.E. is not offered in every area, you need to contact your local Medicare office or visit Medicare.gov online to find out if you can get coverage in your location. You must 55 years old or older, and you will need to be screened to determine if you meet your state's requirements for nursing home level care. If you meet all the requirements, P.A.C.E. can prepare a medical at-home or day facility program designed for your medical needs. The enrollment and screening process will help determine whether you can get this assistance in your home or if it must be provided at an adult day facility. Medicare can assist you in all information and costs from your Medicare or Medicaid to participate.
3. Another more limited option is the Social Managed Care Plan. Information for these plans can also be obtained through Medicare. As of this writing, there are 4 localities where these plans are offered: Portland, Oregon; Long Beach, California; Brooklyn, New York; and Las Vegas, Nevada. Each of these plans have differing premiums and all of them have co-payments. They do offer a very wide range of benefits and all plans require participants to be age 65 or older. You can contact the individual plans directly for comprehensive details on benefits, availability, and costs.
4. In addition to these programs, there are other services than might make it possible for a person to remain at home and get the assistance they need. Meals on Wheels, Adult Day Care Facilities and private home healthcare workers are just a few such options. Depending on your individual circumstances, Medicare and Medicaid may pay some of the costs involved.

Tips & Warnings

• Keep a folder of all the agencies that you are working with, a phone number, and a contact person.
• If a nursing home is determined to be the best source of care, visit several unannounced to find the one that best serves your expectations and needs.
• This information is meant to give you a starting point in evaluating potential alternatives. You should contact Medicare/Medicaid and have a professional thoroughly explain your options.
• Before signing up for any program, make absolutely sure that you have all the facts, including costs. Ask for written information on programs of interest.