How Does Emergency Nursing Home Admittance Work?

Updated

Certified Care Manager, Aging Life Care Professional, and National Master Guardian Emeritus

In today’s world, nursing homes don’t always have the best reputation. It’s true that most people would probably prefer to avoid going to a nursing home. Similarly, it’s difficult to navigate this process with loved ones. This leads us to wonder how emergency nursing home admittance works?

Jump ahead to these sections:

Before beginning this discussion, it is essential to distinguish between a nursing home and a skilled nursing home. A skilled nursing home is a short-term placement for rehabilitation services following a three-night stay in the hospital.

If you have a Medicare Advantage plan, they might waive the three-night stay. If the three-night requirement is met, skilled nursing care is covered by Medicare insurance. In other words, the purpose of skilled nursing is to provide a high level of physical and occupational therapy with a short-term goal of getting the patient back home.

It’s important to keep in mind that a nursing home is considered a long-term care solution for people who may not fit the criteria for skilled nursing. This is when a patient can’t be safely managed in any other setting. Medicare does not pay for emergency nursing home admission. We will talk about what to expect with an emergency nursing home admission, what you need to get admitted, and how to pay for it.

What Is Emergency Nursing Home Admittance?

First, what exactly is emergency nursing home admittance? Since this is a topic most people don’t think of until they have to, it’s normal to have questions. The healthcare system can be tricky and confusing, even to those familiar with the process. 

In short, an emergency nursing home admission is any admission that wasn’t planned in advance. Hospital beds throughout the country are scarce. There could be occasions where admission to a nursing home for stabilization before discharge elsewhere makes sense.

Although people can stay in the hospital for the amount of time needed to treat their condition, there could come the point where there is no longer a need for hospitalization, yet the patient can’t go home safely.

In other situations, perhaps the patient has tried skilled nursing for rehab but has not made enough progress to continue rehabilitative services or go home. The skilled nursing facility may recommend an emergency nursing home admission when insurance stops paying due to failure to improve. Emergency nursing home admittances aren’t taken lightly, and it’s something you would coordinate with the help of your healthcare team. 

Who Qualifies for Emergency Nursing Home Admittance?

With that in mind, who qualifies for emergency nursing home admittance? Is this something anyone can take advantage of if needed?

State regulations determine qualification for an emergency nursing home admission or any nursing home admission. You can think of a nursing home admission as a last resort in that there are no viable alternatives. 

Emergency admission to a nursing home implies that the stay will be short term but that all depends on whether the patient can recover to the extent a less restrictive placement is possible. Assisted living communities cannot handle complex medical problems, and most have nursing available only on a limited basis. 

With that in mind, this is who qualifies for an emergency nursing home admission:

Someone who has the ability to pay the nursing home

Of course, a nursing home will not admit someone without knowing how the patient will pay for their stay. Either the individual has to already be on Medicaid, can qualify for Medicaid after admission, or pay privately. 

According to Genworth, the median cost of care in 2022 for a semi-private room in a nursing home is $7,908. That cost will be higher in some states and lower in others. Medicaid qualification also varies by state, but generally, an individual can have no more than $2000 in assets. 

Someone with an immediate medical need

Alternatively, not all medical needs can be handled by short-term home health. Home health only provides intermittent medical interventions, not round-the-clock or on-demand care. Some of the medical problems that might necessitate a nursing home stay:

  • Intravenous medications
  • Catheter care
  • Wound care
  • Kidney dialysis
  • Feeding tubes or ventilators
  • Bedbound incontinence

A patient with functional decline

Functional decline describes what happens to someone when they suffer an illness or general debility due to neurological conditions, a stroke, heart attack, uncontrolled diabetes, or any number of other conditions. 

As people age, it is harder to recover due to loss of muscle mass, poor balance, or cognitive impairment. Some examples of functional decline are:

  • Challenges getting dressed and undressed.
  • Needing assistance to bathe safely
  • Assistance with hygiene like brushing teeth or using the bathroom
  • Help with transferring in and out of bed or a chair
  • Medication management 

An individual with cognitive or behavioral problems

Similarly, people with Alzheimer's disease or other types of dementia may have severe cognitive symptoms like wandering, aggression, paranoia, delusions, and impaired memory. 

Some states will not permit a nursing home admission based solely on a psychiatric diagnosis.  Dementia is usually accompanied by functional and medical problems that require close supervision due to cognitive impairment. 

Someone with a discharge from hospice

Finally, in rare cases, someone may be discharged from hospice because the condition that qualified them is in remission or no longer a threat to their life. Still, that doesn’t mean that the patient doesn’t have extensive needs that can’t be met at home or in assisted living. For example, if someone is homebound, has an indwelling catheter, and requires round-the-clock care, they may qualify for a nursing home admission after hospice discharge.

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Emergency Nursing Home Admittance or Admission Process

Now that you know who qualifies for this service, how does the process work? It’s no secret that healthcare, insurance, Medicaid, and everything in between can be tricky. When in doubt, consult with your healthcare team to determine your next steps. 

The emergency nursing home admission process depends on where the patient is when the decision is made to admit him or her to a nursing home. The best way to understand this in practice is by looking at some possible scenarios and how each can affect the process. 

The patient is in the hospital

To begin, the most common process for emergency nursing home admittance is through the hospital. The hospital physician and discharge planner put together all of the paperwork for admission from the hospital.

If you don’t qualify for Medicaid, then there will be a process of determining who is financially responsible for payment. For people who don’t have vast financial resources, it is usually advisable to pick a nursing home that accepts Medicaid if you have to spend down your assets.

The patient is at home

On the other hand, coordinating an emergency nursing home admittance from home can be stressful and confusing. The first step is to locate a nursing home that you think provides the right level of care. 

Finding a good nursing home can be a challenge but check with a physician for recommendations. Keep in mind that the Five-Star Quality Rating System has come under scrutiny due to the discovery that many nursing homes are skirting reporting requirements skewing the results. 

If you have time, visit any nursing home you are considering in person. You can tell a lot by a spontaneous visit. Ask to meet with the director and director of nursing. Staff shortages in nursing homes are at record levels, so assume that any nursing home you choose will have this problem. If you can find a non-profit nursing home in your community, you might have better luck with the quality of care.

Meet with the admissions coordinator of the nursing home you decide on and ask about the admission process. You may be required to guarantee payment if your loved one does not qualify for Medicaid. Some nursing homes will not accept a “Medicaid Pending” patient without a guarantee of payment before Medicaid takes effect. 

Lastly, the nursing home may provide transportation to the facility, but you should ask about it. If you need medical transport to keep your loved one safe, you may have to pay an additional fee. 

The patient is in assisted living

An admission from assisted living could be more manageable since the staff may have experience in expediting an emergency admission. They will have your loved one’s demographic information and medication list. 

An assisted living may also have nursing homes they recommend and can inform you of criteria for returning to the community following the emergency nursing home admission. You may have to pay for your loved one’s apartment during their absence, but most facilities will give you a discount on the room rate.

What Documents Will You Need for Emergency Nursing Home Admittance?

Every state will dictate documents that you need for an emergency nursing home admission. Hopefully, you will have completed the end-of-life planning checklist, making much of this easier. Generally, these are the documents you can expect to provide.

A physician’s order

It isn’t enough for you or anyone else to think or document the reason for an emergency nursing home admission. A physician must confirm that your loved one needs a nursing home level of care. If your family member hasn’t seen their physician in a while, the physician may require a visit to confirm their medical condition. 

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Medical history

The physician needs to provide a complete medical history with diagnoses, medications, and any other relevant information. Also, the doctor needs to include orders for care for the attending physician and staff at the nursing home. Once your loved one enters a nursing home, the nursing home physician takes over their care.

State forms

Each state requires that the patient or power of attorney fill out state forms that certify the patient requires a nursing home level of care. If your loved one is in the hospital, the attending will fill out the appropriate paperwork. The primary care physician fills out these state forms if your loved one is at home.

Vaccine requirements

It used to be that the only vaccines nursing homes were concerned about were tuberculosis, flu, and pneumonia shots. Nursing homes require recent proof of these vaccines; otherwise, they give these shots within three days of admission. 

Now, we have COVID to worry about. Since nursing homes have been disproportionately affected by COVID, they may require a COVID test before admission and proof of vaccination. Always check with the specific facility about vaccine deadlines and requirements. 

Admission paperwork

The admission paperwork for nursing homes can be lengthy. It usually includes:

  • Responsible family information
  • Signatures for nursing home policies and responsibilities signed by the patient or power of attorney
  • Detailed financial information, including bank account, retirement, and other assets if you apply for Medicaid
  • Who is legally responsible for paying
  • Mortuary information
  • Do Not Resuscitate (DRR) orders
  • Living will
  • End-of-life care wishes

Understanding Emergency Nursing Home Admission

Ultimately, an emergency nursing home admission can be a significant stressor for you and your loved one. Prepare to be an advocate and support your loved one’s efforts to return home. If they can’t come home, monitor signs of loneliness while they are in the nursing home, visit often, and do everything you can to bring comfort and care to a challenging situation.

It’s normal to be intimidated by the nursing home process, but you’re not alone. Use your healthcare team as an advocate for your loved one’s wishes, putting their needs first. Together, you’ll find the right solution for your loved one’s unique situation. 

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