Caregiving and Legal Issues

Q. My Mother has dementia and is no longer capable to care for herself in her own home. Where do I start?

A. Contact the Genesee County Office for the Aging to discuss long term care options and begin the process. Should it be determined that your mother requires placement in a long term care facility or a medical model daycare, the Genesee County Nursing Home can accommodate your mother's needs at a multitude of levels.

Q. I have heard people talk about power of attorney, health care proxies, living wills, and advance directives? What are these and how can I go about getting these documents executed for my elderly loved ones?

A. The Genesee County Office for the Aging has legal services available for Genesee County residents over the age of 60 to explain and prepare these documents.

Q. How does Medicaid work regarding the home and assets?

A. Contact the Genesee County Office for the Aging to arrange a legal appointment to learn the details.

Q. Is there an Alzheimer's Support Group in Genesee County?

A. Yes, in October of 2004, the Genesee County Nursing Home has launched a group. For further information, contact Pat Nowicki or Gene Stark at (585) 344-0584 for further information; or you may contact the Genesee County Office for the Aging at (585) 343-1611.

Adult Homes

Q: What is an Adult Care Home?

A: An Adult Care Home in New York State is licensed by the State Health Department. It provides room and board, housekeeping, laundry, medication management, and some personal care and supervision for adults who choose not to stay alone or who can no longer safely live alone. Residents in Adult Care Homes are free to go out in the community as they are able. Generally residents must be able to walk on their own, but they may use a cane or walker. Residents who need assistance with bathing, grooming, dressing, taking medications, and handling money can receive the help needed. An Adult Care Home may care for persons who are sometimes confused, but many usually cannot manage a person who wanders. However, the Genesee County Adult Home offers a "Special Care Community Dementia Program" which offers secure housing to those with dementia and wandering issues.

Q: How do Adult Care Homes differ from Nursing Homes?

A: An Adult Care Home is much less costly than a nursing home. To be admitted to a nursing home a person must be impaired in almost all aspects of daily living. Although some nursing home residents are able to make brief outings from the nursing home, most are not up to day trips even with assistance. By definition, people in nursing homes need some medical care daily and/or significant assistance with activities of daily living.

Q: What is provided by an Adult Care Home?

A: An Adult Care Home provides you with your own single bed, dresser, chair, wastebasket, and closet space in a semi-private room. The Genesee County Adult Home lets you bring some of your own bedroom furniture, TV set, radio, or stereo, and your easy chair; if you want. We encourage you to bring pictures and personal items to decorate your room.

Q: Is Medicaid accepted to pay for care in Adult Care Homes?

In addition to private pay, Adult Care Homes can accept Medicaid to pay for care received. Check with the Admissions Coordinator of the Genesee County Nursing Home to see what payment form is required given your financial circumstances.

Q. If someone lives in the Adult Home/Domiciliary, can they still come and go as they please?

A. When someone lives in the Genesee County Adult Home/Domiciliary, they are still considered members of the community. If they are assigned to the Special Care Community Dementia Unit, they must be accompanied by staff, family, or friend to leave the unit. This is because it is designed as a secured unit for the residents' safety. However, if they are assigned to the third floor, then they can come and go as they please, providing they sign themselves in and out.

Q. The decision to place a loved one in the nursing home or adult home is a difficult one. Is there anywhere to go for support?

A. Yes, the Genesee County Office for the Aging offers a Caregiver Support Group and Caregiver Counseling. In addition, the Genesee County Nursing Home hosts an Alzheimer's Disease and Related Disorders support group.

Rehabilitation Care Facilities

Q: What services are available to individuals seeking in-patient rehabilitation following an illness or surgery, where the individual needs intensive rehabilitation as part of the recovery process?

A: A full range of rehabilitative services are available for patients based on an assessment of their needs at the time of admission. Medical, Nursing, Social Work, Dietary and Rehabilitative staff members assess each resident's ability to return to the community, coordinate services and arrange for equipment and other needs as indicated.

Q: Are there facilities within Genesee County that can provide in-patient Rehabilitation Services or do I need to go out of county for this type of care?

A: Among other local facilities, the Genesee County Nursing Home has a rehabilitation unit.

Skilled Nursing Care Facilities

Q: What services are included in skilled nursing care facilities?

A: A full range of Medical, Nursing, Social Work, Dietary and Rehabilitative services are provided along with social and recreational activities appropriate to the needs of the residents.

Q: What is the cost of skilled nursing home care?

A: Generally speaking, a skilled nursing home stay costs approximately $7000 to $8000 per month.

Q: Who pays for skilled nursing home care?

A: This is a very complex question, because it depends upon the person's insurance, financial status, veteran status, and medical condition. The best advice is to discuss your individual circumstances directly with the Admissions Coordinator to find out.

Q: Will Medicare pay for the first 100 days in a skilled nursing facility?

A: Medicare can pay up to 100 days as long as the resident has a three (3) night hospital stay prior to admission and their care needs meet the requirements to qualify for coverage. Co-insurance will pay co-payments for days 21-100 if the resident's care continues to qualify for Medicare coverage. Medicare Managed Care HMOs have essentially the same coverage as Medicare/co-insurance, and requires a pre-certification.

Q: If one plans to go to a nursing care facility, does that mean that they or their spouse has to sell their home and spend their life savings to pay for the needed care?

A: Typically, upon admission to the nursing home, a resident needs to spend down to a certain level before they can qualify for Medicaid, which is a Federal insurance program that pays for long term care health benefits in a nursing home (or other settings) for those who meet the income and resource guidelines. In 1989, the Spousal Impoverishment Act was passed which allows the spouse of a resident to maintain their family home and a significant amount of resources. Details on income and resource eligibility are available from Genesee County Office for the Aging or Genesee County Department of Social Services.

The Genesee County Office for the Aging's Legal Services for the Elderly Program has legal counsel who can assess your individual situation to determine how your resources and assets would be looked at in regards to paying for skilled nursing home care.

Q: I'm told that a PRI is necessary to be considered for admission to a nursing home. What is a PRI?

A: Admission to Genesee County Nursing Home and Adult Home/Domiciliary requires a Patient Review Instrument (PRI) to be completed to determine the level of care a person needs. The PRI is conducted by the hospital, skilled nursing home or rehabilitation center when you are a patient preparing for discharge; or if you are in your home or other residential facility, the Genesee County Health Department, the Visiting Nurses Association of Western New York, and Westside Home Care Agency can do this. The results of the PRI are valid for 90 days.

Q: Is it necessary to have a doctor in order to be admitted to the nursing home and adult home?

A: Yes, a doctor must complete medical forms regarding current condition and medical history.

Q: What should I look for when evaluating nursing homes to determine which one I will choose to provide residential care for myself or a family member?

A: The New York State Health Department regularly surveys and monitors nursing homes in New York State and provides each nursing home with a survey report identifying how they rated in the most recent State survey of their facility. Each facility should have a copy of that survey report posted for visitors to see. Also, the New York State Health Department website has review criteria and reports from New York State Survey results for individual facilities posted on their site.