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Nursing Home Guide

Health & Benefits

This article provides information on how to choose a nursing home; your rights as a nursing home resident; and Medicare/Medicaid coverage. This information is from

Selecting a Nursing Home

The majority of nursing homes are staffed by compassionate and caring individuals who provide excellent service to the residents. By knowing what to look for, residents and their families can find the best nursing home possible.

Many people simply choose the closest facility. Before making this decision, however, it is important to do careful research. Some facilities are better and offer more appropriate care than others. Unfortunately, there are facilities that consistently violate state standards and subject their residents to poor care. You should start by getting recommendations from friends living in nursing homes and their relatives. Ask your physician and nursing staff if there are places close to you that stand out as very good or very bad.

Pick three or four facilities close to home and prepare to visit. Ask to talk to the Administrator or the Director of Nursing. The following questions will help you decide whether a facility is right for your loved one. Pay attention if staff members don't give you straight answers. Notice when the answers are inconsistent with what you observe at the facility.

Call the Texas Department of Health and Human Services at (800) 458-9858 and ask about the places you are considering. Although the agency employees cannot designate a facility "good" or "bad" or recommend one facility over another, they can answer the following questions about any facility:

  • Have there been any proposed license terminations in the past two years?
  • How many complaints have been filed in the past year?
  • How many complaints have been found to be valid in the past year?
  • How many deficiencies have been cited in the past two years?
  • How many "quality of care" violations have been cited in the past two years?
  • When was the last visit by the agenct, and what was the purpose of the visit?
  • Has the owner of this facility had other facilities recommended for license termination?

Alternatives to Nursing Homes

Home care

Depending on your needs, you may be able to get help with your personal activities (like laundry, shopping, cooking, and cleaning) at home from family members, friends, or volunteer groups.

If you think you need home care, talk to your family to see if they can help with your care or help arrange for other care providers. There are also some home health care agencies that can help with nursing or attendant care in your home.

Medicare only pays for home care if you meet certain conditions. To learn more, view the booklet Medicare and Home Health Care. To get a free copy, visit the Medicare Publications tool. You can also call (800) MEDICARE, (800) 633-4227. TTY users should call (877) 486-2048.

Accessory Dwelling Units (ADUs)

If you or a loved one owns a single-family home, adding an accessory dwelling unit (ADU) to an existing home may help you keep your independence. An ADU, sometimes called an "in-law apartment," an "accessory apartment," or a "second unit," is a second living space within a home or on a lot. It has a separate living and sleeping area, a place to cook, and a bathroom.

Space like an upper floor, basement, attic, or space over a garage may be turned into an ADU. Family members might be interested in living in an ADU in your home, or, you may want to build a separate living space at your family member's home.

Check with your local zoning office to be sure ADUs are allowed in your area, and if there are special rules. The cost for an ADU can vary widely depending on how big it is and how much it costs for building materials and workers.

Subsidized Senior Housing

There are federal and state programs that help pay for housing for some older people with low to moderate incomes. Some of these housing programs also offer help with meals and other activities like housekeeping, shopping, and doing the laundry. Residents usually live in their own apartments in the complex. Rent payments are usually a percentage of your income (a sliding scale).

Board and Care Homes

Board and care homes are group living arrangements designed to meet the needs of people who can't live independently but don't need nursing home services. Most board and care homes provide help with some of the activities of daily living like bathing, dressing, and using the bathroom.

Board and care homes are sometimes called "group homes." Many of these homes aren't paid for by Medicare or Medicaid. The monthly charge is usually a percentage of your income (a sliding scale) that covers the cost of rent, meals, and other basic shared services.

Assisted Living Facilities

These facilities provide help with activities of daily living like bathing, dressing, and using the bathroom. They may also help with care most people do themselves like taking medicine or using eye drops and additional services like getting to appointments or preparing meals.

Residents often live in their own room or apartment within a building or group of buildings and have some or all of their meals together. Social and recreational activities are usually provided. Some of these facilities have health services on site.

In most cases, assisted living residents pay a regular monthly rent, and then pay additional fees for the services they get. The term "assisted living" may mean different things in different facilities. Not all assisted living facilities provide the same services. It's important that you contact the facility and make sure they can meet your needs.

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