Description of Services
Nursing homes offer an array of services, ranging from skilled nursing care (such as rehabilitation or care performed by licensed nurses) to non-skilled, or custodial, care. Nursing homes provide room, board (meals), activities, personal care and 24-hour nursing supervision and access to medical services. In this section the following services provided by nursing homes will be discussed.
- Physician services
- Nursing services
- Social services
- Dietary services
- Pharmacy, laboratory and radiology services
- Dental services
- Therapeutic recreation and activities
- Rehabilitation services - Occupational therapy, physical therapy, speech therapy, audio-logic services
- Resident evaluation and care planning
- Housekeeping services
Mr. Bridges didn't want to admit it, but he could see that his wife Ethel was becoming increasingly forgetful and confused. He had begun to do all the cooking and housekeeping and was afraid to leave Mrs. Bridges alone at home. When she fell and broke her right hip, she was admitted to the hospital and her hip was pinned. However, it was soon clear that she was not a good candidate for rehabilitation because she couldn't remember what the therapists tried to teach her. Though she needed a lot of assistance with her activities of daily living, she did not need direct care by a licensed nurse on a frequent basis. Therefore, she did not qualify for Medicare skilled care. Instead she needed comprehensive, or custodial, care, which is not paid for by Medicare. Mr. Bridges wanted to take his wife home, but she needed much more help with dressing, bathing, toileting and walking than she had prior to the fall, and he could not manage her care by himself. Their children lived in another state and were unable to leave their families to help care for their mother. Though he was reluctant to consider nursing home care, the doctor and other hospital staff told Mr. Bridges that caring for his wife would jeopardize his own health. He found a nursing home not far from his house that had a vacancy and Mrs. Bridges was discharged there. Mr. Bridges visits her every day. He paid the full cost of her care for a year until she became eligible for Maryland Medical Assistance.
Skilled Nursing Care
Mrs. Norman, a 78 year-old widow, had lived alone in her own home since her husband's death in 1987. A very independent woman, she was a volunteer at her church, attended classes at the senior center and regularly took her grandchildren to visit the museums and other educational sites in Baltimore. When she fell and broke her hip while shopping, the store manager called an ambulance immediately. Mrs. Norman was seen in the emergency room and diagnosed with a broken hip. She had her hip pinned, but could not go home immediately because she needed intensive physical and occupational therapy twice a day for several weeks to help her regain full mobility. She was accepted for skilled nursing care by, and transferred to, a skilled care rehabilitation facility. She made steady progress in her rehabilitation program and her original length of stay of 14 days was extended for 7 more days. At discharge she returned home and a Medicare homecare agency provided several more weeks of physical and occupational therapy in her home. When Mrs. Norman was discharged from homecare she needed to use a cane while walking, but was able to fully resume her previous level of activity. Since she had met the criteria for reimbursement under the Medicare program and had required less than 20 days of skilled care, she had only limited out-of-pocket expenses for her rehabilitation program.