Nursing Homes: What You Need to Know

Introduction

Today, we live longer than our grandparents did, and our lives and health care systems are more complex. We have good reason to wonder how we will get the care we need if disability or illness strikes, and how we will pay for it. You can make better decisions by knowing ahead of time what your choices are, by learning what to expect and by carefully planning your finances. Far too often, decisions about our health care, especially about long-term and rehabilitative care, are made during a crisis. Regardless of the timing, you can and should evaluate various nursing homes and other long-term care providers to make the best decision. You don’t have to be a professional or an expert. You just need reliable information.

This book is meant for anyone thinking about the possibility of needing nursing home care or long-term care in his or her own home. It should also prove helpful for friends and family members of individuals who may need long-term care.

Nursing homes are not your only option for rehabilitation, and long-term services and support. Chapter 9 discusses in-home alternatives to nursing home care.

Chapter 10 lists agencies and organizations that can help you make the right choice and get needed care.

When you finish this book, discuss it with your family. Talk about the financial implications of choosing a nursing home. Share with them your hopes – and worries – about the prospect of long-term care. But most importantly, let them know your wishes. You are the best person to decide your future. This book can help you take the first step toward peace of mind.

Brian E. Frosh Maryland Attorney General Table of Contents

1. AN OVERVIEW: PLANNING FOR YOUR FUTURE...... 2

2. NURSING HOME SERVICES...... 9

3. TOURING A NURSING HOME...... 14

4. JUDGING THE QUALITY OF A NURSING HOME...... 24

5. HOW TO PAY FOR NURSING HOME CARE...... 29

6. BEFORE YOU SIGN A CONTRACT…READ THIS...... 43

7. YOUR RIGHTS UNDER THE LAW...... 48

8. HOW TO COMPLAIN WHEN QUALITY CARE IS LACKING...... 54

9. ALTERNATIVES TO A NURSING HOME...... 57

10. WHERE TO GET HELP...... 66

ACKNOWLEDGEMENTS...... 79

A Note About Hyperlinks

At the time of this printing (2019), the hyperlinks in this guide to other websites or webpages on the Internet were veri- fied as accurate and up-to-date. However, hyperlinks to websites and webpages may change over time, rendering some Internet addresses in this guide inoperative. We will make every effort to ensure that the Internet version of this guide is up-to-date, but users of the hard-copy booklet may experience broken links in the future.

You will also see some Internet links in this guide that begin with “rebrand.ly” followed by a short description of the page to which they refer. We have utilized a link “shortening” service in an effort to keep long Internet addresses to reasonable length for those who need to type them.

Although we have made every effort to ensure accuracy, the Office of the Attorney General is not responsible for any materials stored on hyperlinked sites that are not under the direct control of the Office. CHAPTER 1 Chapter 1 AN OVERVIEW: PLANNING FOR YOUR FUTURE

Five Basic Guidelines for a chronic condition or disability to Consider that requires months or years of medical care, and in some cases, for the rest 1. Consider your future realistically. of an individual’s life. Nationwide, about 25% of nursing home residents When you plan your retirement, you who require long-term care stay in a probably look forward to spending nursing home for at least three years. more time with family and friends, taking it easy, or perhaps traveling. 2. Prevent a crisis. Nobody wants to think about illness, injuries, or nursing homes, but need- Most people are forced to learn about ing medical care outside the home is a nursing homes when they become ill. reality for many Maryland residents. Time is short, money is needed quick- Many people go to a nursing home for ly, and family members may be upset. rehabilitation or recuperation after an To prevent a crisis, find out ahead of injury or hospitalization. Their stays time how nursing homes work. Learn may be relatively short—less than a about the laws that protect nursing month. Others go for long-term care home residents and their families. With this information, you can make better decisions.

3. Talk to your family.

If you become seriously ill or have an accident or stroke, who will take care of you? You may be surprised to learn how much care—or how little—your family and friends would be able to provide for you at home. Let them know your feelings, and what your wishes are. You should prepare an advance directive, which gives you the opportunity to provide instructions or general guidance about the care you want or don’t want. Although an ad- 2 AN OVERVIEW: PLANNING FOR YOUR FUTURE

vance directive doesn’t require it, you when their money runs short. Medic- may wish to appoint an agent to act aid is a government program to help on your behalf in health care matters. people who don’t have enough money For more information about advance to pay their medical bills. (Medicaid directives in Maryland, see Chapter 7. is also commonly referred to as Medi- An advance directive form provided cal Assistance. In this booklet, we use by the Office of the Attorney General the term Medicaid.) can be accessed online by clicking on the Advanced Directives / Living For comprehensive descriptions of Wills link at www.marylandattor- Medicare and Medicaid, and the dif- neygeneral.gov. You can also call the ference between the two federal pro- Office of the Attorney General at 410- grams, see Chapter 5. 576-7000 or 1-888-743-0023 to ask for a copy to be mailed to you. In planning for your future, consider whether long-term care insurance is 4. Think about how you will pay. an option for you. Long-term care in- Nursing homes surance is not the same thing as Me- are expensive, Nursing homes and community-based digap insurance, which you may have but health insurance long-term care can be expensive. At an to supplement your Medicare benefits. seldom covers average yearly cost of about $110,000 the cost. Many ($119,000 for a private room), nursing See Chapter 5 for other possible ways people start out home care is one of the biggest expens- to pay for long-term care, such as vet- by paying their es you may ever face. Health insurance erans’ benefits. own bills, and seldom covers the cost of the nursing then apply for home. Most people think that Medi- 5. Find out what resources are Medicaid when care will pay the bills if they enter a available. their money nursing home. This is not true; Medi- runs short. care rarely covers the cost of nursing Every Maryland county has resources homes (in Maryland, less than 20% to help provide you with information of nursing home residents have Medi- on selecting a nursing home or to help care as their primary payer). Likewise, you remain in the community. If you “Medigap” insurance policies and need guidance, contact any of the private health insurance rarely cover agencies listed in this booklet. nursing homes. While Medicare has a benefit that covers the cost of certain Frequently Asked services in Medicare skilled nursing Questions homes, this is a limited benefit. If you need longer-term nursing home care or 1. What types of long-term care care that Medicare doesn’t cover, how are available? will you manage to pay the bills? Different types of medical and nurs- Many people start out by paying their ing services are available to meet your own bills and then apply for Medicaid needs. However, not all nursing homes 3 CHAPTER 1

provide all types or levels of care. 1 (Low: resident needs occasional It’s important that you discuss with assistance and supervision); Level 2 your medical professional the type of (Moderate: resident needs monitoring care that you need. You may also ask and limited assistance); and Level 3 your local health department about (High: resident needs comprehensive its evaluation service that helps you support for many deficits). identify all your medical and personal needs. For more information about For more information, please refer to the types of long-term care available, the University of Maryland booklet a helpful guide is available from the on assisted living, entitled “Assisted Maryland Health Care Commission at Living: What You Need to Know,” rebrand.ly/MHCCNursingHomes. available at rebrand.ly/AssistedLiv- ingMD. You may hear the following terms used to describe different types of Home and Community-Based care, whether provided in a nursing Long-Term Care Services: In the Like nursing home or not. past, Medicaid only covered long- homes, term care services if the services were assisted living Nursing Homes: These homes are delivered in a nursing home. Under a programs are licensed to care for individuals who Medicaid Waiver Program, you can also licensed; have medical conditions or disabili- now also receive long-term care in however, they ties that require medical services and a community setting. These “Home are subject to nursing services supervised by a reg- and Community-Based Services” less regulation may include assisted living, in-home than nursing istered nurse. homes. personal care aides, and respite care. Assisted Living: Assisted living The Medicaid Waiver Programs are programs provide housing and sup- for individuals who would qualify for portive services, supervision, per- nursing home care under Medicaid, sonalized assistance, health-related but want to remain in the community services, or a combination of these (see Chapter 9). services. They meet the needs of residents who need help with activities Subacute Care: Subacute care is like bathing, dressing, eating, and us- goal-oriented treatment rendered im- ing the restroom. Assisted living pro- mediately after, or instead of, acute grams vary greatly in size and cost. hospitalization. This type of care is Some may be so small that they are used to treat active complex medi- located in the provider’s home. Like cal conditions or to administer tech- nursing homes, assisted living pro- nically complex treatments until a grams are also licensed, but they are condition is stabilized or a treatment regulated less than nursing homes course is completed. Subacute Care and your rights are different. Assisted Units, sometimes called Transitional living programs are licensed based on Care Units, are typically established the level of care they provide: Level in hospitals for individuals who need 4 AN OVERVIEW: PLANNING FOR YOUR FUTURE

short-term services covered under by the State. Some hospices only pro- Medicare Part A. They are licensed vide services in private homes and by the State in the same way as nurs- some have their own inpatient hospice ing homes, and therefore are subject facilities. Medicare reimburses vari- to all the laws and regulations that ap- ous kinds of hospice services, some ply to other nursing homes. of which may be provided in a nursing home. These include home hospice Specialty Hospitals: These hospitals services, but also inpatient hospice ser- are licensed to provide services to in- vices under certain circumstances. dividuals with certain conditions that do not require acute care, but are ap- Home Health Agencies: These agen- propriately provided in a hospital set- cies provide services, such as skilled ting. These include facilities or units nursing and home health assistance, to for those with long-term hospital sick or disabled individuals in their own needs or chronic diseases that need homes. This is not the same as nursing treatment in a post-acute setting. Oc- home care. Medicare has Part A and casionally, an individual may be dis- Part B coverage for qualified persons charged directly from an acute care who need home health services. Some nursing hospital to a specialty hospital, after homes in which the individual may be then dis- Residential Service Agencies pro- Maryland may charged to home or to a nursing home. vide a more limited range of services have waiting than home health agencies. lists. Palliative Care: Palliative care is specialized medical care focused on 2. Is a bed available for me? providing the patient with relief from the symptoms, pain, and stress of a Some nursing homes have a waiting serious illness or condition, with the list. Nursing homes evaluate whether goal of improving the quality of life they have the capability to provide ser- for the patient, their family, and other vices to a particular resident. Not all caregivers. Palliative care may be pro- nursing homes offer the same servic- vided along with curative treatments. es. For example, some nursing homes If you are being seen at a hospital for a provide services to residents needing serious illness or condition, you may a ventilator and some don’t. Nursing want to ask about the availability of homes may also establish “special palliative care services in the hospital care units” designated for particular or at other health care programs, fa- kinds of needs. Nursing homes are cilities, clinics, or physicians’ offices. not required to accept all applicants. However, you are protected by federal Hospice Care: Hospice is supportive and state civil rights laws, which pro- care that focuses on comfort and qual- tect against illegal discrimination. ity of life, rather than curative treatment, for people in the final phase of a If you will be entering a nursing home terminal illness. Hospices are licensed from a hospital, ask to speak to the 5 CHAPTER 1

hospital’s discharge planner or social visit Eldercare Locator at www.elder- worker who can help you find a bed care.gov for general information. in a nursing home. All hospitals that treat Medicare patients must provide 5. What if I can no longer make de- this service. cisions for myself?

Federal law requires that any person Anticipating your need for a nursing with a serious mental illness or devel- home is only one part of planning opmental disability who applies to en- for your future. Another important ter a nursing home must be evaluated consideration is who will make deci- first to see if they are able to stay in sions for you if you can’t make them their home or if they require nursing yourself due to serious injury, ill- home care. If the evaluation shows ness, or disability. You can prepare that the person could live at home for this possibility by signing legal with community-based services, the documents that stipulate the level of law prohibits admission to a nursing medical care you wish to receive and/ home. This process is called Pread- or appoint someone else to make deci- mission Screening and Resident Re- sions about your health care and your view (PASRR). property. Only a competent person can write such a document, so it’s 3. What if I’m turned away? important to think about this well in advance. If you believe that you have been wrongly turned away by a nursing Advance Directives home, contact the Legal Services for Health Care Program nearest you, the Long-Term Care Ombudsman (an advocate for An advance directive for health care residents) in your county, the Office states what care you would want and/ of Health Care Quality, the Office of or who you would want to make health the Attorney General, or the Maryland care decisions for you if you can no Department of Aging (see Chapter 10). longer communicate effectively with your doctors. A living will and a du- 4. Where can I get general infor- rable power of attorney for health care mation or advice? are both forms of advance directives. A written advance directive may be Call the Long-Term Care Ombuds- prepared in either a paper or electron- man, Maryland Access Point (former- ic format. ly referred to as Senior Information and Assistance Offices), or Maryland In an advance directive, you may ap- Legal Aid, which provides free legal point someone to make health care de- advice to financially-eligible seniors cisions for you. This person is called and individuals with long-term care your agent. You may also express your issues (see Chapter 10). You can also wishes about what care you do or don’t 6 AN OVERVIEW: PLANNING FOR YOUR FUTURE

want. For example, if you would not want if you are unable to communi- want to be kept alive on artificial life cate in the future. support if there is no possibility of recovery, you may state that in your ad- No particular advance directive form vance directive and direct your agent to is required; there are many from carry out this wish. which you can choose. The Maryland statutory form can be found by click- If you don’t have an advance direc- ing on the Advanced Directives / Liv- tive, and you are unable to make your ing Wills link at www.marylandattor- own medical decisions, doctors will neygeneral.gov. look to a relative or friend, which might not be the person you would You may also prepare an advance di- pick, to make decisions. rective electronically. There are electronic advance directive services that Whether you have an advance direc- are officially recognized by the Mary- tive or not, it’s important that you land Health Care Commission. More speak to your loved ones and your information on electronic advance doctors now about what you would directives can be found on the Com-

7 CHAPTER 1

mission’s website at rebrand.ly/MHC- still able to make your own decisions, CElectronicAD your agent cannot override you. . You may also benefit from reviewing Maryland statutory power of attorney these publications on the Maryland forms are available on the General Attorney General’s website. Assembly’s website. • Making Medical Decisions for • Personal Financial Power of Attor- Someone Else: A Maryland Hand- ney: rebrand.ly/MDStatute17202 book (rebrand.ly/OAGProxyHand- • Limited Power of Attorney: re- book) brand.ly/MDStatute17203 • Advance Directive Information Sheet (rebrand.ly/OAGHPInfo) • Maryland’s Planning for Incapac- Where to Get Help with an Advance ity Guide, jointly published by Directive or Power of Attorney Maryland Legal Aid, Maryland Department of Aging, and the You should talk to an attorney about AARP Foundation preparing these documents for you and about estate planning in general. Financial Power of If you are aged 60 or over and meet the Attorney financial eligibility requirements (i.e., earn a low to moderate income), you Another important document is a may be eligible for the 60+ 2.0 Legal power of attorney for financial mat- Program to help draft documents at a ters. This is similar to an advance di- low cost. The 60+ 2.0 Legal Program rective for health care, except that a is a pilot program administered by the power of attorney document requires non-profit organization Civil Justice, you to appoint an agent to act for you Inc. Contact that organization at 410- in business and financial matters. If 706-0174 or visit www.civiljusticenet- you have money or property in your work.org for more information. name, it may be important that you have a power of attorney for finances. If you can’t afford to pay a lawyer for If you don’t have one, and you lose a will, a living will, a power of attor- the ability to handle your finances, ney for financial purposes, an advance it may be necessary for someone to health care directive, or deed chang- go to court for guardianship of your es, you may be able to obtain low-cost property. Preparing a power of attor- legal services from the 60+ 2.0 Legal ney now can avoid complicated legal Program. See Chapter 10 for a list of problems in the future. The person other legal services resources. you appoint as your power of attorney is your agent. It’s very important that you appoint someone you can trust, because a financial power of attorney can be easily misused. If you are 8 NURSING HOME SERVICES Chapter 2 NURSING HOME SERVICES

To get the high quality care you need passed certain tests related to geriatric and deserve, it’s important to under- care. GNAs provide routine bedside stand what a nursing home can offer care and work under the direction of and whether it’s the best place for RNs and LPNs. They help residents you to receive care. Despite a resi- bathe, get dressed, eat, and move dent’s medical status, their dignity about. Some GNAs who receive addi- and individuality are to be preserved tional training may administer medi- to the greatest extent possible, and cations under the direction of licensed nursing home employees should al- nurses. These GNAs are frequently ways treat residents with courtesy referred to as “medicine aides.” Some and respect. Nursing home care is nursing homes utilize feeding assis- one of the biggest expenses you may tants in addition to other aides. ever face. (For alternatives to nursing home care, see Chapter 9.)

Nursing Services

Nursing care is what nursing homes are all about. Nurses and their assistants, who are often called aides, keep you clean and comfortable, monitor your medical condition, give you medications, and look after your daily needs.

In Maryland, nursing homes must have a registered nurse (RN) on duty twenty-four hours a day, seven days a week. Additional registered nurses, licensed practical nurses (LPN), and support personnel must be available to meet the needs of all residents. RNs and LPNs supervise nursing services and provide intermediate and skilled care to residents.

Geriatric nursing assistants (GNAs) have completed a training course and 9 CHAPTER 2

If you decide to contract for “private vide the medicine needed by their duty” nursing or aide services to sup- residents, and that pharmacy should plement the services provided by the participate with any Medicare Part D nursing home, you may seek these prescription drug plan you select. services through a Nursing Referral Service Agency. Be aware that these The nursing home must have a con- agencies are licensed by the State tract with the pharmacy to ensure through the Office of Health Care timeliness, quality, and other related Quality. More information is available requirements. If it doesn’t participate online at rebrand.ly/MHCCNRSA. with your prescription drug plan, work with the nursing home to make appropriate arrangements. You have Medications the right to select your own Medicare Part D prescription drug plan. Ask Some nursing home residents with about the arrangements that are made chronic ailments take many different for medications or other items not medications each day. Under Mary- covered by Part D or any other pay- Consumer Tip: land law, a consulting pharmacist ment plan, and find out what the nurs- Ask the nursing is required to work closely with the ing home’s pharmacy will charge you. home to tell nursing home, doctors, and nursing You have the right to select your own you the ratio of staff to make sure you receive the pharmacy, but only if the pharmacy nursing staff to right medication at the right time (for enters into an agreement with the residents. example, with food or at bedtime). A nursing home to abide by the home’s pharmacist is required to review ev- policies. ery month all medications given to each resident. Unless your doctor has If you are a Medicaid recipient, and said that you are capable of taking not eligible for Medicare Part D, your own medications, a trained aide Medicaid will pay for the prescription will be responsible for administering drugs the nursing home gives you. them to you. Often, to avoid confu- sion, many nursing homes use the Physician Services unit dose method of dispensing drugs. The unit dose method individually You must be under the care of a doc- packages and labels pills for you, thus tor within the first 30 days of living in reducing errors. a nursing home. If you don’t already have a doctor, you may select one from You may wish to ask your doctor if a list of those who routinely practice at you can use generic drugs, as they the nursing home. The nursing home are less expensive than brand-name will have policies and procedures for drugs. The cost of medication is usu- doctors. If you keep your own family ally not included in the basic fee for doctor, the doctor must agree to com- a nursing home. Many nursing homes ply with the policies and procedures in contract with one pharmacy to pro- the nursing home. 10 NURSING HOME SERVICES

A doctor, nurse practitioner, or physi- ment and services are available and cian assistant must visit you at least used at any nursing home you are every 30 days to evaluate your con- considering. dition and review your medications. Additionally, the doctor, nurse prac- Residents who have difficulty with titioner, or physician assistant should fine motor skills and performing ac- visit you as frequently as your medi- tivities of daily living may benefit cal condition requires it. The doctor from occupational therapy. An oc- must visit at least every 120 days. cupational therapist or occupational therapy assistant helps people with Each nursing home has a medical di- illness or injury become as indepen- rector who must be a physician. You dent as possible in their everyday ac- can discuss issues about physician tivities. This is accomplished through services with the medical director. directed activities, exercises, and in- Under Maryland law, a nursing home struction in adaptive equipment. must have a doctor available to the nursing home staff. The home is also A speech and language therapist required to arrange emergency trans- helps residents speak clearly. This is A pharmacist fers to a hospital. especially important for people who is required to are hard of hearing, have neuromus- review every If you have Medicare Part B cover- cular disorders, or have had a stroke. month all age, services provided by your doc- medications tor, nurse practitioner, or physician Therapeutic services may be covered given to each assistant in the nursing home will by Medicare, Medicaid, or private resident. continue to be covered under Medi- insurance. You can ask the nursing care Part B, whether your basic care home about how you will know when is paid for by Medicare Part A, Med- therapy services are not covered, how icaid, or yourself. much this will cost you, and your right to appeal from denials of ben- Therapy Services efits under Medicare.

Residents who have difficulty mov- Your doctor, nurse practitioner, or ing around because of illness or in- physician assistant can order physical jury may benefit from physical ther- therapy, speech therapy, and occupa- apy. A physical therapist or physical tional therapy for you. therapy assistant uses exercise, mas- sage, and special equipment such as Social Services ultrasound, electrical stimulation, whirlpool baths, and parallel bars to Many people find it difficult to leave help residents improve their strength their family and friends and move to and agility. They also teach you to an unfamiliar place. A nursing home use wheelchairs, braces, and artificial social worker helps residents identify limbs. You should ask what equip- and maintain psychosocial, emotional, 11 CHAPTER 2

and mental health needs, and to gener- Resident Councils ally improve the quality of residents’ lives in nursing homes by promoting Residents often find it easier to ad- Every home independence. All nursing homes pro- dress problems as a group. Nursing should offer vide social services to both residents activities to keep home residents have the right to or- and their families. If a nursing home residents active. ganize and participate in independent has 120 or more beds, it must employ resident groups in the nursing home. a full-time social worker. If a resident council exists, the nursing home must provide a private place Activities for the group to meet. The nursing home must provide a designated staff Every nursing home should offer an person who is responsible for assist- ongoing program of activities de- ing the resident council and respond- signed to meet the interests and pro- ing to written requests that result mote the well-being of each resident. from the group meetings. Ideally, activities should be stimulat- ing and interesting, and should vary Staff and visitors may only attend from week to week. A good nurs- these meetings by invitation from the ing home will have a daily variety group. Nursing home administrators of activities to suit each resident’s and/or staff must listen to the coun- preferences. Typical activities might cil’s views and act upon their griev- include bingo, arts and crafts, trivia, ances and recommendations concern- ice cream socials, music programs, ing decisions that affect resident care holiday and birthday parties, window and life in the home. The resident gardening, storytelling, dances, and council may also work with the local shopping excursions. The more social Long-Term Care Ombudsman Pro- activities, the better. gram (see Chapter 4). 12 NURSING HOME SERVICES

Family Councils Religious Services

The families of residents also have A good nursing home will help resi- the right to meet in the nursing home dents who choose to attend religious with other family members. A family services. Ministerial staff will often council has the same rights as a resi- visit the home upon request. Many dent council: to be afforded a private homes provide religious services on meeting space, to have staff or other the premises, while others arrange visitors attend only upon request, and transportation to and from local plac- to have a designated staff member es of worship. provide assistance. The family council may also work with the local Long- Laundry Services Term Care Ombudsman Program. Every nursing home provides laun- The nursing home must listen to the dry service. If you are on Medicaid, views and act upon the grievances the institution must do your personal and recommendations of the family laundry at no extra charge. If you in- council concerning decisions affect- tend to be a private pay resident, ask A good nursing ing resident care and life in the home. whether laundry service is included home will help The administrator of the nursing home in the basic monthly fee. residents who must respond to all written correspon- choose to attend dence from the family council within religious 14 calendar days. All correspondence services. between the family council and the administrator of the nursing home is to be immediately placed in two family council logs. One log will retain all communications as written and will be maintained in a confidential manner. In the other log—the public log—information identifying any resident will be removed. The public log must be available to current and prospective residents and their families during business hours.

13 CHAPTER 3

Chapter 3 TOURING A NURSING HOME

Choosing the right nursing home is not Services at rebrand.ly/CMSHome- easy. There are many factors to con- Compare and the Maryland Health sider. Gather as much information as Care Commission’s Nursing you can to help make the right choice. Home Guide at rebrand.ly/MHC- CHomeGuide. If you don’t have How to Get Started access to the Internet, call your local Long-Term Care Ombudsman 1. Locate nursing homes near family listed in Chapter 10 to request a list members and friends. The ability of nursing homes. to have frequent visitors is more 2. Review the publicly available in- important to a nursing home resi- formation on the homes that inter- dent than just about anything else. est you (see Chapter 4). To locate homes, use both the Nurs- 3. Talk with people you trust—your ing Home Compare website of the doctor, religious advisor, family, Centers for Medicare and Medicaid and friends—to get their opinion on what nursing homes to visit. 4. Tour the homes you are considering.

Visiting the Nursing Home

Visit the nursing home before you make a decision. If you are in the hospital or otherwise unable to visit yourself, ask a family member or friend to tour the home. It takes only an hour or two to inspect the home and inter- view the people who work there.

Think about what things are important to you. Discuss them with your family first, and then with the staff during your visits. For example, do you want a bed by the window? Would you like a home that has an area where you can walk outside safely? As you make

14 TOURING A NURSING HOME

a decision, it’s good to think about the ing part in and enjoying recreational quality of care and the quality of life activities and social events? Talk with provided in a nursing home. them if possible, but remember that some residents may suffer from de- The best time for a first visit is on a mentia or Alzheimer’s disease. If you weekday, during the late morning or use a wheelchair or may require one midday. You may also want to visit in the future, could you pass through about noon on a Saturday or Sun- the doorways? Use the drinking foun- day, when you may be able to speak tains? Reach the light switches? Open to other visitors and learn about the and close the doors? Get from one home from another perspective. Keep floor to another? detailed notes of your visit and write down any questions you may want to Ask about the home’s fall preven- ask staff later. Bring a checklist of tion program. Physical restraints such questions with you (a sample check- as cuffs, belts, and vests are not ac- list is available at the end of this chap- ceptable except in very rare cases. ter). The Maryland Health Care Com- Ask about how the home deals with mission has two lists: one for people residents who wander, yell uncontrol- who are about to be discharged from lably, or are agitated. The first step Residents a hospital and don’t have much time should always be verbal coaching and are happier to make a decision (rebrand.ly/MHC- cuing. Generally, sedatives and tran- in nursing CImmediate) and a second checklist quilizers should not be used to control homes that have trained, for people with more time to shop these behaviors. They should be used dedicated, and around (rebrand.ly/MHCCStandard). only when medically necessary with a well-supervised Once you arrive for your tour, explore doctor’s written order. staff. the home to see how it’s maintained. Do the residents appear to be com- Observe whether the staff is consci- fortable and cared for? Are they tak- entious and pleasant to the residents.

CHEMICALS AND ODORS

Nursing homes should be pleasant places for residents and staff. While there might be occasional odors from residents who lack bladder control or for other reasons, a good nursing home will respond in a timely manner to change clothes and linens so there are minimal odors. Also, strong chemical cleaners and deodorants should not be used to mask such smells. Heavy urine or chemical deodorant smells are a clear sign that conscientious care is not being provided. Moreover, it’s unhealthy for residents to breathe these chemicals and odors for a long time.

15 CHAPTER 3

Residents are happier in nursing During your tour, be sure to ask the homes that have well-trained, dedi- administrator and admissions di- cated, and well-supervised staff. All rector many questions. Don’t worry employees, regardless of their role, about taking up their time. After all, should interact with the residents. meeting with you is part of their job. Watching these interactions can tell Verify any information you were told you a great deal about the quality of a over the phone. Ask them again about nursing home. the types of care offered, whether the home is certified by Medicaid and For most residents, the most impor- Medicare, and if the home has any tant part of a nursing home is their special services or programs. room. Observe how much individuality is promoted at the nursing You should also review the most re- home. It means a great deal to have cent government survey and com- your favorite pictures on the wall, plaint investigation reports, which your own bedspread, your personal should be posted or readily available belongings on the shelves, and a TV in each home. The reports will usual- or radio. Be sure to ask the adminis- ly contain a response from the home. trator if theft is a problem, and what Chapter 4 discusses how to use these is done to prevent it. reports and judge the quality of the nursing home. Ask about whether the nursing home permits smoking. Policies vary wide- Ask the administrator to give you con- ly among nursing homes, and most tact information for a member of both don’t allow smoking at all. the resident and family councils (if they exist), who will be able to provide you The most common complaint of nurs- with a consumer’s perspective on the ing home residents is the food. Natu- nursing home. Ask the council members rally, your health and morale are af- about any concerns and whether they fected by what you eat. Mealtime is would recommend this nursing home. also an opportunity to socialize. Be sure to ask how meals are served (for As soon as possible after your visit, write example, buffet style, in the dining down anything you saw or heard that room, or in the resident’s room), what wasn’t already recorded on your check- kind of snacks are available, and what list. Place those notes and your complet- assistance is provided to those who ed checklist in a notebook for reference. need help eating. Ask to see a meal being prepared and served. Look at a Staff Turnover and posted menu for the month. Purchase Retention a meal to taste. Choices must be offered at each meal if you don’t want A nursing home where staff is contin- the prepared menu item or if you have ually changing will probably not pro- dietary or religious restrictions. vide as good care as a nursing home 16 TOURING A NURSING HOME

YOUNGER RESIDENTS

A small number of nursing home residents are between 25 and 55 years old. Some are disabled from birth, while others have had strokes or injuries at an early age. Often, younger residents have no one their own age with whom to interact. Traditional programs may do little to meet the emotional needs of young adults, who may struggle in an environment designed for elders.

If you are a younger resident, try to find a home geared to young adults or one with more residents in your age bracket. Ask how many young residents reside at the home and ask if you can speak with one of them. Ask the nursing home if it has special programs for young adults. Consumer Tip: Ask what the staff turnover rate is. A with stable staffing. Staff turnover Culture Change home that is measures how many staff members chronically have stopped working there and reten- “Culture change” refers to nursing short-staffed tion measures how long current staff home actions that focus on the routines cannot deliver members have been working there. and preferences of the individual, rath- good care. These rates can be important indica- er than the typical routines of an insti- New staff tors of nursing home quality. Keep in tution. For example, a nursing home often cannot mind that most nursing homes have that has a dining room with certain recognize a high turnover and low retention rates, homey characteristics—like nice light- change in a and that it’s often difficult to keep ing, placemats, and small dining ta- resident’s bles—is using culture change to make both at ideal levels. Compare the re- condition. it more comfortable. Culture change tention and turnover rates of the nurs- means that the home schedules meals, ing homes that you’re considering. bathing, and sleep based on the sched- Ask the nursing home administrator ules of the individual residents, rather about the home’s retention and turn- than on what is easiest for the staff to over rates. provide. Culture change emphasizes that each resident is an individual who Nursing homes are required to post has distinct preferences that should be a list of the staff members on each honored whenever possible. shift who are caring for the residents in each section of the nursing home. Ask what culture change action, if any, During your visit, look to see how the nursing home is using or is plan- many staff members are caring for ning. For more information on cul- the residents. ture change in nursing homes, visit www.pioneernetwork.net.

17 CHAPTER 3

If you haven’t already done so, this would be a good time to ask for a copy of the home’s admission contract and other documents in its admission package.

For additional information about selecting a nursing home, refer to the Maryland Health Care Com- mission’s Consumer Guide to Long-Term Care (rebrand.ly/MHC- CLongTerm).

Follow-Up Visits SPECIAL NEEDS

After you have narrowed your If you have a specific illness or choices, visit the home(s) at least one more time to ask follow-up injury, you will want to know questions that may have arisen what kinds of care the nursing since your first visit. See if your home provides for people with initial opinion still holds. your condition. Some nursing homes specialize in car- The best time for a second visit is ing for residents with specific on the weekend or in the early eve- disabilities. Some have special ning, when fewer staff are on duty. care units, such as for patients Use your follow-up visits to walk leisurely through the home. Take on ventilators. Be sure to men- time to talk with the residents. Fi- tion any special needs you nally, consider this: Would you feel have, and ask if the home is comfortable living there or visit- equipped to meet them. ing? If your answer is “yes,” then the nursing home would likely be a good choice for you.

18 TOURING A NURSING HOME

Nursing Home Tour Checklist

You can write directly in this booklet or photocopy this checklist and take it with you to complete during your tour.

Date: Name of Facility Day of Week and Time of Your Visit: Name of Staff Person Hosting You:

Residents’ Well-Being YES NO Do the residents seem cared for well? Are residents dressed appropriately for the environment and temperature? Are the residents’ clothes clean, shoes on, and nails clipped? Is residents’ hair combed? Are beards and moustaches well-groomed? Are residents up and moving around? Are residents in wheelchairs frequently moved from place to place, not just parked in one place? Do residents do more than just sit and stare at the walls or television? Are residents talking amongst themselves? Are residents free from restraints? In what types of activities are the residents engaged?

What are the protocols for discussing residents’ medical matters? Is this done privately?

How regularly is personal laundry done?

19 CHAPTER 3

Home-Like Environment YES NO Is the home bright and cheerful? Is the home clean? Is the temperature comfortable? Do the rooms have good ventilation, air conditioning, and individual thermostats? Is there counter space for personal items? Have residents decorated their own rooms? Are bathing and toilet areas private? Is fresh drinking water within easy reach of the bed? Is the water pitcher clean? Does each bed have a curtain or screen for privacy? Is there adequate closet space? Can possessions be kept reasonably secure? Does each resident have a sink and mirror or an adjoining bathroom? Does each room have a private phone? Is cable television available? Is the home free of unwanted noise that can be disruptive to the residents, such as staff using an intercom system? Do residents choose their own sleeping schedule? Do residents choose their own bathing schedule? How do activities address the needs and preferences of residents?

20 TOURING A NURSING HOME

Staff YES NO Are employees respectful toward the residents? Do employees know residents by their names? Are residents treated like adults? Is the staff friendly to you? Is the administrator receptive to your questions? Are employees dressed neatly? Do residents seem at ease with the staff? Are residents using the activity rooms? Are staff members in sight? What are the turnover and retention rates at this home? How many nurses and aides are on duty at the time of your visit?

Residents’ Safety YES NO Are emergency exit doors well-marked, unobstructed, and unlocked? Are there wheelchair ramps? Are there sufficient smoke/carbon monoxide alarms and sprinklers? Are lobby and hallway floors clean? Are patient areas well-lit? Do halls have handrails? Are fire, evacuation, and disaster plans posted? Do tubs have non-slip surfaces and grab bars? Does each resident’s bed have a call button within easy reach? Are hallways wide enough for two wheelchairs to pass? Are hallways clear so residents can pass safely? Are there press-down door handles rather than doorknobs? Are there safe places to walk and sit outside? Is the home free from unpleasant odors? Is there a plan for notifying family members about the status of residents if there is an emergency (power outage, tornado, or flooding, for example)? What is the home’s smoking policy? Feel free to ask for a copy.

21 CHAPTER 3

Food and Dining YES NO Are the dining rooms and kitchen clean? Are the dining room and kitchen reasonably odor-free and without the smell of heavy chemicals? Does the home provide special diets such as low-cholesterol, low-salt, or vegetarian? Do the meal options appeal to you? Are residents allowed to bring personal spices, condiments, utensils, or other items to the table? Are the tables easily accessible to wheelchairs? Can residents eat in their rooms if they prefer? Can snacks be brought into the home? How does the home feed the residents who are unable to feed themselves?

Services and Programs YES NO Does the home participate in Medicare? Does the home participate in Medicaid? Does the home have arrangements with a pharmacy to deliver medications for residents? Can residents use their Medicare Part D prescription drug plan? Is there an adequate physical therapy program? Does the home have a resident council and/or family council? Is it possible to attend religious services? Does the home have private areas for residents to meet with family, visitors, or doctors? What transportation is available for residents who want to participate in social, religious, or community activities outside the home? Is this transportation wheelchair-accessible? Do the activities offered appeal to you?

What activities and field trips has the home organized that take into account residents’ interests?

What special events or holiday parties are held for the residents?

What hospital does the home have arrangements with to transfer residents to in the event of an emergency?

22 TOURING A NURSING HOME

Admission

Are there any residential openings?

If not, how long is the waiting list?

What is the nursing home’s daily rate?

What services are covered by the daily rate?

What services are extra?

What are the costs of these extra services?

May I have a copy of your admission contract and other documents in your admission package?

Other notes about this facility:

Consumer Tip: During your tour, use a copy of this checklist. Place the completed copy of your checklist in a notebook along with your notes of conversations with nursing home personnel and any available brochures or other materials about the nursing home.

23 CHAPTER 4 Chapter 4 JUDGING THE QUALITY OF A NURSING HOME

It’s important to carefully research the quality of a nursing home before signing a contract. You can learn a lot by visiting a nursing home, as discussed in Chapter 3. You can obtain additional information about the quality of a home’s care from other sources. Much of this information comes from nursing home inspections conducted by government agencies.

Inspections by the State

All nursing homes in Maryland must have a State license to operate and must meet standards for resident safety, personnel, and the physical environment. Additionally, if a home wants Medicare or Medicaid to help pay for some resident expenses, it must meet certain federal requirements.

24 JUDGING THE QUALITY OF A NURSING HOME

Maryland’s Office of Health Care directly benefit a resident by prompt- Quality (OHCQ) surveys over 200 ing a nursing home to correct problems nursing homes to monitor compliance noted in a complaint, OHCQ does not with state and federal standards. In- represent the resident. OHCQ is an spection teams survey each nursing enforcement agency acting on behalf home in Maryland at least once every of both Maryland and the federal gov- 15 months. These teams include regis- ernment to ensure compliance with tered nurses, dietitians, fire safety in- statutes and regulations. spectors, and sanitation experts. The inspection teams look at many things, Survey or Inspection including infection control, resident Results Nursing homes care, housekeeping, fire protection, must make physical safety, maintenance, staff- If you want the survey reports for a inspection ing patterns, and staff training. The particular nursing home, you can ob- reports readily inspections are unannounced and can tain a copy from the Long-Term Care available to the be conducted at any time, 24 hours a Ombudsman’s Office, the OHCQ, and public. day, seven days a week. some libraries. In addition, nursing homes must make the reports read- If OHCQ finds any health or safety ily available to the public. Frequent- violations, it will require the home ly, they are located in a binder in the to correct the problems within a cer- lobby area; you should not have to tain time. OHCQ can also prevent the ask for a copy to review. The nursing home from accepting new residents, home may also provide a copy of its stop Medicare payments to the home, responses to survey reports, which impose financial penalties, or revoke might include explanations for why it the home’s license to operate. disagreed with certain findings. OHCQ may also inspect a nursing home when it receives a complaint. Unlike the Long-Term Care Om- budsman’s Program, OHCQ does not act as an advocate for a person who files a complaint. Rather, it reviews evidence gathered through the ex- amination of nursing home records or interviews to determine whether the nursing home violated any statutes or regulations. OHCQ will impose penalties on a nursing home only if there is sufficient evidence that the home has violated a statute or regulation.

Although OHCQ’s imposition of penalties against a nursing home may in-

25 CHAPTER 4

Look at the reports for the past two or three years to see if there are patterns of problems that have not been correct- ed or to see if the home has adequate- ly addressed the problems identified. Visit rebrand.ly/CMSHomeCompare for an online summary of the reports for each nursing home.

Some findings or deficiencies are more serious than others are. A home with Centers for multiple minor deficiencies may actu- Medicare and ally provide better care than one with Medicaid Services fewer, but more serious, violations. A Nursing Home home that has a large number of de- Compare & Five-Star ficiencies may indicate inattention to R atings System details that affect the overall quality Consumer Tip: of care and quality of life. However, When touring a CMS is the federal agency that reg- the severity of the problem is also ulates nursing homes. Its Nursing nursing home, important. Pay attention to both the see if you notice Home Compare database includes quantity and severity of problems. information on all Medicare and any of the When touring a nursing home, see if problems noted Medicaid-certified nursing homes you notice any of the problems noted on surveys and is available online (rebrand.ly/ on the survey or inspection report. or inspection CMSHomeCompare). Nursing Home

reports. Compare allows you to search for The reports provide a detailed histo- nursing homes by name, state, city, ry of a nursing home’s problems and or zip code, and allows you to do a management’s efforts to address them. side-by-side comparison of differ- It takes patience and determination to ent homes. This website provides fully understand these materials. Feel the most recent information CMS free to discuss the survey reports with the nursing home administrator, your has about who owns the facility, in- local Long-Term Care Ombudsman, spections, staffing, quality measures, or a member of the nursing home’s complaints, and regulatory compli- resident or family council. ance.

The Maryland Health Care Com- Nursing Home Compare also rates mission (MHCC) and the Centers each nursing home from one to five for Medicare and Medicaid Services stars (five stars being the best). Please (CMS) help people sort through the keep in mind that the five-star rating wide array of public data that is avail- system is only one source for your re- able on nursing homes online, includ- search because the information used ing inspection results. These resourc- to determine ratings tells only part es are discussed in more detail below. of the story. CMS recognizes that the

26 JUDGING THE QUALITY OF A NURSING HOME

system has limitations. For one thing, cludes comprehensive information the system grades on a curve. The on all nursing homes in Maryland. curve is within each state, so the web- Much, but not all, of the information site is of less benefit when compar- is similar to CMS’s Nursing Home ing nursing homes in different states. Compare, so you may want to visit Remember, it’s essential that you visit both sites. the nursing homes you’re considering. Don’t just rely on information you Information on the MHCC website find online. that isn’t on the CMS website includes number of rooms by type (private or Special Focus Facility semi-private, for example), proximity Initiative of toilet facilities to rooms, and specialized services such as dementia CMS also maintains a Special Fo- units, dialysis care, or ventilator care. cus Facility (SFF) list, which identi- Additionally, MHCC’s website pub- fies nursing homes that have serious lishes the results of annual satisfac- or widespread deficiencies. These tion surveys. MHCC surveys nursing homes will receive more frequent home residents and their family mem- survey visits and must demonstrate bers to measure their overall experi- that the home has made significant ences. This information is not avail- improvement before it can graduate able on CMS’s website. from the SFF list. Nursing homes on the SFF list that fail to improve may The Long-Term Care be excluded from participating in Ombudsman Progr am Medicare and/or Medicaid. The SFF list can be accessed at rebrand.ly/ The Long-Term Care Ombudsman SFFProgramList. Program operates statewide and has offices in each county and Baltimore If you are considering one of the nurs- City (see Chapter 10). An ombudsman ing homes on the SFF list, be sure to provides residents and their families discuss it with the nursing home ad- with information. Ombudsmen also ministrator, a member of the nursing advocates for residents and work to home’s resident or family council, or resolve grievances that a resident may a Long-Term Care Ombudsman. have about quality of care and quality of life in their nursing home and Maryland Health assisting living facility. Ombudsmen, Care Commission whose services are free, have legal Nursing Home Guide authority to visit all licensed nursing homes or assisted living facilities. The The MHCC also produces a Consum- ombudsman is not an employee of any er Guide to Long-Term Care, which nursing home and has authority under is only available online at rebrand. federal and state law to promote the ly/MHCCLongTerm. The guide in- rights of residents. 27 CHAPTER 4

Ombudsmen visit nursing homes The Long-Term Care Ombudsman regularly and respond to complaints, Program is especially interested in educate staff and the public about res- problems affecting the health, safety, idents’ rights, and work with resident welfare, and legal rights of nursing and family councils. The Long-Term home residents. As a result, the lo- Care Ombudsman Program is not an cal ombudsman has a good working enforcement agency, like the Office knowledge of the living conditions at of Health Care Quality is, but can most nursing homes. While ombuds- help you file a complaint. A resident’s men cannot recommend one nursing discussions with an ombudsman are home over another, they can make confidential, unless the resident gives sure that you have the most up-to- permission for their name to be used. date information and have taken into account all the various resources.

Ombudsmen work to resolve grievances that a resident may have about quality of care and quality of life in their nursing home or assisted living facility.

28 HOW TO PAY FOR NURSING HOME CARE Chapter 5 HOW TO PAY FOR NURSING HOME CARE

People who pay for nursing home care home expenses, unless it’s for a short with their own money are known as pri- stay. But, depending upon your needs vate pay residents. However, most peo- and personal resources, there are ple don’t have the funds to pay out-of- other options available to help pay for pocket for nursing home care for very nursing home care, including Medic- long because of its high cost. Actual aid, Long-Term Care Insurance, and costs vary based on the facility, loca- Veterans Administration benefits. tion, and the type of care you need. In Maryland, costs can range from $4,000 Other financial management options (assisted living) to nearly $10,000 (nurs- include annuities, obtaining a reverse ing home care) per month. mortgage, selling assets, and utiliz- ing accelerated death benefits from Generally, health insurance (includ- a life insurance policy. You should ing Medicare) does not cover nursing consult with your financial advisor to 29 CHAPTER 5

determine if any of the options make care that most people can do them- sense for you. Since many people who selves such as administering eye drops stay in a nursing home for a long time or taking care of colostomy or blad- ultimately have to rely on Medicaid, der catheters. It’s important to know and the rules governing Medicaid are Medicare’s coverage requirements so complicated, most of this chapter is that you and your doctor can discuss devoted to highlighting some of the whether skilled nursing care and/or issues and questions people frequent- rehabilitation services are needed. ly ask about Medicaid. For definitions and details, visit www. cms.gov/Medicare/Medicare.html. When making your financial plans, you should keep in mind that you may Medicare Part A can help pay for up incur a number of personal expenses to 100 days of skilled or rehabilitative while in a nursing home (clothing, nursing care at a time if you contin- Consumer Tip: salon services, telephone, and televi- ue to meet Medicare’s requirements. The cost of sion, for example) as well as certain Medicare Part A pays for all covered medical care in a nursing home medical expenses that are not covered services for the first 20 days of your is deductible by any insurance or government ben- approved stay in a nursing home. You as a medical efits program, including Medicaid. will be required to pay a high copay- expense on your These expenses will vary depending ment for the remaining 80 days of a federal and on your wants and needs. covered stay. Some Medicare supple- state income mental policies may offer limited tax returns. Medicare coverage for skilled nursing care in a This deduction nursing home and, depending on the may ease the Medicare is the federal program that terms of the policy, may cover some of burden for some helps pay your doctor and hospital the costs you are responsible for from “private pay” bills if you are over age 65 or have days 21 to 100. patients. certain disabilities. Almost everyone who receives Social Security benefits Once Medicare determines you no is covered by Medicare. longer need skilled nursing care or rehabilitation services, Medicare stops Medicare coverage for nursing homes paying for these services. is limited. Generally, Medicare Part A will pay only for skilled or rehabilita- If you are eligible for Medicare Part tive nursing care that is provided in an A, the nursing home will submit a approved facility, and only for a short Medicare claim for you. If the nursing time after hospitalization. Medicare home concludes that Medicare will does not, however, cover the cost of not pay for a service, it must give you custodial care, such as help with daily a written notice. You may ask Medi- activities of living (getting in and out care to review the nursing home’s de- of bed, eating, bathing, dressing, and cision. Until Medicare determines the using the bathroom, for example). Nor care is not covered, the nursing home does Medicare cover health-related cannot collect more than your co- 30 HOW TO PAY FOR NURSING HOME CARE

payment from you. If Medicare later may also want to contact the Medicare determines that it does not cover the Rights Center, www.medicarerights. service, you will be responsible for the org, for more information or addition- full cost of care. al resources.

Of course, if you have Medicare cov- When will Medicare erage for doctor’s services, Medicare cover skilled care? Part B will continue to cover your reasonable and necessary doctor bills Medicare will cover skilled care in a for needed services while you are in nursing home only if all the following a nursing home, even if it doesn’t pay are true. the nursing home bill. To learn more • You have Medicare Part A (hospi- about Medicare coverage of nurs- tal insurance) and have days left in ing home expenses or how to appeal your benefit period available to use. a Medicare denial of payment, call • You were formally admitted as the Senior Health Insurance Program an inpatient to a hospital for three (SHIP) counselor in your county, consecutive days or more, starting or call Medicare customer service with the day the hospital admits at 1-800-MEDICARE (1-800-633- you as an inpatient but not includ- 4273). Visit rebrand.ly/AgingSHIP ing the day you leave the hospital. to locate a county SHIP office. You You must enter the skilled nursing 31 CHAPTER 5

home within a short period of time skilled care if the resident was im- (generally 30 days) after leaving proving. That is not true. When a the hospital. beneficiary needs skilled nursing or • Your doctor has ordered services therapy services under Medicare’s that require the skills of profes- skilled nursing facility, home health, sional personnel such as registered and outpatient therapy benefits in or- nurses, licensed practical nurses, der to maintain their current condition physical therapists, occupational or to prevent or slow further deterio- therapists, speech-language pa- ration, the Medicare program covers thologists, or audiologists, and the such services (provided all other cov- services are provided by or under erage criteria are met). Coverage can- the supervision of such personnel. not be denied because the care is not • You require the skilled care on a expected to improve or maintain the daily basis and the services can patient’s clinical condition. only be provided in a skilled nursing home on an inpatient basis. Private Long-Term Consumer Tip: If only rehabilitation services are Care Insurance Before you enter needed, “daily care” may be con- a nursing home, sidered Monday through Friday if Some insurance companies offer find out whether therapy services are not available “long-term care” insurance to help it participates on weekends. pay for the cost of nursing home with Medicare, • You need these skilled services care. This is not the same as Me- Veterans for a medical condition that was digap supplemental insurance, Affairs, or treated during a qualifying three- which may help with your Medicare Medicaid day hospital stay, or for a sepa- copayments and deductibles. Long- programs. rate medical condition that started term care insurance policies may while you were getting skilled care also cover assisted living and home for the first medical condition. For care support. Depending on your example, if you are in a skilled age when you apply and the ben- nursing home because you broke efits provided, these policies may your hip, and then have a stroke, be expensive, with premiums rang- Medicare may cover rehabilitation ing from several hundred to several services for the stroke, even if you thousand dollars a year. The insur- no longer need rehabilitation for ers are regulated by the Maryland your hip. Insurance Administration. • The skilled services must be reasonable and necessary for the diagnosis Long-term care policies advertised, or treatment of your condition. sold, or delivered in Maryland: • You enter a Medicare-certified • Must provide at least 24 months of nursing home. coverage for all levels of nursing home care; It was a common belief at one time • Must cover Alzheimer’s and relat- that Medicare would only pay for ed diseases, as well as other senile 32 HOW TO PAY FOR NURSING HOME CARE

dementia disorders; document carefully to make sure your • May exclude coverage for a pre- coverage will be adequate. If it isn’t, existing condition only if you re- you may look for a policy that pro- ceived treatment or medical advice vides broader coverage. for the condition within six months prior to coverage; Don’t be dishonest when filling out an • May exclude coverage of mental application form or a medical ques- or nervous conditions or diseases tionnaire. In fact, you may want to other than Alzheimer’s disease; ask your doctor to review your an- • May exclude coverage of alcohol swers for accuracy. Some companies, or drug addiction; especially those that offer immedi- • May not, when covering home health ate coverage within 24 to 48 hours, care, require that you would need may not verify your history until you care in a nursing home if you were make a claim for nursing home ben- not receiving home health care; efits. If they find at that time that you • (Those that provide benefits for answered your original questionnaire home health care services) may not inaccurately, they may refuse cover- limit eligible services provided by age and cancel your policy. In such a registered nurses or licensed prac- case, you will have paid premiums for tical nurses; a number of years only to have your • May not increase premiums solely claim refused because of an inaccu- because you grow older; rate medical questionnaire. • Must offer an inflation protection option; Before buying long-term care insur- • May cancel coverage only if you ance, study the policies very carefully. don’t pay or if you significantly The Maryland Insurance Administra- misrepresent your medical condition has useful consumer information tion; that can be found at rebrand.ly/MIA- • May only cancel coverage after Consumer. In addition, your local you and another person whom you Area Agency on Aging (see Chapter designate are informed in writing; 10) can refer you to a counselor or to and your local SHIP office. • Must allow you to cancel within 30 days of purchase and receive a full Maryland Long-Term refund. Care Partnership Progr am These are only some of the minimum standards set by law. Before enrolling The Maryland Insurance Adminis- in a policy, your carrier or insurance tration also administers the Mary- producer should provide an outline of land Long-Term Care Insurance coverage and buyer’s guide that gives Partnership Program, an alliance be- an overview of the specific benefits tween Maryland and private insur- of the policy. You should review this ance companies that issue long-term 33 CHAPTER 5

care insurance policies. In addition to the minimum State requirements Private Long-Term for long-term care insurance, a Part- Care Insurance nership Program policy must meet Checklist certain extra federal and State requirements, and be certified as a 1. Does the policy cover alternatives “long-term care partnership policy” to nursing home care, such as home by the Commissioner of the Mary- health, day care, and custodial care? land Insurance Administration. 2. Does the policy renew automatically every year? Partnership policies provide an addi- 3. How long is the waiting period for tional level of protection when com- preexisting conditions? pared to a regular long-term care 4. Does the policy have a deductible insurance policy. In particular, such or a number of days before cover- policies permit individuals to protect age begins? additional assets from spend-down 5. Does the policy’s daily benefits rate requirements under Maryland’s Med- compare favorably with the costs of icaid program. Carriers are required care in your area? to provide a notice with the policy 6. Do the policy benefits cover enough that explains the benefits and the spe- days to assure you coverage for cial rights of a Partnership Policy. The your nursing home stay? schedule page must also state clearly 7. Is there a provision to allow the that it’s a Long-Term Care Partner- benefits to go up with inflation? ship Policy. For more information, please visit the Maryland Insurance Department of Administration’s website at insur- Veterans Affairs ance.maryland.gov. A veteran may qualify for care in a Insurance Riders Veterans Affairs (VA) nursing home or a nursing home that has a contract Another form of insurance for long- with the Department of Veterans Af- term care is available in Maryland. fairs, known as a Community Living Life insurance companies can now Center (CLC). However, space is lim- offer riders, or supplemental poli- ited. Your eligibility is based on clini- cies, to life insurance. These provi- cal need and setting availability. The sions may cover long-term nursing VA will provide Community Living home care instead of, or in addition Center care if you meet certain eligi- to, death benefits. Specific details can bility criteria involving your service be obtained from the Maryland Insur- connected status, level of disability, ance Administration by calling 410- and income. You must first be - en 468-2000 or 1-800-492-6116, or visit- rolled in the VA health system, and be ing insurance.maryland.gov. medically and psychiatrically stable. A copay may be charged for CLC 34 HOW TO PAY FOR NURSING HOME CARE

care based on your VA service-con- the number of Medicaid residents they nected disability status and financial will accept. information. Contact your VA social worker/case manager to complete the Because the rules about qualifying Application for Extended Care Ben- for Medicaid’s long-term care nursing efits (VA Form 10-10EC) to learn the home care program are complicated amount of your copay. and change from time to time, this section is only a summary of some Your eligibility for long-term care of the issues that you should keep in services, provided in any long-term mind before applying. Before making care setting, will be determined based any decision, you should contact one on your need for ongoing treatment, of the Medicaid experts listed on page personal care, and assistance, as well 42 to get more information. as the availability of the service in your location. Other factors, such as financial eligibility, your service-con- Medicaid, Medicare, nected (VA disability) status, insur- or Medical Assistance – Consumer Tip: ance coverage, and/or ability to pay Is there a difference? To find out may also apply. You can find more about Medicaid, information by calling toll-free 1-877- Many people get confused by the consult one 222-VETS (1-877-222-8387), or visit- words Medicaid and Medicare. They of the experts ing rebrand.ly/VAPayLTCare. sound alike. They look alike. Both mentioned on More information about the Depart- are government benefit programs, but page 42. Try ment of Veterans Affairs is available they are different. to plan at least at www.va.gov. five years in advance. Medicaid’s long-term care benefit Medicaid pays your nursing home bills if you do not have enough money to do so. Medicaid (also known as Medical As- Medicaid is also known as Medical sistance) is a joint federal and state Assistance. program that pays nursing home costs for people who can’t afford to pay the Medicare helps pay your doctor and full costs themselves. Each state ad- hospital bills if you are over age 65 ministers its own Medicaid program or have certain disabilities. Medicare with slightly different eligibility rules. has limited nursing home benefits. In Maryland, Medicaid’s long-term care nursing home program is avail- What should I do able only if you are unable to care for first? yourself at home. You must also meet financial eligibility limits regarding You will need to apply for Medicaid income and assets, which differ de- if you are not already enrolled. To pending on your marital status. Be qualify for Medicaid nursing home aware that some nursing homes limit benefits, you must: 35 CHAPTER 5

• Be a resident of Maryland; it’s best to talk to an expert long be- • Be a U.S. citizen or non-citizen fore you may need Medicaid. If you who meets immigration status re- wait until the last minute, Medicaid quirements (see rebrand.ly/MDH- may not promptly pay your bill after MedicaidStatus); you run out of money, causing signifi- • Provide a Social Security Number cant financial problems for you. (SSN) (if you have one and are applying for coverage for yourself); Several months before your money and runs out, obtain an application and • Meet the income and asset limits contact one of the Medicaid experts that apply to your demographic listed on page 42 to get more infor- group. mation. If you are already a nursing home resident, you should begin this To qualify for nursing home care ben- process at least three months before efits, you will also have to meet the your funds run out. You will also medical eligibility standards. need to work through your local De- partment of Social Services (DSS) of- You should not wait until all of your fice, which processes all applications funds have run out before considering for Medicaid (see Chapter 10). If you Medicaid. Because applying for Med- are in a hospital or nursing home, the icaid is a time-consuming process, if social worker can help you apply. you are in or entering a nursing home, What happens After I apply for Medicaid?

Your local DSS office determines whether you are eligible. Your local DSS should send you a letter with its decision within 30 days, or within 60 days if you have a disability. While you await this decision, you must continue to pay the nursing home. Speak to the nursing home’s business office about how much you need to pay.

If the local DSS determines that you are eligible, you will receive a Med- icaid identification card. You should also receive a notice from your caseworker advising you of the amount you are required to pay toward the cost of your care while in the nursing home. This is called the patient-pay 36 HOW TO PAY FOR NURSING HOME CARE

amount. Your nursing home will bill then determine if you are medical- Medicaid for the portion of the bill ly eligible. Your doctor may have you are not expected to pay. to provide Medicaid with a written statement certifying your medical If you have applied for Medicaid, you need for nursing home care. How- must inform your nursing home that ever, the ultimate determination you have done so before receiving of your medical eligibility will be medical services. You must give your made by Medicaid. nursing home a copy of your Medic- aid identification card or approval let- To determine if you are eligible for ter as soon as you receive it. Medicaid, your local DSS will ask you about your: What will DSS ask me? • Income and assets; • Age; Determining your Medicaid eligibil- • Medical expenses; ity is a three-step process: • Marital status; and 1. Your local DSS will determine if • Medical insurance. you are eligible based on your assets. This is called asset eligibil- If you have a spouse, your local DSS ity. If you have too many assets to will also ask about: qualify for Medicaid benefits, your • Your spouse’s assets; application will be denied. • Your spouse’s income; and 2. If you are asset-eligible, then your • Income of other dependents at local DSS will review your income. home. 3. If you are asset-eligible and income-eligible, your local DSS will 37 CHAPTER 5

What will I need to ing accounts; provide? • Credit union share and draft accounts; You will need to provide to DSS: • Certificates of deposit; • Proof of your income and assets • U.S. Savings Bonds; for the last five years (if you have • Individual Retirement Accounts a spouse, you will need proof of (IRA) and Keogh plans; their income and assets, too); • Nursing home trust funds; • Proof of your disability if you are • Trusts, depending on the terms of under the age of 65; and the trusts; • Proof that you are a U.S. citizen, or • Annuities; a non-citizen who meets immigra- • Real estate (other than your home); tion status requirements. • A second, third, or fourth (and any additional) automobile; Some of the documents the local DSS • Boats or recreational vehicles; will need include: • Stocks, bonds, and mutual funds; • Bank statements, including joint ac- and counts; • Land contracts or mortgages held • Pension payment information; on real estate sold. • Social Security benefit information; • Real estate value (other than your What assets do not home); and count? • Recent medical bills. The most common assets not counted You must disclose all of the information are: DSS asks you to provide. If you don’t • Personal belongings and house- provide all of the information, your ap- hold goods; plication may be denied. Medicaid may • One automobile; require up to five years of past records. • Burial spaces and certain related If you receive Medicaid benefits after items for you and your immediate you deliberately failed to disclose all family; your assets or the information DSS re- • Up to $1,500 designated as a burial quested, you may be criminally charged fund for you or your spouse, if you with Medicaid fraud. In addition, your have one; Medicaid payments may be terminated • Prepaid funeral contract; and you may have to repay the benefits • Value of life insurance if total face you received in the past. value of all policies is $1,500 or less per owner, or term insurance What assets count? of any amount; and • Assets that you don’t have the legal The most common assets counted are: right to use or dispose of. If you • Cash, savings accounts, and check- have a spouse, the same is true of assets your spouse doesn’t have the 38 HOW TO PAY FOR NURSING HOME CARE

legal right to use or dispose of. What if I have a There are complex rules about when joint account with the Medicaid program can’t attempt someone other than to collect on its lien. You should con- my spouse? sult with one of the experts listed on page 42 to make sure you understand The entire amount will be counted all of the Medicaid rules concerning as yours unless you prove some of your home. the money belongs to another person. This rule applies to cash assets. If your home is not exempt and DSS counts it as an available asset, you are What about other assets I own with unlikely to be eligible for Medicaid. someone else, such as real estate? How do my assets It’s assumed that each person owns an affect my eligibility? equal share of other assets. You will need to show proof if the ownership DSS will determine your “countable” is different. assets. If you have a spouse, your collective assets, regardless of own- Will my home count ership, are combined. The result is as an asset? called the couple’s combined countable assets. Your home will not count as an asset if your spouse, certain dependent, or DSS will assume that you and your disabled relative lives in the home. spouse share equally in the combined countable assets. In determining if Your home will also not count if you you are asset-eligible, DSS will ignore say that you intend to return to it, and certain amounts from your combined your equity in the home is less than countable assets. The amount ignored $500,000. While your home does not is based on a complicated formula. count as an asset, in this case Medic- You may want to consult with an at- aid may place a lien on it. A lien gives torney who specializes in elder law to the legal right to seek reimbursement maximize the amount your spouse is out of the value of the house of the to- allowed to keep. tal amount Medicaid spent on nursing home care. Medicaid will not place a The countable asset limit is $2,500. lien on your home if: You are asset-eligible if your portion • Your spouse lives in the home; of the countable assets is $2,500 or • A certain dependent lives in the less. If you exceed this limit by even home; or $1 on the first day of a calendar month, • A disabled relative lives in the you will not be eligible for Medicaid home. for the entire month.

39 CHAPTER 5

What happens if my There is no penalty if you transfer assets are over the assets to your spouse, or if you or limit? your spouse transfer assets to your blind child or child with disabili- You may want to use your excess as- ties, regardless of your child’s age or sets to pay medical expenses, living marital status. costs, and other bills, or for other comfort items that are not covered You or your spouse may also transfer by insurance. If you give this money your home, without penalty, to: away, you could face a penalty period • Your children under aged 21; from Medicaid if you reapply. DSS • Your children aged 21 or older liv- may ask you to verify how you used ing in your home, if they can prove your assets if you reapply. they provided care that allowed you to stay at home for at least Can I give my assets two years up until you entered the or income away? nursing home; or • Your sibling, if they are part-own- If you want or need to become eligible er of the home and lived in it for at for Medicaid in the near future, you least one year before you entered generally cannot give away assets or the nursing home. income. This applies to you and your spouse. DSS will look at transfers that If you give away or transfer your as- occurred up to five years before you sets or income in an impermissible apply for Medicaid. For example, sell- way, you will be subject to a penalty ing a car to your child for less than it’s that delays the date you are eligible worth would be counted against you. for Medicaid. If a transfer triggers a

40 HOW TO PAY FOR NURSING HOME CARE penalty, Medicaid will not pay for one What income does month of nursing home care for every DSS count? $6,800 you transferred. DSS counts any income that you re- The transfer of assets is a highly tech- ceive each month, including: nical area of law. You should get ex- • Social Security benefits; pert advice before giving anything • Pension benefits; away or changing the titleholder on • Veterans’ benefits; and any of your property, as this may be • Dividends and interest. considered an improper transfer. How much of my Is there a limit on income can I keep? income? When determining your total month- Yes. You may get help when your in- ly income, DSS will deduct or ignore come is not enough to pay your medi- small amounts you use for certain cal expenses. Usually, you pay part of personal and medical expenses, ex- your medical expenses and Medicaid penses for your spouse to remain at pays the rest. home, and expenses for you to maintain your home if you live alone and intend to return to your home.

41 CHAPTER 5

If I have a spouse, is First, talk with your DSS caseworker there a limit on my or their manager. If you still believe the spouse’s income? action was wrong, get the decision in writing. You may ask for a hearing to No. But if your spouse gives you appeal the decision. You can appeal de- money regularly, DSS will count that cisions about: money as part of your income. • Your financial or medical eligibility; • The amount of the allowance from Do I have to repay your income set aside for your Medicaid? spouse; and • The amount of your assets set aside for your spouse. You may have to repay Medicaid if in the future you obtain the financial You must file a written hearing request means to do so. For example, if you within 90 days of notice of a DSS ac- inherit a large sum of money, you tion. If you are already on Medicaid may have to repay Medicaid. and you appeal within 10 days, you may ask that your benefits continue un- What if I think DSS’s til a decision is reached. You or other actions are wrong? people on your behalf may submit the request for a hearing. Send the hearing request to the Medicaid program or your local DSS office. WHO ARE THE MEDICAID EXPERTS? An administrative hearing will be scheduled for you to tell your side The following professionals are familiar with Medicaid of the story, present any records that rules and are able to assist you with Medicaid-related support your view, and make legal ar- questions or problems. guments. If you are unable to attend • Staff members of the local Department of Social the hearing, a lawyer, friend, or rela- Services tive can attend for you. If you lose, • Staff members of the State Office of Eligibility you can appeal to a higher level. Services at the Department of Health • Staff members of legal services programs, such as Where can I get Maryland Legal Aid legal help? • Lawyers who specialize in Medicaid law Some lawyers in Maryland specialize See Chapter 10 for contact information for each group in elder law, including Medicaid eli- of experts. The Elder Law and Disability Rights Section gibility and nursing home law. Legal of the Maryland State Bar Association (www.msba.org) aid lawyers may be able to help you can provide you with more information on lawyers who at no cost or refer you to a private at- specialize in elder law, including Medicaid. torney who may take the case for free (pro bono).

42 BEFORE YOU SIGN A CONTRACT … READ THIS Chapter 6 BEFORE YOU SIGN A CONTRACT…READ THIS

When you go to live in a nursing home, you and the home’s administrators must sign a nursing home admission contract. This document is legally binding. You should read the contract carefully before you sign. The contract states your rights and obligations as a resident of the nursing home, including how much money you must pay each day or month to live there. This chapter includes items you should check before you sign any nursing home admission contract.

How much will I pay?

Maryland law requires that a nursing home contract list the services included, the basic monthly fee, and all items that cost extra. For Medicaid residents, this monthly fee will include almost all services a resident needs. For residents who do not receive Medicaid benefits, there are extra charges for many services, such as laundry or barber services. The nursing home must disclose those charges to you. The nursing home may increase its charges, but only after it gives you at least 45 days written notice.

43 CHAPTER 6

Can I be forced to pay If someone else signs privately? the contract, what does this obligate A nursing home cannot force you to them to do? pay privately for a certain period of time before you apply for Medicaid. You should sign the contract unless However, if you are not eligible for you are incapable, or authorize some- Medicaid or any other program that one to sign it on your behalf. will pay the nursing home’s bill, you will need to pay privately. It’s illegal for a nursing home to require someone else to pay your nursing home What if I run out of bill unless that person voluntarily agrees money? to do so. If another individual signs the contract, that person may be agreeing The contract must state the nursing to accept some responsibility depend- home’s policy if a private pay resi- ing on the terms of the contract. This dent’s personal funds run out dur- responsibility could include payment Maryland law ing the resident’s stay at the nursing obligations, so your family or friends requires that a home. The nursing home must also should not sign a nursing home contract nursing home say whether it’s a Medicaid-certified without fully understanding the legal contract list provider. If so, then it must accept and financial implications of doing so. the services Medicaid payments when a resident’s included in the own funds run out. If a financial agent is managing your basic monthly funds, the nursing home may require fee and all items How can I file a that person to agree to use your resourc- that cost extra. complaint as a es to pay for nursing home services. resident in the home? If you have a financial agent, that per- The contract must state the proce- son must pay the nursing home using dure to follow when filing a com- your resources. The agent does not ac- plaint against the nursing home (see cept personal responsibility for your Chapter 8). debts, but does accept responsibility to use your resources to pay your debts. Can the home See “What is a financial agent?” and discharge me against “What are the responsibilities of a fi- my wishes? nancial agent?” below.

Yes, within limits. The contract must Who is liable for describe the home’s transfer or dis- injuries, accidents, charge policies, and how a transfer or and theft? discharge decision can be appealed (see Chapter 7). No matter what the nursing home admissions contract says, the home 44 BEFORE YOU SIGN A CONTRACT … READ THIS

is generally liable for any injuries ther, these agreements usually include that its employees cause you through limits on the resident’s attorney fees. misconduct or negligence. In addition, the nursing home is liable if Should I sign your property is damaged or stolen an arbitration because of the home’s negligence. agreement with a nursing home? A nursing home contract that at- tempts to deny these responsibilities There are significant consequences to may indicate a nursing home that choosing arbitration and the decision will be difficult for you and your should be given careful thought. It’s family to deal with over the years. best to wait and make a decision after a You may want to consider another dispute has arisen, when you have time nursing home. to talk to a lawyer to understand the pros and cons of both arbitration and What is arbitration? court processes. For a resident, generally, there are no advantages to signing No matter Arbitration is one way to handle a an arbitration agreement at the time of what the dispute and is an alternative to go- admission because there are no pend- nursing home ing to court. Most nursing home ar- ing disputes with the nursing home. admissions bitration agreements require that any contract says, the home is future disputes between you and the A nursing home cannot require you liable for any nursing home, other than those spe- to sign an arbitration agreement injuries that cifically left out of the agreement, as a condition of admission or as a its employees will be handled by a private judge requirement to continue to receive cause residents called an arbitrator, rather than by a care at the facility. If a nursing home through jury or a courtroom judge. asks you to enter into an agreement misconduct or for binding arbitration, the facility negligence. There are important differences be- must explain the agreement to you in tween using arbitration and going to a form and manner that you under- court. Arbitration is generally final, stand, including in a language that you and your right to challenge it in court understand. You should ask the nurs- is limited, even if the arbitrator made ing home staff if such an agreement is an error. Arbitration generally limits included in the admission documents. the amount of information that can Usually, the arbitration agreement will be obtained, whereas court processes be a separate document from the ad- allow wider access to information. mission contract, but it’s often included Arbitration agreements often include in the admissions package. An admis- requirements that the nursing home sion package may have many forms resident waive the right to pursue pu- that need to be signed, and sometimes nitive damages, which are additional residents sign an arbitration agreement damages that courts sometimes re- without realizing it. ward for serious misconduct. Fur- 45 CHAPTER 6

whether the nursing home will allow you to place them in your room (see A VALID CONTRACT Chapter 7).

If your contract does not meet all the legal What is a financial requirements, let the nursing home know. If agent? the home does not correct the contract, call the Office of Health Care Quality at 1-877- A financial agent is someone who 402-8219. A valid nursing home contract manages your money for you. An provides legal protection to you and your agent may be an attorney, friend, family. You may want to seek legal advice family member, or someone else you before you sign the contract. trust to manage your finances. If you are able and willing to manage your own financial affairs while you are You may decline to sign an arbitration in a nursing home, you may not need agreement by crossing out the pro- an agent. But if you appoint someone posed arbitration clause. If the nurs- else as your agent, that person will ing home says you must agree to ar- have some important responsibilities. bitration to be admitted or to continue your stay at the nursing home, you What are the should contact the Office of Health- responsibilities of a care Quality (see Chapter 10) and may financial agent? want to contact a lawyer or consider a different nursing home. If you hire a financial agent to manage your money for you while you are a What if the nursing resident of a nursing home, that agent home asks for must use your money appropriately. permission to use my In most cases, this means using your name and photo? money to pay for your nursing home care. Financial agents should not use You have a right to privacy in the nurs- your money for their personal benefit. ing home. No one can use your name or photograph without your permission. Your financial agent must also seek You can delete any provision in the con- available Medicaid benefits for you. tract that allows the home to use your When applying for Medicaid, your name or picture whenever it wants to. agent can only spend your money on the items allowed by Medicaid as described in Chapter 5. Your agent must Can I bring my also gather the information the Med- personal belongings? icaid program needs. If you are eligible for Medicaid, Medicaid will tell If there are some possessions that you your agent how much of your income will always want to have with you, must be paid directly to the nursing find out before you sign the contract 46 BEFORE YOU SIGN A CONTRACT … READ THIS

home. Your agent must then begin ity to remain in the nursing home. A paying this amount to the nursing judge may order your agent to com- home in the month that they apply for ply with their responsibilities. Medicaid on your behalf, and not wait until Medicaid benefits are granted The Maryland Office of the Attor- to start payments. When your agent ney General may also take action to applies for Medicaid on your behalf, recover money from your financial they should ask Medicaid to tell them agent if money that was supposed how much should be paid to the nurs- to pay for your nursing home stay ing home each month while awaiting was used for another purpose. The a decision on your eligibility. Attorney General may also ask that a penalty up to $10,000 be imposed If your financial agent doesn’t ful- against your agent if your money is fill the responsibilities described misappropriated. above—for example, not cooperat- ing with the Medicaid application process or failing to use your funds for your benefit—it could jeopardize your Medicaid eligibility and abil-

BEFORE YOU SIGN A CONTRACT, YOU SHOULD:

1. Obtain a copy of the contract and review it ahead of time in the privacy of your own home. If the home will not give you an advance copy, ask to speak with the administrator or consider another nursing home.

2. Obtain a copy of Maryland’s model nursing home admission contract to see how it compares. Call the Office of Health Care Quality at 1-877-402-8219 or visithealth.maryland.gov/ohcq to obtain a copy.

3. See a lawyer or get advice from any of the Legal Services Programs listed in this booklet.

4. Ask the nursing home about any part of the contract you find confusing or unfair. If you make changes in the contract, be sure that both you and the nursing home administrator sign your initials in the margin next to the change. (If the nursing home is uncooperative, you may want to take an advocate with you to negotiate the changes.)

5. Make sure there are no blank spaces that should be filled in and that the contract is completed and correct at the time of signature. You should get an exact copy (or photocopy) of the original contract after it has been filled in and signed by both you and the nursing home official. Make sure you have all exhibits and addenda mentioned in the contract.

47 CHAPTER 7 Chapter 7 YOUR RIGHTS UNDER THE LAW

As a nursing home resident, you have many rights and protections under federal and state law. The goal of these laws is to help nursing home residents fulfill their highest quality of life. These rights are in addition to federal and state constitutional rights you maintain, such as your right to vote. The more you know about your rights, the more secure you and your family will feel. This chapter highlights some of your most important rights. The complete list of the special rights of nursing home residents should be given to you by the nursing home with your admission contract. You can also obtain the list from your local Long-Term Care Ombudsman Program (see Chapter 10).

48 YOUR RIGHTS UNDER THE LAW

Fees Right to Privacy

You should receive a monthly state- You have the right to private tele- ment of your account from the nurs- phone conversations and to see visi- ing home. Your nursing home must tors privately. Staff should knock be- also mail an itemized bill at any time fore entering your room. You have the upon request. Late fees on unpaid right to send and receive mail without charges may not be assessed until 45 it being opened by others. Subject to days after the nursing home issues an federal and state law, your medical re- itemized statement of the charges, or cords are confidential. 30 days after the end of the period covered by the statement, whichever Right to Organize comes later. You have the right to organize and Managing Your participate in resident groups in the Money nursing home, and your family members have the right to meet privately You have the right to manage your in the nursing home with families of own money or have someone else do other residents (see Chapter 2). it for you. If you allow the nursing home to hold money for you, it’s responsible for safely depositing it. Resident Assessment and Comprehensive Your Belongings Care Planning

You have the right to keep and use Federal law requires nursing homes your own clothing and other per- to provide care and services that en- sonal belongings. The nursing home able you to reach and maintain your is responsible for security of items highest possible level of physical and entrusted to the home and, upon re- mental well-being. The nursing home quest, must give you a locked storage must assess your needs within 14 days space for your valuable belongings. of admission.

Your Well-being The assessment is used to develop, review, and revise your plan of care. You have the right to be treated with This plan of care must describe your consideration and respect, to be free medical, nursing, and social needs from mental and physical abuse and and how those needs will be met. It restraints, and to participate in the should include goals, approaches, planning of your own medical treat- timeframes, and who is responsible ment. As a general principle, you may for each approach. Your treatment refuse medication or treatment. You team must review and update your have the right to choose your doctor assessment and care plan every three (see Chapter 2). months, or as medically required. You 49 CHAPTER 7

and your family should be at care plan called “resident-directed care” or meetings. You have the right to have “person-centered care.” It’s impor- anyone else you choose attend. If you tant that you or your family tell nurs- have an intellectual disability or are ing home administrators about your mentally impaired, you may qualify needs, wants, and preferences when for specialized services that should be you are admitted and during the care included in your care plan. plan meetings so that individualized care can be provided. For example, Participation in care planning can a resident who has enjoyed a morn- prevent misunderstandings and prob- ing nap before moving to a nursing lems about care. A resident or family home should be able to continue that member can request a care plan meet- pattern. A resident who likes to listen ing as a way to address any problems to music rather than watch television a resident may experience. should have that opportunity.

Accommodations to Your Future Health Your Needs and Care Treatment Preferences You have It’s never too early to think about cre- the right to Staff should ask you and your fam- ating an advance directive so that your keep and use ily about your likes and dislikes, and wishes for future health care treatment your own should be aware of your routines and are clear. An advance directive pro- clothing and activities. The nursing home must vides instructions about what care you other personal make a reasonable effort to provide would want if you are no longer able belongings. individualized care consistent with to communicate effectively with your your lifetime pattern. This is often doctors. A living will and a durable power of attorney for health care are both forms of advance directives. If you create an advance directive, a health care provider is legally required to follow your instructions. In some special circumstances, such as religious beliefs, a health care provider may decline to carry out your instructions. In such an event, however, the health care provider must assist in transferring you to the care of a provider who will fulfill your advance directives.

Upon admission, a nursing home may ask you to participate in the preparation of a Maryland Medical Orders for Life- Sustaining Treatment (MOLST) form. 50 YOUR RIGHTS UNDER THE LAW

A MOLST form makes your treatment Right to Information wishes known to health care professionals regarding CPR, artificial ventilation, You have the right to examine your artificial nutrition and hydration, and medical records. They should be pro- other life-sustaining treatments. It also vided to you within 24 hours of your makes clear to family, close friends, and request. You have the right to exam- caregivers what medical treatments you ine the most recent state survey of the want or do not want. nursing home (see Chapter 4). You have the right to be fully informed The MOLST form is not the same as in advance about your care and treat- a living will or an advance directive. ment and any changes in that care and A MOLST form contains medical or- treatment. ders related to your current medical condition that health care providers Room Change may act upon immediately to carry out your wishes. This form goes A nursing home must notify you, where you go—to the hospital, reha- your legal representative, or family bilitation center, assisted living, and member of any planned change in back home. In contrast, a living will your room or roommate. Unless you You have the or advance directive is a statement of agree in writing to the relocation, the right to be free your general preferences regarding nursing home must notify you at least from physical how you want to be treated in hypo- 30 days in advance of the proposed and chemical thetical situations. room change. restraints unless they are ordered by your doctor For further information on the Restraints MOLST form, visit marylandmolst. for your health or safety. org. This may be vital should you lose You have the right to be free from the ability to make decisions. physical and chemical restraints unless they are ordered by your doctor Quality of Care for your health or safety. Restraints can be used only as a last resort to The nursing home must ensure that treat your problem, and must be doc- your condition does not worsen un- umented in your medical records. less the nursing home can demon- Restraints should never be used for strate it was unavoidable. Your con- discipline or convenience of the staff. dition includes your ability to bathe, use the toilet, dress, groom, eat, walk, Physical restraints are devices to pre- or otherwise move around the nursing vent you from moving freely or hav- home. If you develop a problem, the ing access to your body. Examples in- nursing home must provide services clude ties, belts, bed rails, and chairs to correct it and try to ensure that it that restrict your movements. Your doesn’t happen again. plan of care should include a schedule for gradually removing restraints. 51 CHAPTER 7

Chemical restraints are drugs used Moving Out to control behavior that are not otherwise required to treat medical Living in a nursing home is volun- symptoms. Examples include antide- tary. You don’t have to stay there if pressants, tranquilizers, or sedatives you don’t want to; but if you consider used to treat agitation, wandering, or leaving against medical advice, you physically aggressive behavior. Any should consult the resources listed chemical restraints should be gradu- in Chapter 10. You are free to move ally withdrawn at least every six to another nursing home or any other months unless your doctor says this place (see Chapter 9). However, the is not a good idea. An independent nursing home admissions contract pharmacist should also review your that you signed may require you to drug intake at least once a year. notify the home in advance. If you fail to do this and just move out, you still Bed Hold may have to pay for a number of days after your move. The nursing home Consumer Tip: If you are on Medicaid and you go to must assist you in planning any move. Involuntary the hospital, the nursing home must discharges allow you to return to the first avail- Can a nursing home must be in able appropriate nursing home bed. If discharge or move me accordance with you wish to hold your bed in the spe- against my wishes? the plan of care cific room in which you lived in the developed by nursing home, you may be required your nursing A nursing home can discharge or to pay to hold the bed. The nursing home and transfer you against your wishes for physician. home is required to tell you in writing only five reasons: of its bed hold policy both at the time • The transfer or discharge is nec- of admission and at the time you are essary for your welfare and your transferred to the hospital. Medicaid, needs can’t be met in the nursing Medicare, and most private insurers home; will not pay for a bed hold. If you are • Your health has improved suffi- ciently so that you no longer need a private pay resident or your insur- the services provided by the nurs- ance will not pay for the bed hold, the ing home; nursing home may refuse to hold the • You are endangering the health or bed unless you continue to pay for it. safety of another individual in the nursing home; Medicaid will pay for any leave- • Your nursing home bills are not of-absence if you are visiting with being paid; or friends or relatives or you are taking • The nursing home closes down. part in a state-approved therapeutic Annoying other residents or staff is or rehabilitative program, as long as not grounds for discharge without your absences do not total more than evidence of harm to others. You may 18 days in a year. Being sent to the also not be discharged for converting hospital is not a leave-of-absence. from private pay or Medicare to Med- 52 YOUR RIGHTS UNDER THE LAW

icaid. If you are or may be eligible for Before you are involuntarily dis- Medicaid, the nursing home must as- charged, the nursing home and your sist you in applying to the program. physician must thoroughly evaluate your medical condition and develop Except in emergencies or if you have a plan for your future care. The dis- been a resident for less than 30 days, charge or transfer must be in accor- the nursing home must give you and dance with this plan of care, which your family 30 days written notice of the nursing home should discuss with its intention to discharge or transfer you or your family. The discharge or you. The notice must: transfer must be to a safe and secure • State the reason for the discharge place where you will receive the care or transfer; that you need. • Inform you of your right to ask for a hearing and consult with an at- At the time of your discharge or trans- torney of your choice; and fer, the nursing home must give you, a • List the agencies that can provide family member, or your lawyer: you with legal assistance and other • A copy of your medical evaluation help in contesting the discharge or and plan of care; transfer. • Information on how to obtain additional prescriptions for your You may appeal this discharge or medications; and transfer within 30 days of receiving • To the extent permitted by law, at the notice. If you want to appeal, you least a three-day supply of your should immediately contact your lo- medications. cal Long-Term Care Ombudsman Program, a legal services program, or The nursing home must also give you a private lawyer. a written statement indicating the date, time, method, and destination of You may request a hearing and, if you your discharge. wish, mediation services. The hearing or mediation proceeding is held before an independent administrative law judge of the Office of Adminis- trative Hearings. At the hearing, the judge will decide whether the nursing home has proven its stated reason for your discharge. Unless an emergency exists, if you request a hearing a nursing home can’t discharge you until the judge makes a final decision affirm- ing the nursing home’s right to discharge you.

53 CHAPTER 8

Chapter 8 HOW TO COMPLAIN WHEN QUALITY CARE IS LACKING

If you have concerns about your rights or the care you or a loved one are receiving in a nursing home, help is available. The appropriate person or agency to contact for assistance depends on the severity of the problem experienced.

Inadequate Care

Internal Complaints If your problem is a one-time occur- rence, feel free to speak directly to the staff person responsible. If you are experiencing recurring problems with your care, however, notify your charge nurse as soon as possible. If the issue remains unresolved or if the charge nurse is dismissive or personally involved in the problem, you can take further steps, such as the following: • Speak directly with the facility’s director of nursing, assistant director of nursing, or the medical director. • File a complaint with the nursing home administrator. • Request the facility’s grievance policy, which must be provided upon request. Ask who the grievance official is and obtain the official’s contact information. • Ask if your facility has a hotline number so you can make confidential reports, if needed.

If you file a complaint, do so in writing and keep a copy if possible. This will make a record of any complaint 54 HOW TO COMPLAIN WHEN QUALITY CARE IS LACKING and help ensure the accuracy of the Patient Abuse and information you or a responsible par- Neglect ty provides. Unfortunately, nursing home resi- Office of Health Care Quality dents occasionally experience abuse If you believe the facility is not tak- or neglect. ing your complaint seriously or if you’re afraid to report your complaint Abuse is any cruel or inhumane treat- to someone at the facility, contact the ment or malicious act that results in Maryland Department of Health’s Of- physical pain or injury, and includes fice of Health Care Quality (OHCQ), hitting, pushing, sexual assault, ex- Consumer Tip: Be sure all your the licensing agency for Maryland cessive rough handling, and unneces- nursing homes, assisted living fa- belongings are sary physical restraint. Physical signs on an inventory cilities, and group homes. To file a of abuse may include unexplained list in the complaint with OHCQ, you can call bruises or other injuries, bone or skull nursing home’s 1-877-402-8219, complete an online fractures, unexplained falls, or multi- files. Label your complaint report form at rebrand.ly/ ple injuries in various stages of heal- belongings, take MDHOHQCComplaints, or mail a ing. Abuse may also cause psycho- photographs paper complaint report form to the logical harm, which could manifest of them, and following address: itself as fear, anxiety, agitation, anger, update the depression, an unwillingness to com- inventory list Maryland Department of Health municate or respond, or subservience periodically. Office of Health Care Quality or anxiousness to please. Report missing 7120 Samuel Morse Drive, 2nd Floor items to the Columbia, MD 21046 Neglect is the refusal to provide nec- nursing home essary assistance and resources for the staff. Maryland Long-Term Care physical needs of a nursing home resi- Ombudsman Program dent, and includes the failure to pro- In addition to contacting OHCQ, you vide adequate food, clothing, toileting, may also contact your local Long- medical treatment, shelter, or super- Term Care Ombudsman. Ombuds- vision. Signs of neglect may include men are excellent advocates who dehydration, malnutrition, untreated work diligently for residents in long- bedsores, lack of proper medical treat- term care facilities, such as nursing ment or medication, inadequate hy- homes, group homes, and assisted liv- giene, overgrown hair and nails, and ing facilities. Any complaint made to unclean clothing or bed linens. an ombudsman will be kept confidential unless you give the ombudsman In Maryland, abuse or neglect of a permission to disclose your name. All nursing home resident is a crime. If counties and Baltimore City maintain you suspect the abuse or neglect of a Long-Term Care Ombudsman Pro- a nursing home resident, you should gram office (see Chapter 10). immediately call the local police. You also should consider contacting Adult 55 CHAPTER 8

Protective Services at 1-800-332- the Consumer Protection Division, 6347, OHCQ, the local Long-Term at 410-528-1840 or [email protected]. Care Ombudsman, and/or the Medic- md.us. aid Fraud Control Unit (MFCU) of the Office of the Attorney General. You How Can Family and can contact MFCU at 410-576-6521 or Friends Help Ensure 1-888-743-0023. You may also file a Quality Care? complaint with MFCU by sending an e-mail to [email protected]. Family members and friends can help md.us. ensure quality care at a nursing home in a number of ways. These include: Financial • Frequent visits; Exploitation • Being proactive and voicing concerns to nursing home staff and Nursing home residents can also, un- administrators; fortunately, be victims of financial • Paying attention to and reporting exploitation. anything that seems out of order or unusual during visits; The Office of the Attorney General • Being involved in care planning can pursue asset recovery on behalf and activities that address a resi- of financially exploited senior citi- dent’s special needs, health goals, zens (aged 68 or older) and vulnerable and preferences; and adults (a person who lacks the physi- • Participating in family council cal or mental capacity to provide for meetings and encouraging resi- their daily needs) by bringing a civil dents to participate in resident action for damages on their behalf council meetings. against persons who financially exploited them by way of deception, in- Family members and friends can also timidation, or undue influence. help ensure quality care at nursing homes by reporting inadequate care, The Attorney General can investi- abuse, neglect, or financial exploita- gate and prosecute any person who tion as detailed above. financially exploits seniors or vulnerable adults, including persons who are close to and trusted by the victim (such as caregivers in nursing homes and financial agents). If you observe what you believe is financial exploitation of a senior citizen or vulnerable adult, or seek more information about financial exploitation, please contact the Attorney General’s Health Education and Advocacy Unit, within 56 ALTERNATIVES TO A NURSING HOME Chapter 9 ALTERNATIVES TO A NURSING HOME

You can often avoid a residency in a long-term stay nursing home if you have the proper services and support to live safely at home or elsewhere in your community. A short-term nursing home stay may be necessary to arrange the services and support you need at home. If your goal is to return home, tell the nursing home of your intentions. Ask the nursing home for help to arrange the necessary services and support.

You can find out how to obtain services and support in your home from several organizations. Each county has an Area Agency on Aging that is familiar with services and support that are available. Maryland also has regional Centers for Independent Living (CIL) that provide counseling and assistance. These agencies work with you to find out what you, and the people who support you, want and need for you to be independent in your home. These agencies can also help you learn how to direct the type of services and support you need so that you can be independent. See Chapter 10 for contact information.

57 CHAPTER 9

Services and Support Day Programs/Drop-In Centers Available Outside a include: Nursing Home • Hospitals/Behavioral Health- Centers for individuals who Identifying what services and sup- need daytime services or support. port are available can be confusing These may be referred to as out- because the same or similar name can patient therapy, intensive outpa- refer to different services. The follow- tient, psychiatric day programs, or ing are brief descriptions of services partial hospitalization. These are available from Medicare, Medicaid, voluntary, comprehensive, multi- and other state and local programs. disciplinary, coordinated treat- You may need one or more of the fol- ment programs for patients having lowing. both short- and long-term treatment needs for mental health is- Be aware: Aide Services at Home include: sues. They are generally available Charges vary. • Personal care aides provide as- five days a week. Check your area Some services sistance with things like bathing, hospitals for options. are free, some grooming, and moving between a • Medical Adult Day Care Centers are covered by wheelchair and bed. Personal care help older adults and people with governmental can also include assistance with disabilities (and their caregivers) programs, some chores and meal preparation and by providing a safe place for them are covered by transportation to places like the during the day, up to seven days a insurance, and week, with supervised activities. In for some you pharmacy and doctor. most counties, these centers are able may have to • Attendant care providers are ex- pay privately. pected to perform personal care to meet the special needs of people Always ask the tasks plus other less-essential with Alzheimer’s and other cogni- provider if you tasks, such as accompanying you tive and neurological disabilities. will have to pay on visits to friends and family. • Peer-to-Peer programs provide for a service. • Professional aide services are support to people with health ser- necessary if your condition re- vice needs. For more information, quires your personal care services contact On Our Own, Maryland to be rendered under the direc- Inc., 1521 S. Edgewood Street, tion of a licensed nurse. This can Suite C, Baltimore, MD 21227, include things like surface wound 410-646-0262, www.onourown- care and dressing changes. Profes- md.org. sional aides include certified nurse aides (CNAs) and geriatric nurse Home-Delivered Meal Services de- aides (GNAs). liver one or two meals every weekday (including holidays) to anyone who is Case Managers/Service Coordina- homebound and can’t shop or cook. tors help arrange the services and There may be a weekly cost of about support you need and choose. $10 for delivered meals, but no senior is turned away for lack of funds. You 58 ALTERNATIVES TO A NURSING HOME

can usually apply by telephone via your Area Agency on Aging. CONSUMER DIRECTION MODEL

Licensed Nurses provide skilled Some services and programs use the consumer direc- nursing care, such as administering tion model, which allows consumers to assess their own intravenous medications or teaching needs for personal care, determine how and by whom you or others how to administer your those needs should be met, and monitor their services. medications. Simply put, consumer direction gives you the power to hire, train, and discharge the service provider of your Congregate Nutrition Programs choice. If this is important to you, ask potential service provide free hot lunches to senior providers how they support consumer direction. Many citizens Monday through Friday at programs that offer consumer direction also help con- hundreds of locations in Maryland. sumers learn how to assess, direct, and monitor their While the meals are free, donations own service needs. are requested. Social activities are also provided. Telephone Reassurance provides Medical Equipment and Supplies daily telephone contact for people include things like walkers, wheel- who live alone and worry about their chairs, and wound care dressings. personal safety or health.

Prescription Drug Deliveries can Therapy Services can include: be arranged with many pharmacies. • Physical therapy to improve mo- When you contact a pharmacy, ask if bility and balance; you will have to pay for home deliv- • Occupational therapy to improve ery and whether you have to keep your daily living skills; and credit card information on file with the • Speech language pathology to im- pharmacy to pay for copayments. prove speech and swallowing abilities. Push-Button Alert is a device worn around the neck or on the wrist that Paying for Services provides contact with specific people and Support whom you choose to notify if you are having a medical problem. Various services and support may be paid for by an array of federal, state, Respite Care workers can temporar- and local governments and private ily relieve family caregivers by stay- funding. Throughout this booklet you ing with a relative for a short period. will find information on some of those Some programs provide funding for funding sources and the specific ser- caregivers of functionally disabled vices and support for which they pay. adults to receive respite care. Chapter 10 lists several resources with which you can discuss these services.

59 CHAPTER 9

Medicare Medicaid

Medicare Home Health Care may pay In the past, Medicaid was gener- for medical or nursing care in your ally structured to pay for long-term home. Generally, it is only available care provided in an institution like after a hospitalization. It may be ap- a nursing home. It was not designed propriate for people recovering from to pay for long-term care provided surgery, heart attacks, accidents, and in the community. This is changing. cancer, as well as for people who are There are a number of programs that frail, have mental disabilities, need provide long-term care services in kidney dialysis, or are terminally ill. the community as well as the Com- Home health care services range from munity Personal Assistance Services NOTE: One of short-term, 24-hour nursing care to Program. the differences weekly physical therapy. between Below is a basic description of Med- Medicare’s The Medicare Home Health Benefit icaid programs that can pay for sup- and Medicaid’s may pay for several services such as: port and services in your home or home health • Skilled nursing services; community. For the most up-to-date care benefit is • Professional aide services; information, please refer to the Mary- that Medicare rules require • Durable medical equipment; land Department of Health’s website that you be • Medical supplies; and at mmcp.health.maryland.gov. “homebound” • Therapies, like physical, occupa- and unable tional, and speech/language. Home and Community-Based to leave your Programs home routinely More information about what Medi- without extreme care will cover in your own home The Community First Choice (CFC) effort. Medicaid is available online. Visit rebrand.ly/ program was established under the rules support CMSHomeCompare and click “Alter- Affordable Care Act and provides as- community natives to Nursing Homes.” sistance with activities of daily liv- integration and ing to Medicaid recipients who have activities so a person does not need to be “homebound” to qualify

60 ALTERNATIVES TO A NURSING HOME

WHO WILL BE PROVIDING MY HOME HEALTH SERVICES?

Some people have complained that agencies send different aides and nurses from one day to the next. As a result, you may not know who will appear on your doorstep. Before you agree to have an agency provide home health care services, inquire about staff consistency by asking:

• What is the company’s policy for making staff changes if I’m not satisfied with the services? • What is the policy for back-up personnel on holidays or if assigned staff are unavailable?

If staffing becomes a problem, including if no one shows up at all, you should promptly discuss the problem with the agency. You may need to change agencies or file a complaint with the Office of Health Care Quality.

a chronic illness, medical condition, • Home health care; or disability. Services are provided • Laboratory services; in the eligible individual’s home or • Mental health services; community residence. The program • Disposable medical supplies; serves Maryland residents who need • Durable medical equipment. support with activities of daily living, such as bathing, grooming, dressing, Individuals seeking to participate in and getting around. Available servic- the CFC program must be living in es include the following: the community and meet the level • Personal assistance services; required to qualify for services in an • Supports planning; institution, such as a nursing home. • Nurse monitoring; They must meet specific financial • Personal emergency response sys- eligibility requirements to qualify for tems; Medicaid. Individuals who qualify • Technology; for federal Supplemental Security • Assistive technology; Income are automatically eligible for • Environmental assessments; Medicaid. • Accessibility adaptations; • Consumer training; The Community Personal Assis- • Transition services; tance Services (CPAS) program pro- • Home-delivered meals. vides personal assistance services, support planning, and nurse moni- CFC participants are also eligible toring for individuals who need help to receive other Medicaid services, with activities of daily living in their which may include the following: homes and who meet the program’s • Physician and hospital care; medical level of care. To qualify for • Pharmacy; the CPAS program, individuals must 61 CHAPTER 9

need a level of care lower than that re- counties, these centers are able to quired for living in an institution such meet the special needs of people with as a nursing home, must live in the Alzheimer’s and other cognitive and community, and meet the same finan- neurological disabilities. People of cial criteria as for the CFC program. any age who need nursing home care CPAS participants also may receive may be eligible for MADCW. Finan- other Medicaid services that are listed cial requirements are similar to the above for the CFC program. aforementioned programs.

The Home and Community-Based For more information on community Options Waiver (HCBO) program Medicaid programs, call Maryland provides community services and sup- Access Point at 1-844-627-5465 or go port to enable older adults and people to www.marylandaccesspoint.info. with physical disabilities to live in their own homes. To qualify, individuals must be 18 years or older and meet Other State and the level required to qualify for ser- Local Programs vices in an institution, such as a nursing home. Participants in the HCBO Department of Disabilities program may receive all the services provided under the CFC program The Attendant Care Program (ACP) and additional services, including as- provides financial reimbursement to sisted living, medical day care, fam- individuals aged 18 to 64 with long- ily training, case management, senior term or severe physical disabilities center plus, dietitian and nutritionist who require attendant services, such services, and behavioral consultation. as in-home assistance with personal The program has financial eligibility care, household chores, and transpor- requirements. A participant’s monthly tation. This program uses a consumer income and assets cannot exceed a direction model. Participants must specified amount, although the indi- meet one of the following criteria: vidual does not need to qualify for • Be a nursing home resident who community Medicaid. Please note that would be able to reside in the the HCBO is a popular program, and community if attendant care is there are a limited number of spots. provided; New applicants to the program may • Be at risk of nursing home place- be placed on a long waiting list. ment if not receiving attendant care services in the community; The Medical Adult Day Care Waiv- • Be employed or actively seeking er (MADCW) helps older adults and employment; or people with disabilities, and their • Be enrolled in an institution of caregivers, by providing a safe place post-secondary or higher for them during the day. In most education.

62 ALTERNATIVES TO A NURSING HOME

Local Department of Social Virtually all health maintenance or- Services ganizations (HMOs), including Medi- care Advantage companies and most In-Home Aide Services include per- Medigap insurance policies, cover sonal care, assistance with chores and some home health care services. But meal preparation, and transportation keep in mind that if you need help to pharmacies, doctors’ offices, or only with activities of daily living, like shopping centers. bathing, dressing, cooking, cleaning, and other personal care services that Local Area Agencies on Aging are not related to health care needs, most insurance policies will not cover Senior Care assists people 65 or old- these services. er who may be at risk of nursing home placement with daily living activities Consumer Tip: Home health at home, such as bathing, dressing, Housing Options agencies, light housekeeping, and preparing group homes, meals. Also provided are an evalu- Shared Living Environments assisted living ation of an individual’s needs and a facilities, case manager to help the individual If you don’t wish to live alone or can’t hospice care obtain services to meet those needs. afford to, the following options may agencies and This program uses a consumer direc- interest you. facilities, and tion model. There are certain income adult medical and asset limits. Assisted Living programs provide day care are housing and supportive services, su- licensed and Respite Care, Telephone Reassur- pervision, personalized assistance, monitored. ance, Home-Delivered Meals, and and health-related services for people Congregate Meals are usually pro- who are unable to perform activities vided by your local Area Agency on of daily living by themselves. Medic- Aging for little, if any, cost. aid does not pay for this service unless you are in the Home and Communi- Private Insurance ty-Based Options Waiver (HCBO) program (for details, see page 62). If If you have private health insurance, you are considering an assisted liv- ask the insurance agent if your policy ing facility, see if it participates in the covers home health care and for how HCBO in case you plan to be on the long. Even if a home health agency HCBO at some point. For more infor- advertises that it will accept insur- mation, please refer to the University ance, this does not mean that your of Maryland School of Law publica- insurance company will necessarily tion entitled “Assisted Living: What cover that particular agency or the You Need to Know.” You can access particular service you need. this document at rebrand.ly/Assist- edLivingMD.

63 CHAPTER 9

Consumer Tip: Group Houses provide semi-indepen- more than one kind of housing and To find out more dent, semi-private living in a house various levels of care. In the same on alternatives shared by several people who split the community, there may be individual to nursing cost of rent, utilities, and meals. homes or apartments for residents homes, contact who still live on their own, an assist- the Senior Shared Housing is offered by home- ed living facility for people who need Information owners who are willing to share their some help with daily care, and a nurs- and Assistance residence. There is no official pro- ing home for those who require more Office within gram for this option; however, many care. Residents move from one level your local Area Agency on Centers for Independent Living (CIL) to another based on their needs, but Aging or your have a list of people who want to share usually stay within the CCRC. local Center for housing to help older adults and people Independent with disabilities remain independent. If you are considering a CCRC, you Living (see should obtain information from the Chapter 10). Continuing Care Retirement Com- Maryland Department of Aging that munities (CCRCs) generally offer will help you weigh the risks and

64 ALTERNATIVES TO A NURSING HOME

benefits of entering a CCRC. More hospice care, please visit the Hos- information and a list of CCRCs in pice and Palliative Care Network of Maryland can be found at rebrand.ly/ Maryland website at www.hnmd.org. AgingCCRC.

Hospice Care

Hospice care is often the best option for people who have a terminal illness. Hospice care involves a team approach—doctors, nurses, social workers, pastoral counselors, therapists, home health aides, and volun- teers provide physical, emotional, Home health agencies, group and spiritual support to terminally ill homes, assisted living facilities, patients and their families. hospice care agencies and facilities, and adult medical day care Hospice care may be covered by facilities are licensed and moni- Medicare and Medicaid. There are tored by the Office of Health different levels of hospice care, Care Quality. which can be provided in a variety of settings, such as your own home, Office of Health Care hospice facilities, hospitals, and nurs- Quality ing homes. 7120 Samuel Morse Drive, 2nd Floor Most hospice programs require you Columbia, MD 21046 and your family to acknowledge in 410-402-8201 writing that you are dying, although 1-877-402-8219 not everyone who receives hospice www.health.maryland.gov/ohcq care passes away within the project- ed time frame. If you are expected to die within the next six months, having these services early is better for managing pain and other end-of-life impacts. Your family’s involvement may be required in order for you to receive hospice services.

For more information on hospice care, please visit www.hospicenet. org. For Maryland-specific information, including where you can receive

65 CHAPTER 10

Where To Get Help

STATEWIDE:

General Information About Senior Health and Medicare Rights Center www.medicarerights.org Support Services Centers for Medicare and Medicaid Services Maryland Access Point 7500 Security Blvd. www.marylandaccesspoint.info Baltimore, MD 21244 1-844-627-5465 (Toll-free) 410-786-3000 TTY: 7-1-1 1-877-267-2323 (Toll-free) TTY: 1-866-226-1819 (Toll-free) Questions About Nursing Homes www.cms.gov/Medicare/Medicare.html

Maryland Department of Health Complaints and Consumer Assistance Office of Health Care Quality 7120 Samuel Morse Dr., 2nd Floor Office of the Attorney General Columbia, MD 21046 Consumer Protection Division 410-402-8201 Health Education and Advocacy Unit 1-877-402-8219 (Toll-free) 200 Saint Paul Pl., 16th Floor www.health.maryland.gov/ohcq Baltimore, MD 21202 410-528-1840 Questions About Eligibility for Medical 1-877-261-8807 (Toll-free) Assistance (Medicaid) TTY: 1-800-735-2258 (from anywhere) or 7-1-1 (in Maryland) Maryland Department of Health www.marylandcares.org Office of Eligibility Services 201 West Preston St. Complaints About Suspected Neglect or Abuse Baltimore, MD 21201 of Nursing Home Residents 410-767-1463 1-877-463-3464 (Toll-free) (select language op- Police: 9-1-1 tion, then option 1, and then option 5) www.mmcp.health.maryland.gov/Pages/Apply Maryland Department of Health for Medicaid.aspx Office of Health Care Quality 7120 Samuel Morse Dr., 2nd Floor Questions About Medicare Columbia, MD 21046 410-402-8201 Medicare Service Center 1-877-402-8219 (Toll-free) 1-800-633-4227 (Toll-free) www.health.maryland.gov/ohcq TTY: 1-877-486-2048 www.medicare.gov

Addresses, telephone numbers, and web links were all accurate 66 as of July 2019, but could change over time. WHERE TO GET HELP

Maryland Department of Human Services Free assistance on writing wills, powers Adult Protective Services of attorney, and health care directives for 1-800-91-PREVENT (1-800-917-7383) financially eligible individuals Office of the Attorney General Medicaid Fraud Control Unit Maryland Volunteer Lawyers Services 410-576-6521 Client Intake 1-888-743-0023 (Toll-free) Monday through Thursday: 9 am to 12 pm www.marylandattorneygeneral.gov/Pages/ 201 North Charles St., Suite 1400 MFCU/default.aspx Baltimore, MD 21201 410-547-6537 Maryland Department of Aging 1-800-510-0050 (Toll-free) State Long-Term Care Ombudsman Program www.mvlslaw.org 301 West Preston St. Baltimore, MD 21201 Low-cost wills, powers of attorney, etc. for 410-767-1100 senior citizens 1-800-243-3425, ext. 71108 (Toll-free) www.aging.maryland.gov/Pages/Ombudsman. 60+ 2.0 Legal Program aspx Civil Justice, Inc. 520 W. Fayette St., Suite 410 Legal Services Programs Baltimore, MD 21201 410-706-0174 Legal advice and representation concerning www.civiljusticenetwork.org nursing home problems [email protected]

Maryland Legal Aid REGIONAL CENTERS FOR Long-Term Care Assistance Project and Maryland INDEPENDENT LIVING Senior Legal Helpline 410-951-7750 Eastern Shore: Caroline, Cecil, Dorchester, 1-866-635-2948 (Toll-free) Kent, Queen Anne’s, Somerset, Talbot, www.mdlab.org Wicomico, and Worcester Counties

Legal advice, advocacy, and services for Bay Area Center for Independent Living, Inc. persons with disabilities 909 Progress Cir., Suite 300 Salisbury, MD 21804 Disability Rights Maryland 443-260-0822 1500 Union Ave., Suite 2000 1-877-511-0744 (Toll-free) Baltimore, MD 21211 www.bayareacil.org 410-727-6352, ext. 0 1-800-233-7201 (Toll-free) Central Maryland: Carroll and Frederick TT Y: 410 -235-5387 Counties www.disabilityrightsmd.org The Freedom Center, Inc. 550 Highland St., Suite 510 67 CHAPTER 10

Frederick, MD 21701 Western Maryland: Allegany, Garrett, and 301-846-7811 Washington Counties 1-844-513-3027 (Toll-free) [email protected] Resources for Independence, Inc. www.thefreedomcenter-md.org 735 East Oldtown Rd. Cumberland, MD 21502 D.C. Metro: Montgomery and Prince George’s 301-784-1774 Counties 1-800-371-1986 (Toll-free) www.rficil.org Independence Now, Inc. 12301 Old Columbia Pike, Suite 101 Southern Maryland: Calvert, Charles, and St. Silver Spring, MD 20904 Mary’s Counties 301-277-2839 TTY: 1-800-735-2258 (from anywhere) or 7-1-1 Southern Maryland Center for Independent (in Maryland) Living, Inc. [email protected] 38588 Brett Way, Suite 1 www.innow.org Mechanicsville, Maryland 20659 301-884-4498 Baltimore Metro: Baltimore City and [email protected] Baltimore and Harford Counties www.smcil.org

Independent Marylanders Achieving Growth Through Empowerment OTHER SERVICES BY COUNTY* (The Image Center) *Area Agencies on Aging are local agencies that 300 Joppa Rd., Suite 302 assist and support older adults, family caregivers, Towson, MD 21286 and adults with disabilities. Long-Term Care Om- 410-982-6311 budsmen are advocates for residents of nursing [email protected] homes, board and care homes, and assisted living www.imagemd.org facilities.

Annapolis Metro: Anne Arundel and Howard ALLEGANY COUNTY Counties Area Agency on Aging Accessible Resources for Independence Allegany County Human Resources Development 1406B Crain Hwy. South, Suite 206 Commission Glen Burnie, MD 21061 125 Virginia Ave. 410-636-2274 Cumberland, MD 21502 TTY: 1-800-735-2258 (from anywhere) or 7-1-1 301-777-5970 (in Maryland) www.alleganyhrdc.org [email protected] www.arinow.org Long-Term Care Ombudsman Program 301-783-1771 www.alleganyhrdc.org/ombudsman-program

Addresses, telephone numbers, and web links were all accurate 68 as of July 2019, but could change over time. WHERE TO GET HELP

Department of Social Services [email protected] www.dhs.maryland.gov/local-offices/anne-arun- 1 Frederick St. del-county Cumberland, MD 21502 301-784-7000 Legal Services Programs www.dhs.maryland.gov/local-offices/allegany- county Maryland Legal Aid 229 Hanover St. Legal Services Programs Annapolis, MD 21404 410-972-2700 Maryland Legal Aid 1-800-666-8330 (Toll-free) Western Maryland Office www.mdlab.org 110 Greene St. Cumberland, MD 21502 Lawyer Referral and Information Service 301-777-7474 (referrals for fee and no-fee services) 1-866-389-5243 (Toll-free) Anne Arundel Bar Association www.mdlab.org P.O. Box 161 Annapolis, MD 21404 Allegany Law Foundation, Inc. 410-222-6859 110 Greene St. www.aabar.org/lris Cumberland MD 21502 301-722-3390 BALTIMORE CITY www.alleganylaw.com Area Agency on Aging ANNE ARUNDEL COUNTY Office of Aging and CARE Services Baltimore City Health Department Area Agency on Aging 417 E Fayette St., 6th Floor Department of Aging and Disabilities Baltimore, MD 21202 2666 Riva Rd., Suite 400 410-396-2273 Annapolis, MD 21401 www.health.baltimorecity.gov/programs/seniors 410-222-4257 TTY: 1-800-735-2258 (from anywhere) or 7-1-1 Long-Term Care Ombudsman Program (in Maryland) 410-396-3144 www.aacounty.org/departments/aging-and-dis- www.health.baltimorecity.gov/seniors/long-term- abilities care-ombudsman Long-Term Care Ombudsman Program Department of Social Services 410-222-4464 www.aacounty.org/services-and-programs/om- Talmadge Branch Building budsman 1910 N. Broadway St. Baltimore, MD 21213 Department of Social Services 443-378-4600 www.dhs.maryland.gov/local-offices/baltimore- 80 West St. city Annapolis, MD 21401 410-269-4500 69 CHAPTER 10

Legal Services Programs Legal Services Programs

Maryland Legal Aid Maryland Legal Aid 500 E. Lexington St. 29 W. Susquehanna Ave., Suite 305 Baltimore, MD 21202 410-427-1800 410-951-7777 1-877-878-5920 (Toll-free) 1-800-999-8904 (Toll-free) www.mdlab.org www.mdlab.org CALVERT COUNTY Bar Association of Baltimore City Senior Legal Services Program Area Agency on Aging 111 N Calvert St., Room 631 Office on Aging Baltimore, MD 21202 450 West Dares Beach Rd. 410-396-1322 Prince Frederick, MD 20678 www.baltimoreseniorlegalservices.org 410-535-4606 301-855-1170 BALTIMORE COUNTY [email protected] www.co.cal.md.us/residents/health/aging Area Agency on Aging Department of Aging Long-Term Care Ombudsman Program 611 Central Ave. 410-535-4606 Towson, MD 21204 301-855-1170 410-887-2594 http://www.co.cal.md.us/index.aspx?NID=1981 www.baltimorecountymd.gov/Agencies/aging Department of Social Services Long-Term Care Ombudsman Program 200 Duke St. 410-887-4200 Prince Frederick, MD 20678 www.baltimorecountymd.gov/Agencies/aging/ 443-550-6900 ombudsman [email protected] www.dhs.maryland.gov/local-offices/calvert- Department of Social Services county 6401 York Rd. Baltimore, MD 21212 Legal Services Programs 410-853-3000 To report abuse/neglect: 410-887-TIME (8463) or Maryland Legal Aid 410-583-9398 Southern Maryland Office www.dhs.maryland.gov/local-offices/baltimore- 15045 Burnt Store Rd. county Hughesville, MD 20637 301-932-6661 1-877-310-1810 (Toll-free) www.mdlab.org

Addresses, telephone numbers, and web links were all accurate 70 as of July 2019, but could change over time. WHERE TO GET HELP

CAROLINE COUNTY Long-Term Care Ombudsman Program 410-386-3800 Area Agency on Aging and Long-Term Care TTY: 1-800-735-2258 (from anywhere) or 7-1-1 Ombudsman Program (in Maryland) Upper Shore Aging, Inc. www.ccgovernment.carr.org/ccg/aging/ltcop.asp 100 Schauber Rd. Chestertown, MD 21620 Department of Social Services 410-778-6000 1232 Tech Ct. 1-800-721-6651 (Toll-free) Westminster, MD 21157 www.uppershoreaging.org 410-386-3300 [email protected] Department of Social Services www.dhs.maryland.gov/local-offices/carroll- 207 South Third St. county Denton, MD 21629 410-819-4500 Legal Services Programs [email protected] www.dhs.maryland.gov/local-offices/caroline- Maryland Legal Aid county Midwestern Maryland Office 22 South Market St., Suite 11 Legal Services Program Frederick, MD 21701 301-694-7414 Maryland Legal Aid 1-800-679-8813 (Toll-free) Upper Eastern Shore Office www.mdlab.org 106 N. Washington St., Suite 101 Easton, MD 21601 CECIL COUNTY 410-763-9676 1-800-477-2543 (Toll-free) Area Agency on Aging www.mdlab.org Aging and Disability Services Division 200 Chesapeake Blvd. CARROLL COUNTY Suite 2550 Elkton, MD 21921 Area Agency on Aging 410-996-5295 Bureau of Aging and Disabilities www.ccgov.org/government/community-services/ aging-and-disability-services 125 Stoner Ave. Westminster, MD 21157 Long-Term Care Ombudsman Program 410-386-3800 410-996-5295 TTY: 1-800-735-2258 (from anywhere) or 7-1-1

(in Maryland) Department of Social Services [email protected] www.ccgovernment.carr.org/ccg/aging 170 East Main St. Elkton, MD 21921 410-996-0100 www.dhs.maryland.gov/local-offices/cecil-county

71 CHAPTER 10

Legal Services Program DORCHESTER COUNTY

Maryland Legal Aid Area Agency on Aging Northeastern Maryland Office Maintaining Active Citizens, Inc. 103 S. Hickory Ave. 909 Progress Cir., Suite 100 Bel Air, MD 21014 Salisbury, MD 21804 410-836-8202 410-742-0505 1-800-444-9529 (Toll-free) www.macinc.org www.mdlab.org Long-Term Care Ombudsman Program CHARLES COUNTY 410-742-0505, ext.104 [email protected] Area Agency on Aging www.macinc.org/resources-support/elder-abuse- Department of Community Services information Aging and Senior Programs Division 8190 Port Tobacco Rd. Department of Social Services Port Tobacco, MD 20677 627 Race St. 301-934-9305 Cambridge, MD 21613 301-870-3388 410-901-4100 www.charlescountymd.gov/cs/aging/aging-and- www.dhs.maryland.gov/local-offices/dorchester- senior-programs county

Long-Term Care Ombudsman Program Legal Services Program 301-934-0109 www.charlescountymd.gov/cs/aging/resident- Maryland Legal Aid advocacy Lower Eastern Shore Office 111 High St. Department of Social Services Salisbury, MD 21801 200 Kent Ave. 410-546-5511 LaPlata, MD 20646 1-800-444-4099 (Toll-free) 301-392-6400 www.mdlab.org [email protected] www.dhs.maryland.gov/local-offices/charles- county FREDERICK COUNTY

Legal Services Programs Area Agency on Aging Senior Services Division Maryland Legal Aid 1440 Taney Ave. Southern Maryland Office Frederick, MD 21702 15045 Burnt Store Rd. 301-600-1605 Hughesville, MD 20637 [email protected] www.frederickcountymd.gov/54/Senior-Services- 301-932-6661 Formerly-Dept-of-Aging 1-877-310-1810 (Toll-free) www.mdlab.org

Addresses, telephone numbers, and web links were all accurate 72 as of July 2019, but could change over time. WHERE TO GET HELP

Long-Term Care Ombudsman Program Legal Services Programs 301-600-2877 www.frederickcountymd.gov/311/Long-Term- Maryland Legal Aid Care-Ombudsman Western Maryland Office 110 Greene St. Department of Social Services Cumberland, MD 21502 1888 North Market St. 301-777-7474 Frederick, MD 21701 1-866-389-5243 (Toll-free) 301-600-4555 www.mdlab.org [email protected]. www.dhs.maryland.gov/local-offices/frederick- county HARFORD COUNTY

Legal Services Programs Area Agency on Aging Department of Community Services Maryland Legal Aid Office on Aging Midwestern Maryland Office 145 N. Hickory Ave. 22 South Market St., Suite 11 Bel Air, MD 21014 Frederick, MD 21701 410-638-3025 301-694-7414 [email protected] 1-800-679-8813 (Toll-free) www.harfordcountymd.gov/651/Office-on-Aging www.mdlab.org Long-Term Care Ombudsman Program GARRETT COUNTY 410-638-3025 www.harfordcountymd.gov/Document- Center/View/6485/Longterm-Ombudsman- Area Agency on Aging Brochure?bidId= Community Action Committee 104 East Center St. Department of Social Services Oakland, MD 21550 2 South Bond St., Suite 300 301-334-9431 www.garrettcac.org/index.php/aging-and-nutri- Bel Air, MD 21014 tion-services 410-836-4700 www.dhs.maryland.gov/local-offices/harford- Long-Term Care Ombudsman Program county 301-334-9431, ext. 6140 www.garrettcac.org/index.php/aging-and-nutri- Legal Services Programs tion-services/long-term-care-services/ombudsman Maryland Legal Aid Department of Social Services Northeastern Maryland Office 12578 Garrett Hwy. 103 South Hickory Ave. Oakland, MD 21550 Bel Air, MD 21014 301-533-3000 410-836-8202 TT Y: 301-334 -5426 1-800-444-9529 (Toll-free) www.dhs.maryland.gov/local-offices/garrett- www.mdlab.org county 73 CHAPTER 10

HOWARD COUNTY 410-778-6000 1-800-721-6651 (Toll-free) Area Agency on Aging www.uppershoreaging.org Office on Aging and Independence 9830 Patuxent Woods Dr. Department of Social Services Columbia, MD 21046 350 High St. 410-313-6410 PO Box 670 [email protected] Chestertown, MD 21620 www.howardcountymd.gov/Departments/Com- 410-810-7600 munity-Resources-and-Services/Office-on-Aging- [email protected] and-Independence www.dhs.maryland.gov/local-offices/kent-county Long-Term Care Ombudsman Program Legal Services Program 410-313-6423 Maryland Legal Aid Department of Social Services Upper Eastern Shore Office 9780 Patuxent Woods Dr. 106 N. Washington St., Suite 101 Columbia, MD 21046 Easton, MD 21601 410-872-8700 410-763-9676 [email protected] www.dhs.maryland.gov/local-offices/howard- 1-800-477-2543 (Toll-free) county www.mdlab.org

Legal Services Programs MONTGOMERY COUNTY

Maryland Legal Aid Area Agency on Aging District Court Department of Health and Human Services 3451 Court House Dr. Senior Services Ellicott City, MD 21043 401 Hungerford Dr., 4th Floor 410-480-1057 Rockville, MD 20850 www.mdlab.org 240-777-3000 www.montgomerycountymd.gov/HHS-Program/ Program.aspx?id=ADS/ADSADSResourceUnit- Lawyer Referral Service p179.html Howard County Bar Association 410-313-3853 Long-Term Care Ombudsman Program www.howardcountybar.org 3950 Ferrara Dr., 2nd Floor Silver Spring, MD 20906 KENT COUNTY 240-777-3369 HHSLTCOmbudsman@montgomerycountymd. Area Agency on Aging and Long-Term Care gov Ombudsman Program www.montgomerycountymd.gov/HHS-Program/ Upper Shore Aging, Inc. ADS/OMBUDSMAN/OmbudIndex.html 100 Schauber Rd. Chestertown, MD 21620 Addresses, telephone numbers, and web links were all accurate 74 as of July 2019, but could change over time. WHERE TO GET HELP

Department of Social Services Department of Social Services 401 Hungerford Dr., 5th Floor 805 Brightseat Rd. Rockville, MD 20850 Landover, MD 20785 240-777-4513 301-909-7000 TTY: 240-777-1245 1-800-332-6347 (Toll-free) www.dhs.maryland.gov/local-offices/montgom- [email protected] ery-county www.dhs.maryland.gov/local-offices/prince- georges-county Legal Services Programs Legal Services Programs Maryland Legal Aid Montgomery County Office Maryland Legal Aid 600 Jefferson Plaza, Suite 430 Metropolitan Maryland Office Rockville, MD 20850 8401 Corporate Dr., Suite 200 240-314-0373 Landover, MD 20785 1-855-880-9487 (Toll-free) 301-560-2101 www.mdlab.org 1-888-215-5316 (Toll-free) www.mdlab.org TESS Community Service Center Legal Aid Clinic Community Legal Services of Prince George’s 8513 Piney Branch Rd. County Silver Spring, MD 20901 P.O. Box 374 240-773-8260 Riverdale, MD 20737 TTY: 1-800-735-2258 (from anywhere) or 7-1-1 240-391-6370 (in Maryland) TTY: 1-800-735-2258 (from anywhere) or 7-1-1 www.montgomerycountymd.gov/HHS-Program/ (in Maryland) OCA/OCATESS-p351.html [email protected] www.clspgc.org PRINCE GEORGE’S COUNTY QUEEN ANNE’S COUNTY Area Agency on Aging Department of Family Services Area Agency on Aging Aging and Disabilities Services Division Department of Community Services 6420 Allentown Rd. Area Agency on Aging Camp Springs, MD 20748 104 Powell St. 301-265-8450 www.princegeorgescountymd.gov/1644/Older- Centreville, MD 21617 Adult-Services 410-758-0848 410-778-9399 Long-Term Care Ombudsman Program www.qac.org/155/Area-Agency-on-Aging-Se- nior-Centers 301-265-8450 www.princegeorgescountymd.gov/1722/Long- Term-Care

75 CHAPTER 10

Long-Term Care Ombudsman Program Department of Social Services 410-758-0848 Joseph D. Carter Building 410-778-9399 23110 Leonard Hall Dr. www.qac.org/171/Long-Term-Care-Ombudsman Leonardtown, MD 20650 240-895-7000 Department of Social Services www.dhs.maryland.gov/local-offices/st-marys- 125 Comet Dr. county Centreville, MD 21617 410-758-8000 Legal Services Programs TT Y: 410 -758-5164 [email protected] Maryland Legal Aid www.dhs.maryland.gov/local-offices/queen- Southern Maryland Office annes-county 15045 Burnt Store Rd. Hughesville, MD 20637 Legal Services Programs 301-932-6661 1-877-310-1810 (Toll-free) Maryland Legal Aid www.mdlab.org Upper Eastern Shore Office 106 N. Washington St., Suite 101 SOMERSET COUNTY Easton, MD 21601 410-763-9676 Area Agency on Aging 1-800-477-2543 (Toll-free) Maintaining Active Citizens, Inc. www.mdlab.org 909 Progress Cir., Suite 100 Salisbury, MD 21804 ST. MARY’S COUNTY 410-742-0505 www.macinc.org Area Agency on Aging Aging and Human Services Long-Term Care Ombudsman Program Garvey Senior Activity Center 410-742-0505, ext.104 41780 Baldridge St. [email protected] www.macinc.org/resources-support/elder-abuse- P.O. Box 653 information Leonardtown, MD 20650 301-475-4200, Ext. 71050 www.stmarysmd.com/aging Department of Social Services 30397 Mt. Vernon Rd. Long-Term Care Ombudsman Program Princess Anne, MD 21853 301-475-4200, Ext. 71055 410-677-4200 www.stmarysmd.com/aging/senior-advocacy.asp [email protected] www.stmarysmd.com/docs/OmbudsmanBro- www.dhs.maryland.gov/local-offices/somerset- churerev102313.pdf county

Addresses, telephone numbers, and web links were all accurate 76 as of July 2019, but could change over time. WHERE TO GET HELP

Legal Services Programs WASHINGTON COUNTY

Maryland Legal Aid Area Agency on Aging Lower Eastern Shore Office Commission on Aging, Inc. 111 High St. 535 East Franklin St. Salisbury, MD 21801 Hagerstown, MD 21740 410-546-5511 301-790-0275 1-800-444-4099 (Toll-free) TTY: 1-800-735-2258 (from anywhere) or 7-1-1 www.mdlab.org (in Maryland) [email protected] TALBOT COUNTY www.wccoaging.org

Area Agency on Aging and Long-Term Care Long-Term Care Ombudsman Program Ombudsman Program 301-790-0275 Upper Shore Aging, Inc. TTY: 1-800-735-2258 (from anywhere) or 7-1-1 100 Schauber Rd. (in Maryland) Chestertown, MD 21620 www.wccoaging.org/programs-services/ombuds- 410-778-6000 man-legal 1-800-721-6651 (Toll-free) www.uppershoreaging.org Department of Social Services 122 North Potomac St. Department of Social Services Hagerstown, MD 21740 301 Bay St. 240-420-2100 Easton, MD 21601 www.dhs.maryland.gov/local-offices/washington- 410-770-4848 county [email protected] www.dhs.maryland.gov/local-offices/talbot- Legal Services Programs county Maryland Legal Aid Legal Services Programs Midwestern Maryland Office 22 South Market St., Suite 11 Maryland Legal Aid Frederick, MD 21701 Upper Eastern Shore Office 301-694-7414 106 N. Washington St., Suite 101 1-800-679-8813 (Toll-free) Easton, MD 21601 www.mdlab.org 410-763-9676 1-800-477-2543 (Toll-free) www.mdlab.org

77 CHAPTER 10

WICOMICO COUNTY WORCESTER COUNTY

Area Agency on Aging Area Agency on Aging Maintaining Active Citizens, Inc. Maintaining Active Citizens, Inc. 909 Progress Cir., Suite 100 909 Progress Cir., Suite 100 Salisbury, MD 21804 Salisbury, MD 21804 410-742-0505 410-742-0505 www.macinc.org www.macinc.org

Long-Term Care Ombudsman Program Long-Term Care Ombudsman Program 410-742-0505, ext.104 410-742-0505, ext.104 [email protected] [email protected] www.macinc.org/resources-support/elder- www.macinc.org/resources-support/elder-abuse- abuse-information information

Department of Social Services Department of Social Services 201 Baptist St., Suite 27 299 Commerce St. Salisbury, MD 21801 Snow Hill, MD 21863 410-713-3900 410-677-6800 [email protected] www.dhs.maryland.gov/local-offices/worcester- www.dhs.maryland.gov/local-offices/wic- county omico-county Legal Services Programs Legal Services Programs Maryland Legal Aid Maryland Legal Aid Lower Eastern Shore Office Lower Eastern Shore Office 111 High St. 111 High St. Salisbury MD 21801 Salisbury, MD 21801 410-546-5511 410-546-5511 1-800-444-4099 (Toll-free) 1-800-444-4099 (Toll-free) www.mdlab.org www.mdlab.org

Addresses, telephone numbers, and web links were all accurate 78 as of July 2019, but could change over time. Acknowledgements

Revision Committee Comments, Input, and Technical Support Paul Ballard Office of the Attorney General Kelly Bagby Department of Health AARP Foundation Litigation Meredith Borden Office of the Attorney General Alice Hedt Department of Health Maryland Long Term Care Ombudsman Kim Cammarata Office of the Attorney General Ellen Kuhn Health Education and Advocacy Unit Former Director, Strider Dickson Health Education and Advocacy Unit Office of the Attorney General Office of the Attorney General Medicaid Fraud Control Unit Van Dorsey Karren Pope-Onwukwe Office of the Attorney General Elder Law Section Maryland Insurance Administration Maryland State Bar Association Yvette Finney Office of the Attorney General Debbie Sokolow Medicaid Fraud Control Unit Former Maryland Gina Fiss Long Term Care Ombudsman Office of the Attorney General Maryland Insurance Administration Health Facilities Gayle Hafner Association of Maryland Maryland Disability Law Center Anne Haffner Hurley LifeSpan Network Long Term Care Assistance Project Legal Aid Maryland David S. Lapp Office of the Attorney General Department of Health Jeffrey Myers Office of the Attorney General Department of Aging In Memoriam of Claire Pierson Harbour Partesotti Office of the Attorney General Who worked passionately and tirelessly to Department of Health Howard Sollins protect the rights of nursing home residents. Ober│Kaler