Nursing homes are the highest level in the continuum of care for senior institutional care.  These organizations have licensed nurses around clock.  They have a Director of Nursing who is responsible for managing the nursing staff at the facility.  This nurse is a Registered Nurse and a mix of registered and practical or vocational nurses fill the remaining nursing positions.  Staff at work at the bedside assisting the licensed nurses are certified nursing assistants or CNAs. 

Nursing homes often have physicians who come to the facility to see residents.  Some physicians prefer to  have the resident brought to their office for exams.  Nurse practitioners and physician assistants may also be included in the team of caregivers depending on the State and the facility. 

In addition to nursing staff, the facility has activity, dietary and social work staff.  These professionals collaborate with the nursing team and physicians to develop a plan of care for the resident.  The plan of care in initiated shortly after admission and updated and modified on a periodic basis.  Families and seniors are invited to these care plan meetings. Attendance is valuable to the staff because it provides them with tailored information about the senior and their life prior to admission to the facility.  Often seniors have memory impairment and are not able to articulate their desires or life stories.  Families play an important role in the development of the individualized plan of care.

The majority of nursing home care is paid for by Medicaid.  Medicare reimburses for a limited time frame if the senior has specific needs and improves over their course of care.  The nursing home must and senior must meet strict criteria if Medicare is to pay for services.  If the senior does not continue to improve, declines or plateaus, Medicare will cease to cover the stay and will be discharged.  This Medicare level of service is called skilled care.  This skilled care may require a co-payment by the senior depending on their insurance coverage.  Other payment options such as private by the family, Medicaid or long term care insurance will then be implemented to pay for services received in the nursing  home.

Nursing homes are reviewed on a periodic basis by a local agency that has an agreement with the Centers for Medicare and Medicaid Services (CMS).  CMS is the Federal agency that oversees the Medicare program.  The contracted local agency has the authority to review and provide oversight for CMS.  The survey findings are published on the Medicare web site at http://www.medicare.gov/NursingHomeCompare/search.aspx (Nursing Home Compare).  Care should be taken as this is regulatory data and it may be outdated.  The time frame of the Nursing Home Compare data reflects only the time frame of the visit which is a few days during the survey.   Selection of a nursing home is more complex than a review of on line regulatory data.  This data can provide a starting point for further review and analysis.

Nursing home care is often described as skilled care.  This is a generic term that indicates that the resident is sick and requires the planning and assistance of a licensed nurse.  Medicare pays for some types of skilled care in specific circumstances as noted earlier.  Skilled care are more intensive and more expensive for the nursing home to provide.  Examples of skilled care might include a feeding tube, infected wounds or complete ADL care.  If a resident still needs nursing home level of care, but does not have skilled needs the level of care in called intermediate.  This indicates that the senior requires custodial rather than higher level care.  Either of these levels of care typically require nursing home living due their complex nature.