Alabama Nursing
Home Association

4156 Carmichael Road
Montgomery, AL 36106
Phone: 334-271-6214
Fax: 334-244-6509
Email: info@anha.org




Alabama Nursing Home Association Consumer Guide

Long Term Care and You
The information that follows was designed to assist you in taking the first steps toward planning the long term care for yourself or a loved one. This information mainly focuses on long term care or nursing facility options. It offers some existing community services and resources to help you make these long term care decisions. Whether you are gathering information for a friend, loved one or yourself, the members of the Alabama Nursing Home Association strive to aid this process by providing relevant, timely information so that you will make wise, informed decisions regarding your long term care needs.


Beginning the Process: Determining Which Care Option is Best for You

Before you make the decision to pursue long-term nursing home care, it is important to accurately determine what housing option would be the best in your situation. Below is a brief description of various care options:

  • Long Term Health Care Facilities (Nursing Facilities)
    These are for individuals with documented medical conditions who require around-the-clock nursing care. Nursing facilities are designed and equipped to care for chronically ill patients who are no longer able to care for themselves. They are staffed by health care professionals, including a physician who serves as medical director, registered nurses (RNs), licensed practical nurses (LPNs), and trained nursing assistants. Nursing facilities also have physical, occupational and speech therapists available and ultimately are designed to rehabilitate residents whenever possible, with the goal of returning these individuals to independent living or life with their families. SPECIAL POPULATIONS who also receive long term care in today's nursing facilities include: physically and/or mentally challenged children and adults, children and adults with debilitating diseases and/or conditions, etc. Special population needs may not be met in all facilities, however. To determine if the special needs of your loved one can be met by a particular nursing facility, please contact your local facility directly.

  • Assisted Living Facilities (ALFs)
    These are licensed by the Alabama Department of Public Health Division of Health Care Facilities and must meet the rules and regulations they set. Assisted Living is for people who are basically able to care for themselves, but need some help with daily activities such as grooming, bathing and personal care. Others may require help in managing medications, obtaining personal care items, handling financial or other activities which fall under the category of "instrumental activities" of daily living.

  • Retirement Communities
    These are generally complexes of apartments or condominiums in which retirees can live independently, enjoying the social advantages and security of group living without the worry of maintaining a house and yard. Some are called "progressive care" or "continuing care" communities. Some offer personal services and even have an adjoining nursing facility for residents who become incapacitated.

  • Adult Day Care
    This is a protective, supervised place for the frail elderly person who has help at home during the evenings but whose family or spouse is employed during the day. Medical and social services are limited, but adult day care can provide general assistance with activities of daily living, socialization and lunches. Some programs even offer restorative and therapeutic services. For more information on approved adult day care providers, please contact your local county Department of Human Resources or the Alabama Department of Human Resources, Office of Social Services Contracts, by calling (334) 242-1650.

  • Outpatient Services
    Some nursing facilities make special services available on an outpatient basis to persons who have not been admitted to the facility. The patient can be brought into the nursing facilities for such services as speech and pathology services, testing, fitting or training in the use of prosthetic or orthotic devices, social or psychological services, nursing care, drugs and biologicals that cannot be self-administered, and other services. For more information on what outpatient services may be available in your area, contact your local nursing facility.

  • Respite Care
    Respite Care offers overnight accommodations, as well as some medical and social supervision, for persons whose families may be temporarily unable to provide their care. Respite programs can often provide families with a much-needed break from the stress of caring for a sick person. For more information on respite care options, please contact the Alabama Association of Home Health Agencies by calling (334) 277-2130.

  • Home Health Care
    Home health care provides medical assistance in the patient's home, generally for 1-2 hours, two or three times a week. Among the services available are nursing care, physical, occupational or speech therapy, medical, social services, home health aide or homemaker services, and medical supplies and services. Some of these services may be reimburseable by Medicare or Medicaid. For more information on home health care, contact the Alabama Association of Home Health Agencies by calling (334) 277-2130.

  • Hospice Care
    Hospice care is a program of comfort and supportive services for patients who can no longer benefit from curative medical treatments. The medical team comprised of nurses, social workers, home health aides and chaplains, provides medical, social and psychosocial care for the patient and the patient's family. Medical care is provided on an intermittent, regularly scheduled basis. Hospice nurses are on call 24-hours a day. For the most part, care is provided in the comfort of the patient's own home or medical facility when needed. For more in formation on the hospice organization in your area, please contact the Alabama Hospice Organization by calling (205) 969-0722 or write to: 1647 Kristi Circle, Birmingham, Alabama 35243.

What is the Difference Between Medicare and Medicaid?

MEDICARE:

Medicare is the nation's health insurance program for all people 65 years of age or over and for certain disabled persons. Run by the Centers for Medicare and Medicaid Services (CMS) of the U.S. Dept. of Health and Human Services, the Medicare program is divided into two sections:

Medicare Part A (Hospital Insurance) helps pay for inpatient hospital care, inpatient care in a skilled nursing facility, home health care, and hospice care. Part A has deductibles and co-insurance, but most people don't have to pay premiums for Medicare Part A. You can sign up for Medicare Part A during a general enrollment period: January 1st - March 31st of each year.

Medicare Part B (Medical Insurance) helps pay for doctor's services, outpatient hospital services, durable medical equipment, and a number of other medical supplies and services not covered by Medicare Part A Hospital Insurance. Medicare Part B has premiums, deductibles and co-insurance amounts that you must pay yourself or through coverage by another insurance plan. If you have Medicare Part A (Hospital Insurance) but not Part B (Medical Insurance), then you can sign up for Medicare Part B during a general enrollment period: January 1st - March 31st of each year.

For more information on Medicare Part A or Part B, please contact the Social Security Administration information office by calling 1-800-772-1213 or Medicare at 1-800-292-8855.

MEDICAID:

Medicaid is a program funded jointly by the federal and state government that provides medical benefits to certain low-income individuals. Operated and administered by the state, this program is subject to broad federal guidelines, state-determined program benefits and eligibility requirements.

In the state of Alabama, Medicaid eligibility is based on several factors:

  • The individual's monthly income;
  • The individual's resources (such as real estate, checking and savings, stocks and bonds, trusts, loans, cash, mutual funds, etc.)
  • Residence requirements (must be a citizen of the United States or a lawful alien admitted for permanent residence, must be a resident of the state of Alabama, and, for institutional stays, must be a resident of the approved medical institution for at least 30 continuous days.);
  • Disposal of resources restrictions (an individual will not be eligible for nursing facility payments if resources such as real estate, checking and savings, stocks and bonds, trusts, loans, cash, mutual funds, etc., are disposed of, deeded, given away, or transferred to another name for less than fair market value of the resource if such disposal is made to meet Medicaid eligibility requirements. The "look back" period for disposal of resources is 3 years. This carries a penalty period from the date of disposal, depending on the uncompensated value of the transfer. The transfer period can be an indefinite length of time if resources have been transferred within 3 years of application.
  • The date of the transfer and the value determine the length of the period of ineligibility;
  • Medical Approval. This means that:
    1. An applicant must be medically approved by Utilization Control or Medicare prior to financial approval. The nursing facility must submit the medical information for this determination;
    2. An individual must apply for and elect to receive any assistance from annuities, pensions, retirements, disability benefits, or other income to which he is entitled. Persons failing to do so may be deemed ineligible for this reason;

Follow-Up To Questions Asked During Medicare Drug Card Program At ANHA Mid-Year

Do residents who have Medicare Part B qualify for Medicare Drug Card?
Yes, a person can qualify for the Medicare-approved card if he or she

  • has Medicare Part A and/or Part B, and
  • does not have any outpatient prescription drug benefit through Medicaid

A person can apply for the Transitional Assistance Card to get a $600 credit to help pay for prescription drugs, if he or she

  • has Medicare Part A and/or Part B
  • does not have any other health insurance with prescription drug coverage (except a Medicare + Choice Plan or a Medigap Policy).
  • has an annual income of no more than $12,569, if single and no more than $16,862 if married (this includes the income of both).
  • does not have Medicaid benefits

Does Alabama Medicaid allow the resident to use the $600 benefit considering Medicare benefits should be exhausted before Medicaid benefits start?
If a person has the $600 transitional card benefit, this benefit should be used during the spend down period prior to submitting any claims to Medicaid for prescription drugs. Prescription medications should not be billed to Medicaid until the $600 benefit is exhausted.

The eligibility for the transitional assistance card is based on income, whereas Medicaid is based on income and assets. Therefore, an individual who has little or no income, but is currently spending down assets, would be able to qualify for the transitional assistance card.

Can the resident be on C+ and the Medicare Discount Program at the same time?
No. As of June 1, 2004, the BlueRx Prescription Discount Card will replace the current C Plus drug discount program. This will be a Medicare Discount Card.

Can the $600 benefit be transferred to another card within the same plan year and what about rollover of benefits?
A person can only change Medicare approved drug discount cards and transfer the remaining balance, if one of the following occurred:

  • he or she moved to another state in which the discount card isn't offered,
  • he or she joined or left a Medicare Managed Care plan,
  • he or she entered or left a long-term care facility, or
  • the private company stopped offering the discount card.

The remaining credit balance can also be transferred if you elect to change cards between November 15, 2004 and December 31, 2004. During this period, a person can choose to change cards.

If he or she keeps the same card and have some of the $600 credit remaining, it can be used in 2005.

What is to keep someone from using (2) cards at the same time?
A person can enroll in only one Medicare-approved drug discount card. CMS has systems in place to monitor this.

If a resident is on Medicaid, does Medicare allow the $600 credit and when?
A person is not eligible for the $600 transitional assistance if he or she has Medicaid benefits.

The CMS website has a resource called, " Guide to Choosing a Medicare-Approved Drug Discount Card," that should be a useful tool for facilities. You can access this at: www.medicare.gov

This is in no way a complete or final statement of Medicaid eligibility requirements, and is subject to change. The Medicaid District Office serving your area should be contacted for information regarding any changes or updating of the rules stated above. If you have applied for Medicaid, you will be notified by the District Office as soon as a decision is made on your application. It will then be your responsibility to notify the District Office of any changes.

You can contact the Alabama Medicaid Agency and find out the phone number of the District Office in your area by calling (334) 242-5000 or www.medicaid.state.al.us

MEDICAID DISTRICT OFFICES:

Auburn-Opelika
Counties Served: Bullock, Chambers, Clay, Coosa, Lee, Macon, Randolph, Russell, Talladega, Tallapoosa
2015 Gateway Drive
Opelika, AL 36801-6836
1-800-362-1504 PHONE
1-877-814-8309 FAX

Birmingham
Counties Served: Jefferson, St. Clair
486 Palisades Boulevard
Birmingham, AL 35209-5154
1-800-362-1504 PHONE
1-877-814-8302 FAX

Decatur
Counties Served: Cullman, Morgan
2119 Westmeade Drive, S.W., Suite 1
Decatur, AL 35603-1050
1-800-362-1504 PHONE
1-877-814-8304 FAX

Dothan
Counties Served: Barbour, Coffee, Conecuh, Covington, Dale, Geneva, Henry, Houston
2652 Fortner Street, Suite 4
Dothan, AL 36305-3203
1-800-362-1504 PHONE
1-877-814-8305 FAX

Florence
Counties Served: Colbert, Franklin, Lauderdale, Lawrence, Marion, Winston
214 E. College Street
Florence, AL 35630-5606
1-800-362-1504 PHONE
1-877-814-8303 FAX

Gadsden
Counties Served: Blount, Calhoun, Cherokee, Cleburne, Dekalb, Etowah, Marshall
200 West Meighan Boluevard, Suite D
Gadsden, AL 35901-3200
1-800-362-1504 PHONE
1-877-814-8306 FAX

Huntsville
Counties Served: Jackson, Madison, Limestone
6515 University Drive NW, Suite B
Huntsville, AL 35806-1775
1-855-733-3160 PHONE
1-855-295-8813 FAX

Mobile
Counties Served: Baldwin, Escambia, Mobile, Washington
2800 Dauphin Street, Suite 105
Mobile, AL 36606-2400
1-800-362-1504 PHONE
1-877-814-8308 FAX

Montgomery
Counties Served: Autauga, Crenshaw, Elmore, Montgomery, Pike
500 Monroe Street
(P.O. Box 5624, Zip 36103-5624)
Montgomery, AL 36104-3744
1-800-362-1504 PHONE
1-877-814-8307 FAX

Selma
Counties Served: Butler, Chilton, Choctaw, Clarke, Dallas, Lowndes, Marengo, Monroe, Perry, Wilcox
106 Executive Park Lane
Selma, AL 36701-7734
1-800-362-1504 PHONE
1-877-814-8311 FAX

Tuscaloosa
Counties Served: Bibb, Fayette, Greene, Hale, Lamar, Pickens, Shelby, Sumter, Tuscaloosa, Walker
907 22nd Avenue
Tuscaloosa, AL 35401-5822
1-800-362-1504 PHONE
1-877-814-8310 FAX


When Long Term Care Is The Appropriate Option:

How To Choose A Nursing Facility

Selecting a nursing facility is one of the most important decisions you may be asked to make, either for yourself or for a family member. Ideally, this decision would be made far in advance with adequate planning. Unfortunately, it is often made during a crisis, such as a severe illness or following surgery. Many people don't have any idea of how to begin their search or what they are really looking for in a nursing facility.

The first step is to make a list of nursing facilities in the desired location. If you need a complete listing of all nursing facilities in Alabama, you may contact the Alabama Department of Public Health, Division of Health Care Facilities (334) 206-5075.

Before visiting any of the facilities on your list, you may wish to contact them by telephone. This could save you some time, since some facilities may not offer the type of care which the resident will require. Make a list of the name, address and phone number of those facilities that can meet the particular needs of your resident.

At those homes, ask if they have beds currently available for placement and ask to be put on their waiting list. Don't be surprised if you hear that many facilities have waiting lists ... placement waiting lists in Alabama's nursing facilities are very common. For your records, make sure you write down the facility name, the date that you called, and the name of the person with whom you spoke. Then you should...

Make an appointment with the administrator and request a complete tour of those homes in which you are interested. Don't be afraid to ask questions. Talk to residents, family members, staff and volunteers. Make a point to sample the food served to residents. Ask to see and make sure the facility and administrator have current licenses from the state. If they do not, you may be dealing with some type of boarding facility falsely claiming to be a nursing facility. Also, you will want to discuss payment options. The admissions director can help determine if you or your loved one qualifies for Medicaid, Medicare or other programs.

Of the items which you will want to consider and/or inquire about when you are considering nursing facility options include the following:

Environment

  • Do you feel welcome when you enter?
  • Is there a window in every bedroom?
  • Are there no more than four (4) beds in each room?
  • Does each bed have a privacy curtain?
  • Does each bed have a nurse call bell?
  • Is there easy access to each bed?
  • Is there adequate closet space?
  • Is the facility clean and free from unpleasant odors?
  • Are the hallways and rooms hazard free?
  • Are the bathrooms convenient to the bedrooms?
  • Is there a sink in each bathroom?
  • Is there a nurse call bell to use in the bathroom?
  • Are there hand grips near the toilets?
  • Do showers and tubs have non-slip surfaces and hand grips?
  • Is there outdoor furniture for residents?
  • Are there walkways outside?
  • Are visiting hours convenient?
  • How are roommates selected?

Dining Room

  • Is the dining room attractive?
  • Are the tables and chairs comfortable?
  • Is there adequate access for wheelchairs in the dining room?
  • Is the food tasty and attractive?
  • Are residents given enough time to eat?
  • Do residents receive help eating if they need it?
  • Are personal likes and dislikes taken into account when planning the menu?
  • Is there a variety from meal to meal?
  • Is food delivered to the rooms of residents unable to eat in the dining room?

Activities

  • Is there an activities room?
  • Are activities tailored to the individual's needs and interests?
  • Have arrangements been made for worship services?
  • Are group and individual activities planned?
  • Are outside trips available?
  • Is there a social services worker available to assist residents and families?
  • Does the facility have contacts with community groups, such as local schools, pet therapy programs or Scouts?

Staffing

  • Do staff members show interest in and affection for individual residents?
  • Are staff members courteous and respectful?
  • Do staff members know residents' names and take time to chat with them?
  • Do staff members respond quickly to resident calls for assistance?
  • Does the staff encourage family visits?
  • Is the administrator available to answer questions, hear complaints or discuss problems?
  • Is the resident happy with the location?
  • Are barbers and beauticians available?

Other

  • Will family and friends be able to visit?
  • How close is the nearest hospital?
  • Is emergency transportation readily available if needed?
  • What types of therapy programs are available?
  • Does the facility have a description of resident rights and responsibilities posted?
  • Does the facility have a resident council?
  • Does the facility have a family council?
  • Are there private areas for residents to meet with family, visitors or physicians?
  • Is a physician available in an emergency? Are personal physicians allowed?
  • Are residents and families involved in developing the resident's care plan?
  • Are all services covered under the basic rate? If not, is a list of specific services not covered in the basic rate available?
  • Is the general atmosphere welcoming?

If you are selecting a nursing facility for someone else, be sure to involve this person in the decision. Moving to a new home is difficult for anyone, but is often more difficult when one is ill and unsure of the move.

Be prepared to ease the transition by accompanying him or her on admission day. Also be ready to visit the new resident regularly and make sure other friends are willing to do so.

An Explanation of the Rights of Nursing Facility Residents

It is the goal of Alabama's nursing facilities to promote and protect the rights of each of their residents. According to the Older American's Act, a federal law which was initially passed in 1965, each nursing facility resident has a right to a dignified existence, self-determination, and communications with and/or access to persons and services both inside and outside of the nursing home. Also included is the right to the individual's freedom of choice, the right to privacy and the right to voice grievances. Some of these resident rights include:

  • the right to be treated with dignity, privacy, respect, and to live in a safe, clean, comfortable, and homelike environment
  • the right to exercise their rights as citizens of the United States and of the State of Alabama, including the right to vote
  • the right to be fully informed in writing of all facility services and charges for those services
  • the right to be informed of their health status and the right to participate in the planning of their own care and treatment, the right to refuse medical treatment, including experimental research, and the right to formulate an advance directive
  • the right to have their money and property protected
  • the right to manage their financial affairs
  • the right to know if they are eligible for Medicaid or Medicare and how to apply for coverage
  • the right of freedom of choice to make their own decisions
  • the right to privacy including accommodations, medical treatment, written and telephone communications, personal care, and meetings of family and resident groups, but this does not require the facility to provide a private room
  • the right to retain and use personal possessions, as space permits
  • the right to privacy and confidentiality of their medical and clinical records
  • the right to an accessible grievance procedure that is easy to use
  • the right to refuse to perform services for the facility unless they desire to do so and it is documented in the plan of care
  • the right to choose the groups and activities in which they wish to participate
  • the right to have guests visit and other personal communications
  • the right to basic procedural safeguards on admission, transfer and discharge
  • the right to get advance notice about a change in room or roommate, and to be told why such a change is needed
  • the right to be informed in writing of the bed-hold policy for temporary absences from the facility
  • the right to be free from physical restraints or psychoactive drugs administered for discipline or convenience, or not required to treat their medical symptoms
  • the right to be free of verbal, mental, sexual, or physical abuse and involuntary seclusion
  • the right to refuse a transfer to another room within the facility under certain circumstances
  • the right to self-administer drugs if the interdisciplinary team has determined that this practice is safe
  • the right to examine the results of the most recent Federal or State survey of the facility
  • the right to be free of interference, coercion, discrimination, or reprisal from the facility in exercising these rights
  • the right to be informed both orally and in writing of their rights and all the rules and regulations governing their conduct and responsibilities during their stay in the facility

Answers To Common Questions About Long Term Care and Nursing Facilities
What types of care are available in nursing facilities?

Most nursing facilities offer services that include: subacute, rehabilitative, medical, skilled nursing and supportive social services for people who have functional limitations or chronic health conditions, and who need on-going health care assistance with their normal activities of daily living (ADL's). Long term care can also include respite care, adult day care, home and community based care and nursing care. Although most long term care services are used by the elderly, young adults, children and even infants use long term care services due to chronic illness or accident.

Nursing facility care is provided in a health care facility that provides a wide range of services to meet both the short-term rehabilitative and the long-term care patient's needs. Today's nursing facilities are staffed by trained professionals who provide essential health and psychosocial services according to a physician's prescribed patient care plan, and in conjunction with state and national standards designed to assure quality care. There are approximately 245 nursing homes in Alabama providing medical and nursing care, social services, and a home-like environment for Alabama's convalescent and chronically ill residents. Alabama's nursing facilities are licensed under the guidelines of and by the Alabama Department of Public Health, Division of Health Care Facilities, to provide a variety of health and rehabilitative care services.

All of Alabama's long-term care facilities now provide care under the guidelines established for Nursing Care Facilities (NCF). In a Nursing Care Facility, 24 hours of nursing care is provided under a physician's order through a comprehensive plan of treatment developed by a team of trained professionals. In NCF facilities, continuous care consists of services which require specialized judgement and skill based on trained knowledge provided by qualified staff members (registered nurses, physical therapists, etc.). These skills are often rehabilitative in nature and must be performed effectively. Any medical complications or special services must be documented by the physician's orders and the nursing notes.

What services are offered to residents of Alabama's nursing facilities?
Four basic types of services are offered by nursing facilities nationally and in Alabama: nursing care, personal care, residential services and medical care.

Nursing Care procedures require that the professional skills of a registered nurse (RN) or licensed practical nurse (LPN) be utilized in nursing home care. Included in the duties of these RN's and LPN's is the administering of medication, injections, catheterizations and similar procedures as ordered by an attending physician. Post-hospital stroke, heart, or orthopedic care with related services such as physical and/or occupational therapy, dental services, dietary consultations, laboratory and x-ray services and a pharmaceutical dispensary are also available.

Personal Care services include help in walking, getting into and out of bed, bathing, dressing, eating and providing special diets as prescribed by a physician.

Residential Services include general supervision and a protective environment, such as room and board and a planned program for the social and spiritual needs of the resident.

In meeting the Medical Care needs of each resident, nursing facilities work under the overall plan of care provided by the resident's physician. In most cases, the resident's personal physician refers him or her to the facility and certifies the need for admission. Once the resident is admitted, the physician writes orders for medication, develops the resident's care plan (including restorative and rehabilitative procedures, special diets and other treatments) and visits periodically. Every nursing facility usually has at least one physician on staff or on call to handle emergency situations.

When is nursing facility care appropriate?
Typically, the need for nursing facility care increases with age. Researchers estimate that the probability of needing nursing facility services is 60% for those individuals 85-94 years of age (Kemper and Murtaugh, New England Journal of Medicine, "Lifetime Use of Nursing Home Care", 1991). The size of a state's elderly population is important in gauging potential future impact on nursing facility services. In the state of Alabama in 2002, 13.1% of the state's population (or 588,542 Alabamians) were ages 65 or above. On the national front, it is estimated that nearly 25% of all Americans ages 85 and older have spent some time in a nursing facility.

In addition, the characteristics of nursing facility residents differ significantly from the elderly living in the community. Statistics show that nursing facility residents tend to have health problems which significantly restrict their ability to care for themselves on a daily basis, such as problems with bathing or dressing. In addition, about two thirds of nursing facility residents have some form of memory impairment or disorientation.

The most common chronic illnesses affecting nursing facility residents are arteriosclerosis, heart disease, chronic brain disorders and arthritis. According to a national study, about half of all nursing facility residents have Alzheimer's disease in various stages of development.

Who assures the quality of care for Alabama's nursing facility residents?
All Alabama nursing facilities are inspected at least once a year by the Alabama Department of Public Health on an unannounced basis. State inspectors look at everything - from staff adequacy and the cleanliness of the facility, to food preparation methods and the proper administration of medications and therapies. In all, these nursing facilities must pass over 500 state and federal regulations, making the long-term care industry one of the most regulated industries in the nation. The State of Alabama also has a very active nursing facility Ombudsman Program designed to assist residents with complaints and the achievement of fair settlements or solutions. Through this program administered by the Alabama Department of Senior Services (334) 242-5743, a volunteer ombudsman visits nursing facility residents on a regular basis to help resolve any resident complaints or concerns.

What is the typical cost of a day of nursing facility care?
In 2003, the typical cost of basic care in a nursing facility in Alabama ranges from approximately $110-160 per day. Included in this typical daily rate is 24-hour room, board, nursing care, recreational activities and social services. Other services, such as physical and speech therapy, are usually charged separately.

How is nursing facility care usually paid for?
In 2003, approximately 73% of nursing facility residents in the state of Alabama had their care paid for by Medicaid, the state's medical program for those citizens with limited incomes. Created in 1965 by the federal government, Medicaid was designed to provide medical coverage for those citizens with limited incomes, and is jointly financed by the state and federal governments. The program is governed by federal guidelines, however state programs vary in eligibility criteria, services covered, and limitations on services.

Surprising to most people is the minor role that is played by Medicare - the nation's health insurance program for the elderly - in nursing facility expenses. In Alabama, Medicare pays for only about twelve percent (12%) of nursing facility care and only 11% on a national level. These figures differ drastically from the public's perception of Medicare's role in long term care financing. A poll conducted by the Gallup Organization revealed the following statistics:

1 in 8 people said that they did not know how they would pay for health care in their retirement years...1 in 4 people said they did not know how they would pay for extended care in a nursing facility if a family member needed it now.

Another misconception that people have is that private insurance policies cover and pay for a large majority of nursing facility care. In reality, most private insurance policies do not include nursing facility care in their coverage. Even though almost one-half of all people over the age of 65 are covered by some type of private health insurance, only about one percent (1%) of nursing facility costs are covered by private insurance.

Because of the lack of insurance protection for nursing facility care, most people who enter into a nursing facility must pay for that care themselves through private pay sources. In the United States in 1999, patients and families financed 23.5% of the cost of nursing facility care.

In what manner will demographics determine the future cost of health care in the United States?
The future of health care costs will be determined in great part by the steadily growing elderly segment of the population. The "graying of America" will continue to influence the direction of health policy development as more and more of the nation's scarce resources will need to be allocated for research and the provision of services.

According to the Social Security Administration's Office of the Actuary, the projected growth of those age 65 years and over is estimated to reach 70.5 million by the year 2050.
Age Year Year Year
2000 2025 2050
65-74 yrs 14.1 27.9 17.3
75-84 yrs 16.9 25.1 37.8
85+ yrs 46.8 6.8 15.4
Yearly Total 35.5 59.8 70.5
Source: Social Security Administration, Office of the Actuary (shown in millions)

Some other long term care facts and statistics:
The primary factors leading to nursing facility care are:
  • Absence of family
  • Exhaustion of financial resources
  • Burden on existing family members
  • The increase of women in the workforce
  • Rising life expectancies
  • Decline in family size over the past 30 years resulting in less children to assist elderly family members
What should I consider when selecting a nursing facility?
Alabama's nursing facilities are alike in many ways:
(1) they all have similar goals and purposes;
(2) they all offer specific types of care; and
(3) they are all subject to the same rules and regulations.

However, there are some differences among facilities that could make one nursing facility better suited to the resident's particular needs than others. When choosing a nursing facility, several things should be considered.

How do you plan to pay for your long-term care? If you plan to pay for the care with a particular type of governmental funding (Medicare, Medicaid, etc.), then the selection of a nursing home will be limited to those facilities who participate (and have eligible beds available) in the program. To determine if a facility participates in federal and/or state programs, simply contact the facility and ask the following questions:
(1) Do you participate in the (Medicare /Medicaid /etc.) program?
(2) How many beds which have been specified for this type funding do you have available?
(3) If you have a waiting list, how long is it?
(4) Then ask to be put on the waiting list and make an appointment to go by and tour the facility.

Will location be a factor in your decision?
For many individuals, location is a prime consideration when selecting a nursing facility ... not only to family members, but also in the general atmosphere of the facility. Just as in any other type of facility, where it is located more than likely will reflect the lifestyle of the community ... be it urban, suburban or rural. Look for a nursing facility which reflects the location and atmosphere in which you and/or the resident would like to reside.

Do you have any special medical/social/psychosocial needs which will require particular attention?
The type of facility you select depends on your individual needs. Not all nursing facilities offer and/or specialize in the same types of services. For example, some nursing facilities offer special therapy programs, some have special programs for those who have Alzheimer's Disease, and others are equipped to treat residents who are tube-fed.

If you have any special needs such as these, it is very important that you contact the facilities on your list and ask if they can accommodate a patient with those needs.

Consumer Guide Help Numbers

HP
PH 334-215-0111
301 Technacenter Drive
Montgomery, AL 36117

AL State Board of Social Work Examiners
Rebecca Goodson , Executive Director
PH 334-242-5860
http://www.socialwork.alabama.gov
100 N. Union Street, Suite 736
Montgomery, AL 36104

Alabama Board of Nursing
Genell Lee, Executive Director
PH 334-293-5200
http://www.abn.alabama.gov
RSA Plaza
770 Washington Ave, Suite 250
Montgomery, AL 36104

Alabama Department of Human Resources
Nancy Buckner, Commissioner
PH 334-242-1310
http://www.dhr.alabama.gov
Gordon Persons Building
50 North Ripley Street
Montgomery, AL 36130


Additional Office Numbers:
DHR Adult Protective Services Hotline
800-458-7214

Alabama Department of Mental Health
Jim Reddoch, Commissioner
PH 334-242-3454
http://www.mh.alabama.gov
100 North Union Street
P.O. Box 301410
Montgomery, AL 36130-1410

Alabama Department of Public Health
Dr. Don Williamson, State Health Officer
PH 334-206-5200
http://www.adph.org
201 Monroe Street
Montgomery, AL 36130

Alabama Department of Public Health - Division of Health Care Facilities
Dr. Tom Geary, Director of Health Provider Standards
PH 334-206-5366
http://www.adph.org
201 Monroe Street,
Suite 710
Montgomery, AL 36130

Additional Office Numbers:
Abuse/ Unusual Occurrences
(FAX) 334-206-5161

Activity Certification
PH 334-206-5111

Elder Care Hotline
PH 1-800-356-9596

Nurse Aide Training/ Abuse Registry (IVR)
PH 334-206-5169

Nurse Aide Training
(FAX) 334-206-3031
http://ph.state.al.us/nar/found2.asp

Alabama Department of Senior Services
Neal Morrison, Commissioner
PH 334-242-5743
http://www.adss.alabama.gov
RSA Plaza
770 Washington Ave., Suite 570
Montgomery, AL 36130

Alabama House of Representatives (Information)
PH 334-242-7600
http://www.legislature.state.al.us
11 South Union Street
Montgomery, AL 36130

Alabama Medicaid Agency
Stephanie Azar, Acting Commissioner
PH 334-242-5000
http://www.medicaid.alabama.gov
501 Dexter Ave.
Montgomery, AL 36104


Additional Office Numbers:
Eligibility Questions
PH 1-800-362-1504

Non-Emergency Transportation Providers
PH 1-800-688-7989

Medicaid Recipient Inquiry Line
PH 1-800-362-1504

Medicaid Medical Services Customer Service
PH 800-362-1504

Alabama Medicaid Agency - Director of LTC Programs
PH 334-242-5009

 

Alabama Medicaid Agency - LTC Admissions & Records
PH 334-242-5684

 

Alabama Medicaid Agency - Provider Audit
PH 334-242-2311

 

Alabama Medicaid Fraud Unit
PH 1-866-452-4930

Alabama State Senate (Information)
PH 334-242-7800
11 South Union Street
Montgomery, AL 36130

http://www.legislature.state.al.us

American Health Care Association
PH 202-842-4444
http://www.ahcancal.org
1201 L Street N.W.
Washington, DC 20005

Additional Office Numbers:
Publications
1-800-321-0343

ANHA Activity/Social Services Auxiliary
PH 334-271-6214
4156 Carmichael Road
Montgomery, AL 36106

ANHA Long Term Care Professional Nurses Auxiliary
PH 334-271-6214
4156 Carmichael Road
Montgomery, AL 36106

Centers for Medicare and Medicaid Services
Renard Murray, Acting Regional Administrator
PH 404-562-7150
http://www.cms.gov
Atlanta Federal Center, 4th Floor
61 Forsyth Street SW, Suite 4T20
Atlanta, GA 30303-8909

Chauncey Group International ProCare Clinical Skills Observation Training
PH 609-720-6500
664 Rosedale Road
Princeton, New Jersey 08540

National Certification Council for Activity Professionals (NCCAP)
PH 757-552-0653
http://www.nccap.org
P.O. Box 62589
Virginia Beach, VA 23466-2589

Office of the Governor of the State of Alabama
Governor Robert Bentley
PH 334-242-7100
http://www.governor.alabama.gov
600 Dexter Ave.
Montgomery, AL 36130

Ombudsman Program at the Alabama Department of Senior Services
Virginia Bell
PH 334-242-5743
http://www.adss.alabama.gov
RSA Plaza
770 Washington Ave., Suite 570
Montgomery, AL 36130

State Health Planning and Development Agency (SHPDA)
Alva Lambert
PH 334-242-4103
http://www.shpda.state.al.us
100 N. Union Street, Suite 870
Montgomery, AL 36104

State of Alabama Board of Examiners of Nursing Home Administrators
Katrina Magdon, Executive Secretary
PH 334-271-2342
http://www.alboenha.state.al.us
4156 Carmichael Road
Montgomery, AL 36106
Definitions and Acronyms

Activities of Daily Living (ADL)
These are physical functions that an independent person performs each day. These include bathing, dressing , toileting, transferring, eating and grooming. Performance of ADLs indicates a person's degree of physical independence as part of a functional assessment.

Administration on Aging (AOA)
This administration is subunit of the Department of Health and Human Services established by the Older Americans Act of 1965 to serve as the coordinator of social services programs for the elderly and as the primary focal point for federal policies affecting the aged. AoA manages the long term care Ombudsman programs, which are authorized under the Older Americans Act, to assist in coordinating the channeling programs for long term care, provides grants for numerous community-based long term care programs and directs research and training programs on gerontology.

Alabama Nursing Home Association (ANHA)
This is a trade association established in 1951 as a statewide network of professionals dedicated to providing excellence and quality of care for Alabama's individuals in need. ANHA is the state's oldest long-term health care association. As of January 2004, ANHA represents approximately 96% of the state's long-term care facilities and is also a member of the American Health Care Association.

Alzheimer's Disease
This is a progressive brain disorder affecting memory, thought and language. Alzheimer's Disease victimizes more than 1.5 million people, mostly the elderly. First observed in 1906 by Alois Alzheimer, a German woman, Alzheimer's Disease is characterized by forgetfulness and poor judgement in the early stages. Gradually, Alzheimer's patients become disoriented, confused and depressed; often severe personality changes result in violent and irrational behavior. Eventually, sometimes as often as five to eight years after the onset, the disease leaves its victims physically disabled and totally incapable of caring for themselves.

American Association of Retired Persons (AARP)
This association was founded in 1958 to improve the quality of life for older Americans; The group has more than 3300 chapters from coast to coast, and consists of more than 20 million members. The AARP acts as an advocate for the elderly on health care and second career opportunities and sponsors consumer programs, driver improvement classes and couseling for widowed men and women.

American College of Health Care Administrators (ACHCA)
This is a professional organization that serves the needs of individual long-term care administrators. The College was established in 1962.

American Health Care Association (AHCA)
This is a federation of 51 affiliated associations, which represents 10,000 non-profit and for-profit long term care providers and cares for one million nursing facility patients nationwide. All AHCA member nursing facilities must be licensed by their state or district government, as must the administrators. AHCA and its affiliate associations are non-profit associations.

Area Agencies on Aging (AAA)
These are offices at the sub-state level charged with implementation of Older Americans Act- social and health services, and with coordinating those services with other programs authorized by the Older American Act, usually a county or city office. Presently, there are over 600 approved agencies.

Arteriosclerosis
This chronic disease is characterized by abnormal thickening and hardening of the arteries (Blood vessels). Affecting nearly one-half of all nursing facility residents, this is the most prevalent chronic disease among the elderly.

Arthritis
This involves the inflammation of one or more joints of the body. Two main types of arthritis are osteoarthritis and rheumatoid arthritis.

Assistant Director of Nursing (ADON)
He or she is a registered nurse employed by a long-term care facility who serves as the assistant to the Director of Nursing in fulfilling her responsibilities.

Assisted Living
This is the care, room and board and the provision of some assistance with the activities of daily living such as: grooming, bathing, eating, etc. This has also been known in the past as domiciliary care.

Bed Holds
This is the act of reserving a nursing care bed for a patient who is absent from the facility. Public payment policies for reserved beds are based on state Medicaid requirements. Most state plans specify requirements for absence, such as short-stay hospitalization.

Centers for Medicare and Medicaid Services (CMS)
This is the agency within the Department of Health and Human Services responsible for developing and implementing policies governing the Medicare and Medicaid programs.

Certificate of Need (CON)
This is a certification made by the state under PL No. 92-641 that determines that a certain health service is needed and authorizes a specific operator, at the operator's request, to provide that service.

Continuum of Care
This is the entire spectrum of specialized health, rehabilitative, and residential services available to the frail and chronically ill. The services focus on the social, residential, rehabilitative and supportive needs of individuals as well as needs that are essentially medical in nature.

Custodial Care
the room and board and other personal assistance services, which do not include a health service component, usually provided on a long-term basis.

Department of Human Resources (DHR)
This is the state's largest social service agency. The agency is responsible for AFCD, food stamps, day care center licensing, child support and many more social service functions.

Diagnostic Related Group (DRG)
This is a group into which all types of illnesses are classified in order to determine payment to hospitals by Medicare.

Director of Nursing (DON)
He or she is a Registered Nurse employed by a long term care facility who reports to the administrator and is responsible for employing and supervising nursing personnel, planning, implementing and evaluating nursing care and operating the nursing department within the philosophy and objectives of the institution.

Division of Health Care Facilities (DHCF)
This is the state agency responsible for licensing applicable health care facilities pursuant to State Law utilizing rules promulgated by the Alabama State Board of Health. Additional responsibilities include assisting health care facilities/ providers in complying with federal certification requirements for Medicare and Medicaid programs. Licensing requirements apply to hospitals, nursing facilities, assisted living facilities, abortion clinics, ambulatory surgical treatment centers, independent clinical laboratories, maternity homes, rehabilitation centers and related medical institutions.

Durable Medical Equipment (DME)
This includes wheelchairs, home dialysis systems for kidney patients, oxygen equipment and other medically necessary gear.

Employment Retirement Income Security Act (ERISA)
This act was passed in 1974 by Congress to guarantee and pay benefits to workers who sometimes lose pension benefits altogether if their companies fail.

Extended Care Facilities (ECF)
These were previously used in Medicare to mean a skilled nursing facility which qualifies for participation in Medicare. In 1972, the law was amended to use the more generic term , "skilled nursing facility" for both Medicare and Medicaid.

Geriatrics
This is the medical specialty focusing on the treatment of health problems for the elderly.

Gerontology
This is the study of the biology, physiology and social processes of aging.

Health Maintenance Organization (HMO)
This organization provides nearly all of the health care a person needs through specially designed doctors, hospitals, nursing facilities, labs and other agencies. No matter how much service is needed, all costs are covered by a pre-set monthly premium, paid in advance.

Health Systems Agency (HSA)
This agency is a local health planning and resources development agency designated under Title XV of the Public Health Services Act. HSAs are non-profit private corporations, public regional planning bodies or single units of local government.

Hypertension
This is abnormally high blood pressure.

Incontinence
This is the inability to control the evacuation of urine or feces.

Instrumental Activities of Daily Living (IADL)
These are home management and independent living activities such as cooking, cleaning, using a telephone, shopping, doing laundry, providing transportation and managing money.

Joint Commission of Accreditation of Health Care Organizations (JCAHO)
This is a private non-profit organization based in Chicago which currently accredits about 80% of the nation's hospitals. Presently, JCAHO accreditation is not required by the State of Alabama Department of Public Health for long term health care facilities. However, some long term care facilities have obtained this accreditation.

Level of Care
This is the intensity of services available in different health care settings. These usually include hospitals, where an acute level of care is provided; nursing care facilities, where rehabilitation services and 24-hour licensed nurse coverage are available; and residential care, where personal care and social programs are provided

Licensed Practical Nurse
He or she is licensed according to state requirements, has graduated from an approved (usually one year) nursing program and hase passed an examination. LPNs provide personal care to residents and certain other tasks under the supervision of a registered nurse.

Living Will
This is a legal statement specifying the preferences of an individual for medical treatment if mechanical support systems are required to sustain life.

Long-term Care
This is the health and/ or personal services required on a long-term basis by persons who are chronically ill, aged or disabled.

Medicaid
This is a federally funded state operated and administered program which provides medical benefits to certain low-income individuals under Title XIX of the Social Security Act. Subject to broad federal guidelines, states determine program benefits, eligibility requirements, rates of payment for providers and methods of administering the program.

Medicare
This is a nationwide health insurance program for people age 65 and over, for those eligible of Social Security disability payments for over two years and for certain workers and their dependents who need kidney transplants of dialysis. The Medicare program was enacted in 1965 as Title XVIII of the Social Security Act and became effective July 1, 1966.

Nurse Practitioner (NP)
He or she is a registered nurse working in an expanded nursing role, usually with a focus on meeting primary health care needs.

Nursing Care Facilities (NCF)
Under Medicare and Medicaid, these are institutions (or distinct parts of an institution) which provide skilled nursing care and related services for residents who require medical nursing or rehabilitation services.

Nursing Facility
This is a facility other than a hospital which provides maintenance and personal or nursing care to individuals unable to care for themselves due to a health problem. Nursing facilities do not include board and care homes.

Occupational Therapy (OT)
This is the treatment to restore, develop and/ or maintain a physical and/ or mentally disabled individual's ability to perform daily living tasks through interpersonal activities designed and adapted by professionally qualified occupational therapists.

Older Americans Act
This is a federal law, initially passed in 1965, to encourage the development of comprehensive planning and to coordinate the provision of services for the elderly, including: health, housing, employment, transportation and social services. Under the direction of the Administration on Aging, a network of state and area agencies on aging is responsible for planning, coordinating and funding services.

Ombudsman (long-term care)
He or she is an individual designated by a state or a substate unit responsible for investigating and resolving complaints made by or for older people in long term care facilities. An ombudsman is responsible for monitoring federal and state policies that relate to long term care facilities, for providing information to the public about the problems of older people in the facilities and for training volunteers to help in the ombudsman program. The long term care ombudsman program is authorized by Title III of the Older Americans Act.

Peer Review Organization (PRO)
This is a contract to Medicare in each state to monitor hospital services under the prospective payment program. PRO's are made up of physicians, nurses and other health care professionals charged with monitoring Medicare cases before, during and after hospital admissions to be sure that treatment has been appropriate and sufficient, but not excessive.

Physical Therapist (PT)
He or she is a trained and state-licensed professional who focuses on restoring physical movement to a person disabled by an injury or stroke.

Professional Standard Review Organization (PSRO)
This is a physician or other professional medical organization that enters into an agreement with the U.S. Department of Health and Human Services (HHS) to assume the responsibility for the review of the quality and appropriateness of services covered by Medicare, Medicaid and the Maternal and Child Health program. PSRO's determine whether services are medically necessary, provided in accordance with professional standards and in the case of institutional services, rendered in the appropriate setting.

Provider
This is a term used in public health programs to refer to a supplier of medical services (e.g., nursing home or hospital)

Registered Nurse (RN)
He or she is a nurse who has graduated from a formal program of nursing education and has been licensed by an appropriate state authority.

Resident Council
This is a resident-run organizations within long term care facilities that make recommendations and decisions about the facility through group discussions. These councils vary in size and organizational structure, but are usually designed to foster communication between and among residents and the facility's staff/ administration to encourage resident independence and help insure the basic rights of nursing facility residents.

Retired Senior Volunteer Program (RSVP)
This places retired persons 60 and over with community based organizations like schools, courts, museums, libraries, hospices and nursing facilities. They volunteer without pay but may be reimbursed for transportation and other out-of-pocket expenses.

Service Corps of Retired Executives (SCORE)
These volunteers are retired business people who aide owners of small businesses or community groups in need of management expertise. Founded in 1965 and co-sponsored by the Small Business Administration.

Social Health Maintenance Program (S/HMO)
a style of HMO that extends the basic group HMO concept to include long term home care, home-delivered meals, counseling and other services designated to keep frail, elderly people out of hospitals and nursing homes.

State Health Planning and Development Agency (SHPDA)
Established by Title XV of the Public Health Services Act, SHPDA prepared the annual preliminary state health plans and the state's medical facilities plan (Hill-Burton). The agency also serves as the designated review agency for purposes of section 1122 of the Social Security Act and administers a certificate-of-need program.

Statewide Health Coordinating Council (SHCC)
This is a state council of providers and consumers (who shall be in the majority) required by Title 15 of the Public Health Services Act. Each SHCC supervises the work of the SHPDA and reviews and coordinates the plans and budgets of HSA plans and the preliminary plans of the state agency. SHCCs also review applications for HAS planning and resource development assistance.

Supplemental Security Income (SSI)
This is a program of support for low-income aged, blind and disabled persons, established by Title XVI of the Social Security Act.

U.S. Department of Health and Human Services (HHS)
This is the federal agency responsible for Food and Drug Administration, Social Security Administration, Centers for Medicare and Medicaid Services, Human Development Services, Public Health, Family Support Administration, Alcohol and Mental Health and Health Resources and Services Administration.

U.S. Department of Veterans Affairs
This is the federal agency responsible for providing benefits to veterans and their dependents.

Utilization Review (UR)
This is a review on a sample or other basis of admissions to the institution, the duration of statys therein and the professional services furnished. The purpose of the UR is to determine the medical necessity of the services and the most efficient use of available helath facilities and services.