An Assisted Living residence (“ALF”) is a facility which is licensed by the Department of Health and Senior Services, and subject to the regulations in N.J.A.C. 8:36, to provide apartment-style housing and congregate dining and to assure that assisted living services are available when needed, to four or more adult persons unrelated to the proprietor. Apartment units offer, at a minimum, one unfurnished room, a private bathroom, a kitchenette, and a lockable door on the unit entrance. Some rooms are doubles. A nursing home or “skilled nursing facility,” on the other hand, are subject to a different set of regulations which are found in N.J.A.C. 8:85. Unlike assisted livings, the nursing homes are also subject to federal and state laws known generally as the Nursing Home Reform Act.Admission, transfer and discharge rights 42 CFR Ä 483
As part of the admission process, a nurse screens the applicant and reviews medical records to determine the level of care that is necessary. There is a basic charge for room, board and housekeeping, and additional services are such as medication administration or greater hands-on assistance with the Activities of Daily Living are added onto the basic charge as needed. Sometimes, couples move into a unit together, even with differing levels of care. The facility may have a dementia unit (“memory care” units) that has a lower staff:patient ratio and where the staff are more particularly trained to deal with the way Alzheimers Disease and other dementias affect the behavior and reactions of the residents.
In assisted living, the resident signs a contract for an array of services, and the relationship is strictly contractual. The level of care is reviewed annually and after any major incident that could lead to a need for a temporary increase in the level of care.
The financial arrangement is different than it is with nursing homes. The daily rate in a nursing home is the same for each resident even though their individualized plan of care, which is required by federal law, may be unique. The ALF on the other hand, builds the bill based on services selected.
Also, although many ALFs participate in the Medicaid program, with the same eligibility criteria as nursing home Medicaid, they typically require that the resident commit to pay the private pay rate for two full years before applying for Medicaid. Either the individual or some willing third party needs to guarantee that the bill will be paid. This is different than what nursing homes are allowed to do, because in a nursing home, once the resident is financially eligible to apply for Medicaid, it is illegal to require a third party to pay the bill.
Another difference is that once the Medicaid application is filed, many ALFs require that the resident’s bill still be paid by somebody, essentially as a loan to the resident, to be refunded by the facility once Medicaid approval is secured. Finally, in some ALFs, even after the Medicaid application has been approved by the State, the resident may be kept on the facility’s internal waiting list. These ALF practices are legal, but the applicant must be provided with an explicit notice about these policies at the time the contract is signed.
All of these issues can be addressed through careful elder care planning. Call for an appointment for advice tailored to your concerns.
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