Most Frequently Asked Questions about Long-Term Care

1. How do I choose a nursing home?

2. What kind of home care services are available and who provides them?

3. How do I apply for home care services?

4. What do I do if my home care services are reduced, terminated or denied?

5. What should I do if I have concerns about my care or the care of a loved one in a facility?

 

1. How do I choose a nursing home?

The Ombudsman Program often receives calls from family members who are seeking information about nursing homes when a loved one needs this level of care. Families often do not know how to evaluate the care provided in the nursing homes they are considering.

While we cannot recommend a particular facility, we can be helpful in assisting families/consumers in evaluating a particular facility or group of facilities. Nursing Home Compare at www.medicare.gov is a great resource for information about the quality of care provided in nursing facilities. Inspection survey results are posted on this web site and surveys from one facility to another are compared. These surveys indicate whether the nursing facility has met health and federal and state health and safety standards.

In addition, we can provide callers with a copy of a Guide to Choosing a Nursing Home published by the Centers for Medicare and Medicaid. This comprehensive guide provides a detailed list of factors to be considered when choosing a nursing home.

We advise the following:

Visit the facilities in your area and ask for a tour of each one. Observe the general appearance and atmosphere of the facility, the interactions between residents and staff, the availability of staff providing care to residents and the quality of meals and activities provided. Also, ask about the most recent inspection survey and review it with the administrator.

Here are some specific observations you should make:

General Atmosphere
Is the facility clean and well maintained ?
Is the temperature comfortable for residents?

Resident Quality of life
Are residents engaged in activities?
Is there a schedule of activities posted?
Are there a variety of activities offered?
Are staff interactions with residents pleasant, respectful?
Do residents appear well groomed and well cared for?
Are call bells within reach?
Are call bells answered promptly?

Quality of Meals
Do meals appear appetizing? Are menus posted?
Do residents who need assistance with meals receive the help they need?

Inspection Surveys
Is the most recent survey posted? Ask the administrator to review it with you. If there are deficiencies, ask about the nature of the deficiency and how the facility has corrected the problem.

Families and consumers should be aware that the regulations governing nursing facilities require a strict standard of care concerning quality of care and quality of life.

These general guidelines for observations of a nursing home may also be used when looking for a residential care or assisted living facility.

2. What home care services are available and who provides them?

A variety of services is available, depending on your needs. You may pay for the services yourself, or you may be eligible for financial assistance that will help you pay for the services you need. For more information about available services, contact the Department of Health and Human Services Office of Elder Services at 1-800-262-2232 and ask for their booklet, “Home Care: Where to Find It.”

3. How do I apply for home care services?

If you know what services you want and are paying privately for your care, you can contact the home care agency directly to arrange for services. If you need financial help to pay for home care or are not sure what services you need or what services are available, contact Goold Health Systems for a free medical eligibility determination assessment.

Goold Health Systems does assessments for the elderly and other consumers who are seeking home care services, including disabled adults who want to live independently. The assessment is done free of charge for people who are in immediate need of services. When possible Goold will also assess people who just want to know what services are available and affordable. There is no charge, and the assessment is confidential. Call them, toll-free, at 1-800-609-7893.

An assessor from Goold will come to your home for the assessment. At the end of your meeting, the assessor will decide whether you are eligible or ineligible for home care. If you are eligible for home care, you will be given a written “Plan of Care.” This plan will include the number of hours and the kinds of services you are eligible for each day, week, or month, as well as the names of the programs that you qualify for. You may also have to complete a MaineCare application that will ask for information about your income, your savings, and your property.

Usually, you will be referred to Elder Independence of Maine (EIM). EIM is a statewide agency that coordinates home care services for clients. They will contact you and your providers to coordinate your care. You do not have to find your own caregivers because EIM will do this for you. You can reach EIM at 1-888-234-3920.

When you start getting home care services, EIM implements the plan of care that was designed for you during the assessment. The coordinating agency contacts the providers you need for your care. The agency hires them to come to your home to help you. You may receive services from more than one provider.

You may be able to choose to have Alpha One coordinate your care instead, if you meet their criteria. Alpha One enables some consumers with disabilities to direct their own care.
If you have Medicare and you are being discharged from a hospital or nursing facility, your doctor can order skilled services to be provided in your home. The discharge planner at the hospital or the social worker at the nursing home can help coordinate these services.

If you or a family member would like to learn more about available home care services, here are some other options:

  • Contact a home care agency directly.
  • If you are in a hospital or nursing home, talk with the social worker.
  • Contact the Maine Department of Health and Human Services (DHHS) Office of Elder Services at 1-800-262-2232.
  • Call your local Area Agency on Aging. If you call, toll-free, 1-877-353-3771 you will be connected with the agency that serves your area. They can also tell you about other resources such as Meals on Wheels and transportation assistance.
  • Call the Ombudsman Program at 1-800-499-0229.

4. What do I do if my home care services are reduced, terminated or denied?

You will receive a written notice if your home care services are being denied, reduced, suspended, or terminated.

If you are currently receiving services and those services are going to be terminated or reduced, you have the right to advance notice before the services change or stop. How much advance notice you get depends on the rules of the program that approved your services. There are some limited exceptions to this advance notice rule: for example, if workers will be endangered coming into your home, or if you have provided false information in order to get care.

The written notice must include the following:

  • the reason for the denial, termination or reduction in services;
  • the date the change will happen;
  • information about your right to appeal;
  • how to request a hearing on your appeal;
  • how to get help with an appeal hearing; and
  • whether services will continue if you appeal the agency decision.

It is very important that you not miss any filing deadlines, so the first thing to do is request an appeal hearing in a timely manner. Generally you have 60 days to appeal any decision. If you are currently receiving services under a MaineCare or state program and you request a hearing within 10 days of the date of the action to reduce or terminate your benefits, in most instances you will continue to receive services while the hearing is pending. The written notice you receive should include specific information on how to appeal the decision.

The rules for home care programs can be complicated, and it is a good idea to get assistance with an appeal. Contact the Ombudsman Program (1-800-499-0229) for assistance in requesting a hearing or in preparing for your appeal. We work cooperatively with legal services agencies such as Legal Services for the Elderly, the Disability Rights Center, and Pine Tree Legal Assistance if you should need someone to represent you at your hearing.

5. What should I do if I have concerns about my care or the care of a loved one in a facility?

If you are concerned about the care you or a loved one is receiving in a nursing or residential care facility, the Ombudsman Program can help. Call the Ombudsman Program to speak with the intake worker who can answer questions and provide some advice on how to address these issues. The Ombudsman Program is available to help address problems directly, but also can provide suggestions on how family members or residents can address concerns. Here are some ideas for how to address problems in a facility:

  • Contact the Ombudsman Program to discuss possible resolutions.
  • Address your concerns directly with facility staff such as the Director of Nursing, Social Worker, Residential Care Director, Charge Nurse or Administrator. If you are uncomfortable addressing the concerns directly, with consent, the Ombudsman Program can help.
  • Residents in a facility may take their concerns to the Resident Council. If other residents have the same problems, it may be beneficial to address them as a group.
  • Family members of residents in nursing facilities have the legal right to form a Family Council to address concerns. Family members could attend a meeting if the facility has a Family Council or may want to start a council.
  • Call the Department of Health and Human Services, Division of Licensing and Regulatory Services complaint line (1-800-383-2441) to report the issues. Licensing and Regulatory Services is responsible for investigating complaints in hospitals, nursing homes, assisted housing facilities and licensed home care agencies.

 

 




 

 

"All long-term care consumers have the right to be treated with dignity and respect."