Nursing Homes: Six Tips for Helping Your Parents Choose a Nursing Home

1 - Do Your Homework

As with most things in life, it's best to plan ahead. You want to begin considering nursing homes before your parent might be in need of one. It's always a bad idea to make important decisions when you are in crisis mode. If you have not planned ahead and your parent suddenly is in need of a nursing home (it tends to sneak up on you), then you will be in crisis mode, stressed out and overwhelmed and you might not make the best decision for your parent.

2 - Check Accreditation and Staffing

It's important to make sure that the nursing home you are considering is safe and in compliance with accreditation standards. The easiest way to do that is to check the Joint Commission on the Accreditation of Healthcare Organizations' website. You can also use the Nursing Home Compare tool on Medicare.gov to compare nursing homes in your area.

3 - Talk with a Professional

A geriatric care manager can be an invaluable resource for you in trying to determine what nursing home is best for your parents and in acting as an advocate for your parent after they have entered the nursing home. You can find a geriatric care manager in your area at the National Association of Professional Geriatric Care Managers website. It is also important to enlist the aid of an elder law attorney who can help you navigate the various benefit programs that may be available to your parent to help pay for their nursing home care. Additionally, elder law attorneys are a great resource who, because they work with many clients involved in similar situations to your parents, know a lot about the quality of the nursing homes in your area and what resources are available to assist you. Additionally, seniors often have legal needs that are different from those of younger folks for example, we might be able to help your parents qualify for Veterans Aid and Attendance or Medicaid.

4 - Speak to Residents and The Loved Ones Who Visit Them

This is the best way to get a real sense for the quality of a nursing home. Who knows better than the residents the quality of care provided at a nursing home? Ask about the quality of the care and the quality of the food. Family members of residents can give you their impressions and talk about how satisfied they are with the nursing home.

5 - Ask for An Activity Calendar

Nursing homes typically post up a calendar of events planned for the week. Ask for a copy of the activities calendar when you are visiting to see if the activities being promised by the marketing folks you are meeting with are actually happening. If you see a room full of residents sitting glassy eyed in front of the television, it's not a good sign.

6 - Be an Advocate for Your Parent

Be an advocate for your parents and for their needs. No one will take a greater interest in your parents' care than you. Visit the nursing home early and visit often. The more you visit your parents at the nursing home, the better care they will receive. Nursing home staff knows which residents' families visit and will make sure that the residents with visitors are well taken care of.

Medicaid Estate Recovery: Can I Stop the Government From Taking My Home

The short answer is YES, you can keep the Government from taking your home if you require nursing home care paid for by the federal Medicaid program.  The Medicaid Estate Recovery program was was created by a requirement in the Omnibus Budget Reconciliation Act of 1993 (OBRA ‘93).  The provision required that states seek to recover the costs of seniors’ medical care from their estates after they died.  

Georgia did not move quickly to obey the federal mandate for Medicaid Estate Recovery, but on July 14, 2004, the Georgia Department of Community Health (DCH), changed Georgia policy and implemented the estate recovery program in Georgia.  It was not until 2006, that they actually began to enforce it.

In Georgia, Medicaid estate recovery applies to anyone who was a Medicaid recipient and who at the time of death was an inpatient in a nursing facility, intermediate care facility for the mentally retarded or other mental institution.  It also applies to those who at the time of death were over the age of fifty-five (55) and were receiving home and community based services.

The definition of an estate is “all real and personal property under the probate code.”  According to DCH, the estate also includes real property passing by joint tenancy, right of survivorship, life estate, survivorship, trust, annuity, homestead or any other arrangement.  The estate additionally includes excess funds from a burial trust or contract, promissory notes, cash and personal property.  The Georgia rules are not compliant with federal law and we do not agree with DCH’s position on this, but there have been no court cases to settle the dispute yet.

The first thing to know is that no action to recover assets (including homes or property) will be taken while a Medicaid recipient, a spouse or qualified children (disabled children) are living in the home and estates valued under $25,000 will not be subject to recovery (see A Snapshot of Georgia Estate Recovery).  So, if you are a Medicaid recipient and either you or your spouse are still living in the home estate recovery will take no action. For a married couple where the husband receives Nursing Home care during his lifetime and then dies, as long as the spouse continues to live in the home, Medicaid estate recovery cannot take any action with respect to that house or other assets.

We recently had a client whose husband was living in a nursing home. The wife owned the home jointly with her husband. She was suffering from cancer and wanted to sell her home and move into a new home with her daughter. Because she was living in the home, it was exempt and the transfer from her husband to her was an exempt transfer. This allowed her to sell the home and she and her daughter bought a new larger home where they could live together and the daughter can help take care of her sick mother. When our client dies, the home show bought with her daughter will not be subject to Medicaid estate recovery.

The second thing to know is that there are ways to protect your assets from estate recovery even though you may be a Medicaid recipient who would ordinarily be subject to the rules.  In cases where we are planning in advance of the need for Medicaid eligibility, we can a special type of trust called a Medicaid Asset Protection Trust to protect the asses inside the trust from the Georgia Estate Recovery Program.  There are also some transfers of assets to family members that are exempt and would protect those assets from estate recovery.  Last, it is possible to transfer the home to the well spouse which allows the well spouse to continue to live in the home or sell it as needed.  The important thing to remember is that you should not be afraid to apply for Medicaid simply because you are concerned about losing your home.  If you work with a qualified elder law attorney, you can protect your assets and receive the benefits you need to help pay for medical care.