Heidi Friedman. Heidi Friedman.

Reports of tragic deaths at a Florida nursing home in the aftermath of Hurricane Irma brought to the forefront public concern over ensuring loved ones are placed in the right facilities. While most people are aware they need to exercise caution before making major decisions, they often neglect to follow proper steps when selecting a nursing home for someone they love.

In my own family, the facility where my 99-year old grandmother was staying and receiving rehabilitation services through Medicare, advised us that grandma “had reached her potential,” and because Medicare would no longer pay for rehabilitation, she had to be discharged immediately. My grandmother could not return home, as she was no longer safe to live alone. My own family was put under extreme pressure to find a nursing home quickly. With less than 24 hours to place grandma, my mother-in-law frantically started the search to find any nursing home that would accept her immediately.

We notified the facility that there was no safe environment to transfer my grandmother to, and we needed more time to research and find the right nursing home for her. My mother-in-law was surprised to learn that she could ask the hospital for the time to find a proper place. Hospitals have financial incentives to discharge patients, sometimes notifying family of discharge decisions within days of the date of discharge. Families then feel they must move their loved ones immediately. This is simply not true. When notified that your loved one is being discharged, you can request time to find the best location to move them.

So, how do you find the right facility?

With 687 licensed nursing homes throughout Florida, finding the best one can be a daunting task. One of the most important things to consider is location. Placing a family member in a facility that is far away from family or friends is not recommended. Patients with involved family members tend to be cared for better. While daily visits are best, visiting at the different times throughout the week helps keep staff members on their toes.

When a location is determined, how do you narrow the search? Several websites, such as Nursing Home Compare, Nursing Home Guide, and Florida Health Finder, enable you to compare facilities, view inspection reports, and other reports regarding any penalties the facilities may have received. Reading family reviews can be informative and show patterns such as low staffing or bad food.

Also, visiting during busy times, such as staff changes and meal times, gives great insight into patient care. Observe how staff interact and speak with each other about patients and administration. Make sure facilities smell clean and do not have overpowering smells, such as urine. Do not be afraid to ask questions and request outside references.

Once a nursing home is found, other issues must be considered. How to pay for the significant cost? Who pays? What happens if we run out of money?

While most nursing homes accept Medicaid as a source of payment, since Medicaid reimbursement tends to be lower than private payers, facilities may advise families who require Medicaid to assist with paying for the cost, that there are a limited number of Medicaid beds available.

Facilities often have wait lists for Medicaid beds, yet, once an individual is admitted into a nursing home, federal law (Nursing Home Reform Act of 1987) prohibits discrimination based on Medicaid status. Patients cannot be treated differently or discharged because they now have Medicaid.  So, entering a nursing home under private pay, then converting to Medicaid, utilizing the services of an elder law attorney, will allow most families to be able to place and keep their loved one in the facility of their choice.

Additionally, many nursing homes provide an overwhelming package of forms and documents to read and complete. They include a document requiring the signature of the financially responsible party. Many family members feel they have no choice but to sign, making them the “responsible party.” Again, relying on federal law (Nursing Home Reform Act of 1987) families need to know that facilities cannot require anyone, except the resident to be financially responsible.  It is important to know that if anyone other than the resident is required to sign this type of form before admission, the facility is violating federal law.

Remember, finding and entering a nursing home is an intimidating and terrifying undertaking, but families need to know that they have certain rights.

Heidi F. Friedman is a shareholder at Becker & Poliakoff who is board certified by the Florida Bar in Elder Law. She may be reached at hfriedman@bplegal.com,