A Nursing Home is a residence that
provides room, meals, skilled nursing and rehabilitative care,
medical services, and protective supervision. It also provides
residents with help with daily living and recreational
activities. Many nursing home residents have physical,
emotional, or mental impairments which keep them from being able
to live independently in their home or apartment. Nursing homes
are certified by State and Federal government agencies to
provide levels of care which range from custodial care to
skilled nursing care that can only be delivered by trained
professionals.
Nursing homes in Michigan provide services for individuals
age 18 and older. Facilities which are licensed to participate
in the Medicaid program must provide directly, or arrange for, a
full range of services for residents who need them, from those
services above the level of room and board
which can be provided in the institutional setting. To obtain
and maintain licensure, nursing homes are required to meet a
number of requirements relating to the provision of services,
residents’ rights and administration.
In general, nursing homes must provide or arrange for the
provision of, at a minimum:
- Nursing and related services and specialized
rehabilitative services;
- Medically-related social services to attain or maintain
the highest practical physical, mental, and psycho-social
well-being.
- Pharmaceutical services to meet the needs of each
resident;
- Dietary services that assure that the meals meet the daily
nutritional and special dietary needs of each resident;
- An on-going program of activities designed to meet the
interests and the physical, mental, and psycho-social
well-being of each resident.
Nursing homes are also required to protect the rights of all
residents, including the right to a dignified existence,
self-determination and communication with and access to persons
and services inside and outside of the facility. A nursing home
must protect the rights of each resident. The resident has the
right to exercise his/her rights as a resident of the facility
and as a citizen of the State and of the United States.
A full listing of residents’ rights should be available
upon request from each nursing facility. Nursing homes are
required to review these rights with the resident and family at
the time of admission.
Payment for Nursing Home care may be through several sources,
although each source may or may not pay for levels of care
provided at the home. The sources include Medicare, Medicaid,
private insurances and private pay.
Medicare payments are restricted to car provided in nursing
homes when the care provided is classified as
"skilled". Payments may continue up to 100 days
provided the level of care continues to be classified as
skilled. Frequently payments do not exceed 20 days.
Medicaid payments are based on financial eligibility tests
and may require a patient pay amount, dependent upon the person’s
income and assets. These amounts are determined at the same time
that financial eligibility is determined. In Michigan, this
determination is made by the Family Independence Agency.
When Medicare and/or Medicaid is paying for the nursing home
stay, facilities are prohibited from charging extra for direct
care and daily needs such as nursing services, dietary services,
room/bed maintenance, routine personal hygiene items and
services to meet the needs of residents, including, but not
limited to: hair hygiene supplies, soaps, dental care items,
deodorants, incontinence care and supplies, over the counter
drugs, bathing, and basic personal laundry.
Facilities may charge for personal use items such as
telephones, televisions, radios, personal comfort items
including smoking materials, novelties and confections,
cosmetics, personal clothing, etc.
Other payment sources include personal long-term care
insurance policies and personal, private payment. Services
covered through private insurance programs may vary dependent
upon the policy purchased. Under private pay arrangements, the
nursing home may charge for each individual service separately.
Usually private pay arrangements have basic room, board and care
packages at a basic rate with all additional services and items
charged at a separate, individual rate.
