Selecting a Nursing Home or Long-Term Care Facility

Please use the questions below as a guide in selecting a nursing home or another long-term care facility for you or a loved one. It's also a good idea to ask the home for a copy of its latest inspection and whether a volunteer ombudsman visits regularly. An ombudsman will advocate for your loved one and other residents. And remember, if you have a complaint about a home, or suspect an elderly or disabled person who lives there is being abused or neglected, call the Adult Abuse and Neglect Hotline, 1-800-392-0210.

Do all facilities provide the same services and care?
What questions should I ask to choose an appropriate facility?
What should I look for when signing a long-term care facility contract?
What happens if I run out of money?
What is the cost of facility care?
Do all facilities take Medicare and/or Medicaid reimbursement for care?
What are my rights as a long-term care facility resident?

Do all facilities provide the same services and care
No, there are different levels of care provided. Missouri's long term care facilities provide different levels of care depending upon a person's needs. Click here to view the different levels of care.

What questions should I ask to choose an appropriate facility?

Try to visit several homes or facilities, more than once if possible, and at different times. You'll be able to see how staff interacts with residents at meal times and during afternoon or evening hours.

For a more complete checklist, contact your local Area Agency on Aging or the Missouri Long-Term Care Ombudsman Program at 1-800-309-3282.

What should I look for when signing a long-term care facility contract?
Residents have rights secured by both state and federal laws (these rights are listed at the end of these questions). The admission agreement is also very important in defining a resident's rights and obligations.

Carefully read the admission agreement and ask questions when you don't understand something. The agreement must specify items and services included in the daily rate, and items and services not included.

It should also state how the facility handles emergency situations and when a resident may be transferred.

Each facility also has a "bed-hold policy" that specifies how residents can secure their bed, or a bed in the facility, if they have to go to the hospital.

The agreement must not require family members to be responsible for their loved one's bills if their loved ones receive Medicaid.

What happens if I run out of money?
Many people enter a skilled nursing or an intermediate care facility as private pay residents and turn to Medicaid when their money runs out. If the home is Medicaid-certified, it must continue to care for a resident who eventually requires Medicaid if a Medicaid bed is available. To ensure continued coverage, request a Medicaid-certified bed upon admission. If there is a suspected diagnosis of mental illness, mental retardation, or related disorder, a special screening process may be required.

Placement in a Medicaid bed allows a person to take advantage of the "division of assets" program. The program helps ensure residents' spouses who live in the community are not impoverished because of their loved one's facility bills. A person can apply for Medicaid at his or her local Division of Family Services office.

In some instances, residents are eligible for a cash grant to help cover the costs of their care. The grant, funded by Missouri tax dollars, is available to eligible low-income persons through application at their local Division of Family Services office.

What is the cost of facility care?
Nationwide, the cost is around is $64,000 per year for a skilled nursing home. The average cost in a residential care facility is around $24,000. When selecting a facility, find out which services are included in the basic daily charge and which are not covered. Ask whether a deposit is required and the procedure for return of the deposit. (Medicaid residents do not have to give a deposit).

Do all facilities accept Medicare and/or Medicaid reimbursement for care?
Many skilled nursing and intermediate care facilities accept Medicare and/or Medicaid reimbursement, but residential care facilities do not. However, residential care facility residents may be eligible for state assistance through the Supplemental Nursing Care grant. In addition residential care facilities may participate in the Medicaid Personal Care Program. The Personal Care Program offers Medicaid-eligible residents assistance with activities of daily living. This program provides residential care residents an alternative to nursing facility care.

What are my rights as a long-term care facility resident?
Missourians who live in a long-term care facility licensed by the state are guaranteed certain rights under the Missouri Omnibus Nursing Home Act of 1979 and the federal Omnibus Budget Reconciliation Act of 1987. The rights are: