FAQ & Facts
FAQ (Frequently Asked Questions)
NMHCA / NMCAL 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.
What 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 Individuals with Intellectual Disabilities (ICFs/IID) must be licensed by the state. Compliance with state licensing requirements is based on annual inspections by surveyors. If a nursing facility or ICF/IID 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 a 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 sixty-three percent of nursing facility residents. Twenty-three percent of residents pay for the care themselves, while thirteen percent rely on Medicare. Long-term care insurance pays for only one percent 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.
Facts About Long-Term Care
Provided below are some interesting facts and figures about long-term care. Long-term care is a rapidly growing industry that provides care for millions of people each year. To understand more about the long-term care industry, quickly browse the following information.
- There are more than 15,600 Nursing facilities in the United States. (AHCA)
- The average facility is 106 beds. (AHCA)
- The average nursing facility has an 84% occupancy rate. (AHCA)
- Medicaid pays for 63% of nursing facility cost while 23% is paid by private pay and 13% is paid by Medicare. (The Centers for Medicare and Medicaid Services-CMS)
- Average nursing facility care costs approximately $75,000 per year. (AHCA)
- In 2008, 9 million Americans needed long-term care services. By 2020, the number will rise to 12 million and skyrocket to as many as 24 million by 2060. (AHCA)
- There are 76 licensed nursing facilities in New Mexico. The average number of residents per facility is 91. (NMHCA)
- New Mexico has approximately 5,800* residents needing assistance with approximately 4.3 activities of daily living. (NMHCA)
- Eighty-nine percent of nursing facility residents in New Mexico are 65 or older. (NMHCA)
*estimated using 83% occupancy by total number of beds.
Assisted Living/Residential Care Facilities
- Fifty-four percent of assisted living facilities allow residents to have overnight guests, and 49% allow residents to keep small pets. (AHCA/NCAL)
- Ninty-three percent of assisted living residents need or accept help with housework, while 86% need or accept help with their daily medication. (NCAL)
- There are approximately 38,500 assisted living residences in the United States, housing approximately 975,000 people including about 131,000 who receive assistance through Medicaid. These numbers are expected to double by the year 2030. (NCAL)
- NCAL surveys also show that 26% of all residents need no help taking care of their activities of daily living (ADLs), while others did in varying degrees. On average, assisted living residents needed help with 1.7 ADLs. (NCAL)
- About 67 percent of assisted living residents paid for services with private funds with another 8% rely on family funding. The Supplementary Security Income (SSI) accounts for 14% of payments with Medicaid payments at around 9%. (AHCA/NCAL)
- A recent NCAL survey found that 58% of residents moved from their home to an assisted living facility, where they stayed for about 3.3 years. Due to the need for a higher level of medical care, 43% of assisted living residents moved to nursing facilities. (NCAL)
- There are approximately 264 licensed assisted living facilities in New Mexico. (NMHCA)
- Licensed New Mexico assisted living facilities range in size from 2 residents to over 200 residents. (NMHCA)
- There are four main categories of intellectual disabilities: mild, moderate, severe, and profound. These categories are based on IQ scores and some assessment of adaptive skills. IQ scores are ranked in the following manner: Mild, IQ of 50 to 70; Moderate, IQ of 35-49; Severe, IQ of 20-34; and Profound, IQ below 20. (AHCA)
- In 2008 there were 93,000 individuals with mental retardation and/or developmental disabilities receiving support and training in ICF/IID facilities. (AHCA)
- A large ICF/IID facility is defined as one that houses more than 15 beds. Facilities with less than 15 beds are considered small. (AHCA)
- ICF/IID facilities are required to meet direct-care staffing requirements based on the residents' age and level of disability. Direct care staffing is defined as present, on-duty staff calculated over all shifts in a 24-hour period for each defined residential living unit. (AHCA)
- According to the U.S. General Accounting Office, individuals with developmental disabilities receive more than $13 billion annually in public funding for long-term care-second only to the elderly. (AHCA)
- Medicaid is the primary payor of ICF/IID services. In 2009, Medicaid expenditures for ICF/IID were approximately $13 billion and accounted for roughly 3.5% of total Medicaid expenditures. The average cost per client was $68,612. (AHCA)
- There are 43 licensed ICF/IID facilities in New Mexico serving 263 residents. (NMHCA)
- In New Mexico, the average number of ICF/IID residents in one facility is 6. (NM Licensing and Certification Department)