Publication : Brochures
Alternatives to Nursing Home
This information has been prepared
by the Elder Law Section and the Public Awareness Committee of the Maryland
State Bar Association. It is intended to inform the public and not serve
as legal advice.
While nursing homes may be necessary for certain individuals
because of their medical needs, Maryland seniors can choose from a variety
of supported living arrangements. This information has been prepared in an
effort to discuss the options and agencies that can help make the choice
Remaining at Home
Most seniors prefer to remain in their own home for as
long as possible. A person who is ill or disabled and needs assistance may
consider bringing help to his or her own home. These services can range from
housekeeping, to meals delivered to the house or advanced medical care.
- The Department of Health and Mental Hygiene maintains
a director of licensed entities, e.g., home health, residential service
agencies and hospice programs that are available for certain health-related
services. Contact (410) 764-4980.
- Medicaid – (Maryland Medical Assistance) covers
some home health care and personal care for qualified people with low incomes.
- Medicare – (administered by Social Security) and
some private insurance plans cover skilled nursing care in the home, if
ordered by a doctor and the recipient meets certain requirements. Personal
care such as assistance with bathing, feeding or dressing is only covered
if skilled nursing care is necessary.
An Assisted Living Program can be an alternative to nursing
home placement for many individuals. These programs are licensed by the Maryland
Department of Health and Mental Hygiene and monitored in conjunction with
the Office of Aging and the Department of Human Resources. These programs
provide housing and a combination of supportive services. Programs vary in
size from small residential to larger facilities.
Depending on the level of care provided by a program, the
degree of service may vary. Services may include: 1) monitoring residents’ general
health; 2) providing supervision and assistance with daily living activities;
3) coordinating access to medication and/or treatment; 4) monitoring and
managing residents’ behavioral needs, including psychological needs;
5) offering residents social and recreational activities.
Although there is currently very little public funding
for assisted living, individuals who receive Supplemental Security Income
(SSI) or Medical Assistance and meet certain eligibility guidelines may be
eligible to receive additional funds to hope pay or defray the costs of the
program. In addition, private insurance, e.g., long-term care insurance may
cover some costs.
For more information, contact the Department of Health
and Mental Hygiene at (410) 764-2770 or your local agency on Aging or Department
of Human Resources.
Continuing Care Communities
These communities typically promise a lifetime residence
plus a range of services. Some provide facilities, while others are affiliated
with nearby nursing homes. Seniors live in garden apartments, high-rises
or private cottages, but move into other units, as health care needs change.
Many continuing care communities began as church affiliated "life
care" homes, where residents turned over all their assets in return
for a promise of a home and medical care for the rest of their lives. Today,
seniors have more options. For-profit companies run some communities and
there are many different payment options. Some communities require a large
down payment with monthly charges from that day forward; others may be more
like rentals, even cooperative or condominiums, with additional services
paid by the resident as services are needed.
Continuing care communities must meet certain requirements
of the State of Maryland, but not all programs are the same. It is important
to read the contract carefully, understand the costs involved, whether the
entry fee is refundable, what health care is provided, whether a community
has an extensive care or fee for service contract, what role the residents
have in the management of the community and how residency and health care
decisions are made.
The continuing care community should encourage talking
with the residents about their opinion of the facility as well as providing
a guided tour.
For information, contact the Maryland State Office on Aging
at (410) 767-1100 or (800) 338-0153.
Government Subsidized Housing
There are many federally funded assisted rental housing
programs around Maryland for seniors with low or moderate incomes. Non-profit
groups or the local housing authority may run them. Some facilities offer
services for those who cannot manage all daily living activities. In congregate
housing, meals may be served in a main dining room. Some of the programs
employ a coordinator who assists in obtaining community services.
For more information contact your local Housing Authority
or local agency on aging.
Adult Evaluation and Review Services – Geriatric
A local health department can send a team to your home
at no cost to help you decide which type of services would meet your needs.
The teams have input from doctors, nurses and social workers. For more information,
contact your local health department.
Making a Choice
Remember you have a right to choose. When trying to find
the right alternative, consider your present and future needs, along with
personal preference and budget. Visit the places under consideration, ask
questions and carefully read all contacts. You have the right to obtain legal
advice about the rights and responsibilities in the contract before it is
signed. Keep in mind that the Department of Health and Mental Hygiene, the
Department of Human Resources, the Maryland Office on Aging and your local
office on aging are available for information and referrals.
Alternatives to Nursing Home Placement © 1993, MSBA, Inc.
All rights reserved. No part of this work may be reproduced in any form without
written permission from the Maryland State Bar Association.