FAQ

Will Medicare pay for everything?

Medicare only pays 100 percent for the first 20 days of a nursing home stay. For days 21 through 100, Medicare pays all but $141.50 per day. Medicare only pays for a nursing home stay if the beneficiary has had a three-night stay as an inpatient in a hospital within 30 days of being admitted to the nursing home and the beneficiary requires skilled care, as defined by Medicare. Medicare coverage ends as soon as the beneficiary no longer requires skilled care.

Medicare coverage is limited and dependent on several variables. The bottom line is that you cannot depend on Medicare to cover your nursing home expenses.

Medicaid is a government program that pays medical costs for persons with limited income and limited assets. Medicaid will assist in paying nursing home costs once a beneficiary qualifies for the benefit. In order to be eligible for Medicaid, your income and assets must be below the amount that is set by your state of residence.

For more information visit Medicare or Medicaid.

Will Medicare and/or Medicaid pay for my loved one in a nursing home?

Here's a link to information about Medicaid on the Washington State Department of Social and Health Services web site.

How do I choose a nursing home for my loved one?

What’s the best way to choose a rehabilitation and skilled care center (nursing home) for your loved one? Visit all the nursing homes in the area. Tour each one. Think about the services that your loved one will need. Whether it’s physical, occupational or speech therapy, or another specialized service, it’s important that the staff members who guide your tours know what services your loved one needs and can assure you that they provide them.

You can try to determine the kind of care your loved one would receive at a particular center by looking at and possibly visiting with the current residents. Are they nicely groomed and dressed? Are they dressed in clothing appropriate to the time of day? Is their clothing clean and hair neatly styled? Look around the building. Is the lawn mowed and are the flower beds weeded? Is the building clean? Occasional odors are not uncommon in healthcare facilities, but there shouldn’t be lingering odors, and you shouldn’t be hit in the face with odors when you walk in the door. Lingering and pervasive odors can be a sign of poor care.

Ask about the activities program. Are there activities available all hours of the day, evenings, weekends and holidays? Are there activities that you think your loved one would enjoy?

Review the center’s survey history. The Centers for Medicare & Medicaid Services contracts with each state to conduct onsite surveys that determine whether its nursing homes meet quality and performance standards. Ask to see the results of the last survey. Make a determination as to whether any citations they may have received were related to poor documentation or poor care. There is a difference. Each citation is given a scope and severity level. A scope and severity of G, H or I means that the center was cited for actual harm to a resident. A scope and severity of J, K or L means that no actual harm occurred, but a resident or residents were put at risk.

Write down some notes about what you liked and disliked about each center. Choosing a nursing home is usually not an easy process, especially if there are many in the area. Instead of just relying on the feeling you get when you tour a center, taking note of the items mentioned above should help make your decision easier.

If you have any further questions, please call and ask to speak with someone about your concerns. We will be glad to help!

What are advanced directives?

The term ‘advance directive’ refers to your oral and written instructions about your future medical care in the event you are unable to express your medical wishes.

There are two types of advance directives: a health care directive and a durable power of attorney for health care.

Health care directive (also known as a living will) – A health care directive, commonly referred to as a ‘living will’, is a legal document specifying your wishes regarding the care you receive at the end of life should you be unable to communicate them. In Washington state, the directive is used only if you have a terminal condition where life-sustaining treatment would only artificially prolong the process of dying; or if you are in an irreversible coma and there is no reasonable hope of recovery.

Health care directives may also be called a directive to a physician, declaration or medical directive.

Durable power of attorney for health care – A durable power of attorney for health care is a legal document allowing you to name a person as your health care agent – someone who is authorized to consent to, stop or refuse most medical treatment for you if a physician determines you cannot make these decisions yourself. Once appointed, your health care agent can speak on your behalf anytime you are unable to make your own medical decisions, not only at the end of life.

This type of advance directive is also referred to as a health care proxy, appointment of health care agent or a medical power of attorney.

Do I need an advance directive?

Advance directives are the best possible assurance that decisions regarding your future medical care will reflect your own wishes, in the event that you are unable to voice these wishes. For this reason, every person aged 18 or over should prepare a directive.

Do I need both a living will and a durable power of attorney for health care?

Yes. Having both a living will and a durable power of attorney for health care will provide the best protection for your treatment wishes.

A durable power of attorney will allow for some flexibility regarding treatment decisions, since the agent that you choose to represent your wishes will be able to respond to unexpected changes in your condition and base decisions not just on your written wishes, but also on their familiarity with you and your feelings regarding your care.

A living will is necessary to provide instruction in case your agent is unable to serve, to provide evidence that the agent is acting in good faith in case the agent’s decisions are challenged, or to serve as the primary record of your wishes in case you are unable to appoint a health care agent.

Are advance directives legal?

Yes. There are federal and state laws that govern the use of advance directives. The federal law, the Patient Self-Determination Act, requires health care facilities that receive Medicaid and Medicare funds to inform patients of their rights to execute advance directives. All 50 states and the District of Columbia have laws recognizing the use of advance directives.

Will my Washington state advance directive be recognized in another state?

Many states have laws that honor out-of-state directives. If you travel, take copies of your directives with you. If you spend a significant amount of time in another state, it is a good idea to fill out an advance directive form for that particular state.

(Note: Washington state does not require the durable power of attorney for health care to be notarized or witnessed. As some states do require notarization, you may want to do so in the event you travel out-of-state.)

Will advance directives be recognized in emergencies?

No. During most emergencies, there is not enough time for emergency service personnel to consult the patient’s advance directive. Once the patient is under the direct care of a physician, there will be time for the advance directive to be evaluated and/or the health care agent to be consulted.

What should I do with these forms once completed?

Signed copies of the completed directives should be included in your medical record, given to any person to whom you give your durable power of attorney – including any alternate people you may have named – and to your personal attorney. Originals should be in a safe but accessible place (not a safe deposit box).

What are some other things to remember?

• It is essential that you have honest and open discussions with your appointed health care agent, doctor(s), clergy, and family and friends about your wishes concerning medical treatment. Discuss your wishes with them often, especially if your medical condition changes.
• If you wish to make changes to the directives, you should complete new documents.
• You can always revoke one or both of your Washington state directives. If you choose to revoke your documents, make sure you notify your health care agent, alternate agents, your family and your doctor(s).

Where can I get more information?

You are encouraged to discuss the directives with your physician. Any legal questions you may have about the use and effect of these directives should be answered by an attorney.

For more information and links to advanced directive forms you can visit:

Washington State Medical Association: Advance Directives Information

https://www.caringinfo.org/wp-content/uploads/Washington.pdf