 MHCA answers many
questions for consumers and providers every day. Below are several of our most frequently
asked questions. If you still have unanswered questions, please feel free to e-mail
us using the 'Contact NMHCA' icon at the lower right hand corner of this screen or at
nmhca@nmhca.orgWhat is long term care?
Long term care includes a range of services for people
who have functional limitations or chronic health conditions. Their needs include
sub-acute, rehabilitative, medical, skilled nursing and supportive social services. Long
term care services are provided in a variety of settings, including nursing or assisted
living facilities, respite care, adult day care, and home and community based settings.
What are surveys?
All New Mexico nursing facilities, residential
care facilities and intermediate care facilities for the mentally retarded (ICF/MRs) must
be licensed by the state. Compliance with state licensing requirements is based on annual
inspections by surveyors. If a nursing facility or ICF/MR serves individuals whose care is
financed by Medicare or Medicaid, additional federal regulations must be met. Again, New
Mexico Department of Health surveyors are charged with inspecting facilities and enforcing
requirements. In addition to annual inspections, facilities may be surveyed in response to
complaints or as follow-up to previous investigations. Failure to meet state or federal
regulations may result in fines or other penalties against a facility. In cases of serious
non-compliance, a facility's license may be revoked and/or government payments may no
longer be approved for serving Medicare/Medicaid clients. Although it is commonly believed
that facilities are notified of survey times, inspections are unannounced. A $2000 fine
may be levied against anyone who notifies a nursing facility when a survey will be
conducted.
Who pays for Long Term Care?
According to the American Health Care Association (AHCA),
Medicaid pays for 69% of nursing facility residents. Twenty-four percent of
residents pay for the care themselves, while 7% rely on Medicare. Long Term Care
insurance pays for only 3% of care.
Do I really need Long Term Care Insurance?
Long Term Care insurance provides individuals with the
option to choose what type of long term care facility they prefer and the guarantee of
quality care. Long term care insurance will protect your family from financial
burden should you need long term care in the future.
Who do I contact if I have concerns about a long
term care facility?
The long term care Ombudsman Program advocates on behalf
of long term care residents. This program monitors long term care facilities on a
yearly basis to ensure quality care. The Ombudsman program is funded by the U.S.
Department of Health and Human Services' Administration on Aging. Ombudsmen can
answer questions about how a long term care facility is organized and regulated. |
