Assisted Living & Nursing Home Admission Requirements

As we grow older, our ability to care for ourselves begins to decline. Many seniors are able to adjust while still living at home while others may need to change their living arrangements. Many elderly people will get a home care aide from a home care agency near them or choose to live with their family members. Sometimes, seniors may not have family that lives nearby or they may prefer to live on their own terms in an assisted living community. Seniors who have more intensive care needs may not have the option of staying in an assisted living community and will need to seek a suitable nursing home instead.

Seniors who need extra support in the form of assisted living or skilled nursing care have a wide range of options to choose from. The most common senior housing options for long term care are nursing homes and assisted living facilities. Seniors who suffer from memory conditions or those with special needs such as seniors with hearing impairment also can find supportive housing options. While it may seem like transitioning is as easy as picking a location and moving in, there is much more involved in the admissions process.

We have put together a simple guide that is full of information that will help you navigate the admission process to assisted living facilities and nursing homes. Once you understand what to expect, you can manage any problems you may run into along the way.

Who is Eligible for Assisted Living?

There are many requirements a potential resident must meet in order to be accepted into an assisted living facility. There is no end age limit for assisted living, however, to be able to enroll, the resident must be at least 18 years of age. The remaining criteria revolve around the level of care needed, medical conditions that must be considered, and the ability to pay for cost of care of a spot in the chosen facility. We will cover those in more detail later in our blog post. Some specific potential residents are not suitable for enrollment in assisted living communities.

Potential residents who have moderate to severe cognitive impairments are not best served in an assisted living facility. Those who are prone to unusual behaviors, wandering and constant forgetfulness may also benefit from a more monitored environment that is not offered in assisted living. Seniors who have a wide range of medical conditions that may require constant skilled nursing care are not suited to living in an assisted living setting. Wheelchair-bound residents are often discouraged from enrolling in assisted living care. However, unless the resident is bedridden, there is no reason a senior who uses a wheelchair would not be suitable. We have more detailed information regarding wheelchair-bound seniors and assisted living in another guide.

Who is Eligible for Nursing Home Care?

Nursing homes fall under federal and state regulation in addition to being eligible for government-funded coverage. This is one reason it is important that all admission rules are followed and that eligibility criteria are met. There is no exact definition for what is considered required for nursing home level of care since there had not been a federal guideline put forth to follow. Every state will set its own guidelines that differ depending on location.

There are four basic areas which most states cover when determining who is suitable for nursing home care. It is important to check the list in your particular state as our guide is merely a common generalization and not comprehensive or exact for each state.

1. Medical Needs & Health Issues – The medical needs of the seniors such as catheter care, intravenous injections, medication maintenance, and other health-related issues are evaluated. Those with minor needs may not be considered for nursing home care.
2. Physical Functional Ability – The level of ADL’s (activities of daily living) a senior is able or unable to perform are evaluated during admission. In order to enroll in assisted living, a person must be able to perform most of their own daily tasks, however nursing homes do not have such strict requirements. Nursing homes offer skilled caregivers who are able to provide more assistance than what is offered in other long-term care facilities.
3. Behavioral Problems – Nursing homes will evaluate behaviors and other issues in seniors during the admission process. Most often, these are associated with seniors who suffer from memory conditions. Seniors that exhibit behaviors such as wandering, aggression, and impulsiveness that are tied to memory conditions may be considered for nursing homes with memory care units.
4. Cognitive Impairment – A senior’s mental function will be evaluated when being considered for nursing home care. This assessment is especially important for seniors who suffer from Parkinson’s disease, Alzheimer’s disease, Lewy body dementia or other memory conditions.

Depending on the state, some nursing homes may require a diagnosis from a licensed medical professional for their specific ailment. These must state that the senior requires enrollment in a nursing home in order to be admitted. 

Common Paperwork & Tests Required During Admission

Seniors may choose to enter into an assisted living facility directly from their own private home or from the home of a loved one. Some seniors are referred to an assisted living facility when they are discharged from a hospital, rehabilitation center, or move to assisted living from a short-term nursing care facility. No matter how a senior arrives at an assisted living community, the admission process remains the same for everyone. Though some requirements may vary slightly at each location and in each state, we will list some of the most common requirements.

Assisted Living Requirements

Assisted living communities are intended for seniors or individuals that only require a moderate level of assistance daily. Each resident will need to provide a recent chest X-ray or the recent results of a tuberculosis test. Only seniors or other residents who test negative will be considered for enrollment. Physical and medical histories of the resident will need to be provided during the application process.

Nursing Home Requirements

Nursing homes and skilled nursing care facilities will need a doctor's order for admission if the senior is being transferred from a hospital. Usually, the discharge papers will contain this information, or the senior's regular doctor can write an order on their behalf. In addition to the referral, a doctor will need to write an order for treatment and medications for the nursing home staff to follow. Just like in an assisted living home, a nursing home will need to review the medical history to determine facility suitability. A negative TB test or chest film is also required. Every state has its own certification form which will carry a different name depending on your location. This state-required form certifies that the senior meets the criteria laid out by the state for enrolling in a nursing home.

Nursing Home Admission Rules You Should Know

Long-term care facilities that have Medicare certification and follow state Medicaid regulations have a specific set of rules that must be followed. This usually applies to nursing homes, skilled nursing locations, and hospice care, however they can apply to assisted living communities in some cases. Most nursing homes will add these requirements to their admission agreement for resident review prior to enrollment.

There are new regulations that nursing home residents should be aware of prior to starting the admission process. One of those covers the way disputes between facilities and residents are resolved. In the past, rules allowed nursing homes to keep many of their disputes out of court and out of the public eye. New rules limit this ability. Nursing homes can no longer require residents to agree to private arbitration as a part of the admission process.

Payment policies vary from location to location however, all nursing homes are barred from discharge over Medicaid payment issues. In the past, many nursing homes discharged seniors who used Medicaid to pay for their stay, but those payments were late or deferred by the government. Some nursing homes may require families to sign a waiver to cover missed or late Medicaid payments, but this is against the law.

Nursing homes will all have different visiting hours depending on their own policies. However, family members have the right to visit their loved ones at any time of the day or night. This is not often laid out clearly during the admission process, but it is the law. Facilities do have the right to limit non-relative visiting hours, however.

Patient Advocates are needed for each resident. Every resident in a nursing home has a very long list of rights they are entitled to, however, just the existence of those rights is not always enough. A resident in a nursing home needs a patient advocate that is able to enforce their rights and ensure they receive the care they are entitled to. The advocate must have their status authorized in writing through a healthcare power of attorney or by designation.

Assisted Living Admission Rules You Should Know

Eldercare such as nursing homes, memory care facilities, and assisted living communities are full of regulations, guidelines, and rules that must be followed. While many of these rules are in place to keep seniors safe, there are some that are confusing even for veteran caregivers to understand. Different levels of senior care have different laws that apply, which can make qualifying for an assisted living spot seem impossible. Here are a few little-known admissions and residency rules that you should keep in mind.

Medication mandates can differ from state to state. Assisted living facilities in some states will discharge a resident who refuses to take any medications that are prescribed for their care. Not all locations fall under this legal mandate, but it is important to check the rules of your state during your enrollment process.

The care plan command is required in several states. This not well-known requirement dictates that staff in assisted living facilities perform a needs assessment of each resident. This comprehensive assessment is performed during enrollment and is re-done annually.

The Band-Aid application ban prevents the majority of assisted living homes from offering all but the basic health care for residents. That means, depending on which state you live in, caregivers would not even be able to offer simple first aid to their residents. This is in place to ensure medical care is not offered by untrained caregivers. You should keep this in mind when choosing a facility if you or your loved one has any form of a medical condition.

Continuous medical care cut off points are another important rule to review during the assisted living admission process. Assisted living communities are intended for those who need moderate care. However, there is a certain point at which a senior may no longer be eligible for assisted living and will need to transition to a nursing home.

Our Thoughts on The Admission Process

Seniors who move into assisted living do so with the intention of aging in place. As is normal when a person grows older, health will eventually decline. It is important to choose an assisted living community that offers a balance of protecting the safety and health of a resident while also allowing them to live as independently as possible.

There are many facilities that are a combination of assisted living facility and a nursing home, and even independent living, as well as stand-alone nursing home communities. Nursing homes prioritize medical care over the desire to live autonomously and are better suited to seniors who have complex health issues.

Both types of senior long-term care homes have their own admission guidelines and eligibility criteria that are based on a resident's level of care needs. Assisted living is best for seniors who need basic assistance with medication management, personal care, and other basic activities. Nursing homes are best for seniors who are no longer able to care for themselves and also require skilled nursing care on a daily basis. Choosing the facility that best fits the needs of the senior will ensure that the admission process goes smoothly and that there is a lower chance of application rejection.