GeorgiaLegalAid.orgGeorgia

Long Term Care Options in Georgia

Information

LONG TERM CARE IN GEORGIA

Natalie Thomas
Georgia Department of Human Resources
Division of Aging Services

Last Revised: October 2002

Long-term care refers to medical, rehabilitative, social and support services provided to people who need assistance in caring for themselves. Usually these services are needed because of physical or mental disabilities that require varying degrees of assistance and medical/nursing management. Long-term care services can be delivered in a wide variety of settings ranging from a private home to a nursing facility.

While nursing facilities continue to be a major provider of long-term care, a growing number of programs and residential options are available to help people live as independently as possible in their own homes and communities despite their need for long-term care services.


NURSING HOMES:

A nursing home is a residential setting in which nursing care, related health care services, and rehabilitation services are provided to residents of the facility. Nursing homes also provide physical and speech therapy, supervision of diet and medications, and personal care such as help with dressing and bathing.

How to Choose a Nursing Home

A search for the most suitable nursing home should begin with obtaining a list of facilities in the most desirable location for the resident. Often this will be an area where family and friends can visit conveniently. A list of facilities may be obtained by contacting the local long-term care ombudsman program serving that area. (See Appendix F.) Visits to the facility by friends and relatives are important to observe the appearance of the facility and residents, to observe interactions between staff and residents, and to review posted notices such as the activities schedule and food menus. Any violations identified in the most recent survey of the facility by regulators are available for review. Be aware that many facilities have waiting lists, making it sometimes difficult to be placed in one=s first choice of facility.


For more information about choosing a nursing home, you may order the pamphlet "Selecting a Nursing Home: A Guide to Making an Informed Decision" free of charge from the State Bar of Georgia at (404) 527-8792 or 1-800-334-6865. This pamphlet is also on the georgialegalaid.org web site under the same title.

How to Pay for Nursing Home Care

Most nursing home residents in Georgia receive Medicaid benefits to cover the cost of their care. The resident's monthly income goes toward part of the cost and the remainder of the cost is paid by Medicaid. Medicare pays for only a limited number of days in a nursing home and for only certain types of services ; i.e., the resident must need "skilled care" after a hospital stay. Some residents pay for their care privately. They may receive benefits from a long-term care insurance policy.

Residents' Rights

The Long-Term Care Residents' Bill of Rights in Georgia is a state law listing certain basic rights of all nursing home residents, such as:

  • the right to privacy
  • the right to enter and leave the home as one chooses
  • the right to choose or refuse medical treatment
  • the right to adequate notice before being transferred or discharged

The complete list of rights must be posted in the facility and provided to residents upon admission to the facility.

A copy of The Long-Term Care Residents' Bill of Rights may be obtained from the Office of Regulatory Services, Georgia Department of Human Resources by calling (404) 657-5850.

In addition, federal law enumerates additional rights for residents in homes which receive Medicare or Medicaid funding. Whenever there is a question regarding residents' rights, the Long-Term Care Ombudsman Program may be contacted for information and assistance.

Where to Make a Complaint about a Nursing Home

When there are complaints about nursing homes or residents wish to enforce their rights, these options are available:

1) For informal investigation and discussion of the problem: Discuss the complaint directly with the facility staff or administration or with the local long-term care ombudsman program, an advocacy program which serves residents of long-term care facilities.

2) For formal investigation by a regulatory agency and any time abuse is suspected: Make a complaint either in writing or by calling the Office of Regulatory Services, Georgia Department of Human Resources at 1-800-878-6442.

3) To enforce those rights listed in the Long-Term Care Residents' Bill of Rights: A resident or representative may ask for a hearing before an Administrative Law Judge or may bring a case in court.

PERSONAL CARE HOMES:

A personal care home is a dwelling that provides or arranges for the provision of housing, food services and one or more personal services for two or more unrelated adults. Other states and even similar facilities within Georgia use terms like "assisted living facilities", "group homes", "adult residential care facilities" and "board and care homes" to describe what Georgia law defines as "personal care homes".

A personal care home provides meals, personal care and watchful oversight for people who need some supervision and/or help with their daily personal needs. Unlike a nursing facility, a personal care home does not provide nursing or medical care.

How to Choose a Personal Care Home

1) Visits to the facility are important to observe the appearance of the facility and residents, to observe interactions between staff and residents, and to determine whether the facility provides a suitable environment for the individual seeking placement. A list of facilities in a particular area may be obtained from the local long-term care ombudsman program serving that region. Personal care homes vary widely in size, cost, and quality, so it is very important to visit a number of facilities before choosing one.

2) Admissions agreements should be carefully reviewed and compared to determine what services are provided and at what cost. Also, always check to make sure that the facility is licensed by the Department of Human Resources.

How to Pay for Personal Care Home Care

Personal care homes are almost entirely private pay and rates charged vary greatly. Some personal care homes provide services to the resident for the amount of their monthly Social Security or Supplemental Security Income (SSI) income. Few long-term care insurance policies cover personal care home services. Medicare does not reimburse personal care home providers for their services. In Georgia, personal care home providers are generally not reimbursed by Medicaid, except for those who participate in the Medicaid-funded Alternative Living Services, a part of the Community Care Services Program. (See Community Care below.)

Residents' Rights

Residents in personal care homes have rights provided by state law which are listed in the regulations governing personal care homes. These rights include:

  • the right to be free from physical and chemical restraints
  • the right to privacy
  • the right to consent to or refuse medical treatment

The list of these rights should be provided upon admission to a personal care home.

A copy of these rights (and other regulations governing personal care homes) may be obtained from the Office of Regulatory Services, Georgia Department of Human Resources at (404) 657-5850. Whenever there is a question regarding personal care home residents' rights, the Long-Term Care Ombudsman Program may be contacted for information and assistance.

Where to Make a Complaint about a Personal Care Home

When there are complaints about the rights of residents or the quality of care they are receiving in personal care homes, these options are available:

1) For informal investigation and discussion of the problem: Discuss the complaint directly with the facility staff or administration or to the local long-term care ombudsman program, an advocacy program which serves residents of long term care facilities.

2) For formal investigation by a regulatory agency and any time abuse is suspected: Make a complaint either in writing or by calling the Office of Regulatory Services, Georgia Department of Human Resources at 1-800-878-6442.

3) To enforce those rights listed in the personal care home regulations: A resident or representative may ask for a hearing before an Administrative Law Judge or may bring a case in court.

THE LONG-TERM CARE OMBUDSMAN PROGRAM:

The Long-Term Care Ombudsman Program advocates for residents of long-term care facilities (nursing homes and personal care homes) to improve residents' quality of life. An ombudsman (meaning "citizen representative") acts on behalf of persons who need assistance in advocating their own cause. Representatives of the

Long-Term Care Ombudsman Program perform this advocacy role on behalf of individuals who reside in long-term care facilities.

Ombudsmen work to resolve residents' complaints about everything from cold food and lost laundry to concerns about resident funds and violations of residents' rights. They advocate for residents' rights before staff, community groups and government agencies.

Ombudsmen investigate and work to resolve complaints affecting residents, provide information to the public, and encourage long-term care facilities and governmental entities to improve their services to long-term care residents.

In Georgia, there are fifteen (15) community ombudsman programs serving all of the state's nursing facilities and personal care homes. You may reach the Ombudsman Program serving your area through the local Area Agency on Aging or by calling the State Long-Term Care Ombudsman Program at (404) 657-5319. (See Appendix F.) In addition, the telephone numbers of the state and community ombudsman programs must be posted in a prominent place in each nursing home and personal care home.


COMMUNITY CARE SERVICES PROGRAM (CCSP):

The Community Care Services Program (CCSP), administered by the Department of Human Resources, is designed to assist older Georgians in continuing to live in the community rather than enter a nursing home. Some elderly persons need help to remain reasonably independent in their homes but do not need the care provided in a nursing home. The CCSP, funded by the Department of Medical Assistance (Medicaid), was developed to give older Georgians a greater choice in deciding where they live and what assistance they need.

Services Provided

The CCSP provides a range of home and community-based services which include: Adult Day Health, Alternative Living Services, Care Coordination, Emergency Response Services, Home Delivered Meals, Home Delivered Services, Personal Support Services, and Respite Care Services.

Eligibility

1) Be certified for intermediate nursing home care;

2) Be assessed by the CCSP registered nurse (RN) and be determined to have health and personal needs which can be adequately met in the community within established cost limits; and

3) Be an eligible Medicaid recipient or potentially eligible for Medicaid.

How To Apply

To apply for CCSP or to refer someone, contact the Area Agency on Aging in your area.

OTHER HOME AND COMMUNITY BASED SERVICES:

In addition to the Community Care Services Program, other home and community based services are funded primarily through Title III of the Older Americans Act, the Social Services Block Grant, and state funds.

Eligibility

1) Be age 60 or over; and

2) Be determined to have a need which can be met by the service(s).

Please note that in some areas, there may be waiting lists for some or all of these services, or that some of the services may not be available at this time.

How to Access other Home and Community Based Services

To apply for these services, or to refer someone else, contact the Area Agency on Aging in your area.

From Access: Benefits and Resources for Older Georgians
Last Revised: October 2002

Natalie Thomas
Georgia Department of Human Resources
Division of Aging Services
Two Peachtree Street, NW
36th Floor
Atlanta, Georgia 30303-3142
(404) 657-5258

Last Review and Update: Jan 15, 2004