As a love one’s health changes, some of the most difficult decisions for caregivers involve residential care transitions. Families are often surprised when elderly loved ones end up on wait lists after applying for residence in long-term care facilities. What are these wait lists? How do they work in Connecticut? What do families need to know about the effect wait lists have on nursing home admissions? Are wait lists used by other long-term care facilities like assisted living centers? Certified Elder Law Attorney Franklin Drazen explains the basics.

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Wait Lists in Nursing Homes

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Let’s look at the admission process of a nursing home first. If the elder is living at home, family members obtain applications for homes they are interested in, complete those forms, and then return them. If the elder is hospitalized, the hospital social worker or discharge planner is responsible for requesting applications on the elder’s behalf and assisting the elder, family, guardian or conservator with the completion of the application.

When an application is requested, the nursing home must send you an application and dated receipt within two days. At this time, the nursing home will place your loved one’s name on the dated list of applicants. This list only shows that your loved one has requested an application and that it has been mailed to you.

Upon receipt of the application, you complete it and return it to the nursing facility. When the application is received by the nursing facility, your name will be placed on the nursing facility waiting list. It is not until your loved one’s name is placed on the waiting list that he or she will be considered for a bed in the nursing facility. Generally, a nursing home must admit applicants on a first-come, first-served basis, based on the date the home receives a completed application. However, Connecticut law provides that if a nursing facility has a certain percentage of beds occupied by Medicaid recipients, or the only room available is a private room, the facility may refuse to admit Medicaid applicants.

In addition to legalized discrimination against those covered by Medicaid, there are many exceptions to the first-come, first served requirement. For example, an elder should be allowed to be admitted ahead of others on the waiting list if his or her spouse is already a patient in the nursing facility, or if the elder requires short term rehabilitation or respite care, or if he or she is currently residing in a facility that is shutting down.

The reality of the wait list means that it is difficult or impossible to know when your elderly loved one will actually be admitted to the nursing home. It will depend on how many people are ahead of your loved one on the list and how quickly beds become available. Keep in mind that the nursing facility must inform you of your loved one’s place on the wait list whenever you ask for the information.

In all Connecticut nursing homes, once people are on the wait list, they stay there. A person can’t be removed unless he or she has been on the wait list at least 90 days, the nursing facility writes to the elder or his/her caregivers asking if they wish to remain on the list, or the elder or his/her representative does not respond to the letter within 30 days.

If a person rises to the top of the wait list but doesn’t need nursing home care, what happens? In Connecticut, the person retains his or her position at the top of the wait list instead of being sent to the back of the line as is common in other states. The nursing home will go down the list, offering a bed to each person until it’s finally taken. If an elder doesn’t yet need nursing home care, admissions personnel will typically ask families to call when the elder is ready. When an opening occurs, it goes to the person at the front of the line who is ready for that level of care.

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Wait Lists in Other Long-Term Care Settings

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Many families don’t realize that the use of wait lists isn’t just limited to nursing homes. Many types of senior residences rely on them to manage demand. That’s why it’s very important for family caregivers to be proactive and complete admissions paperwork early, often months before the transition will take place. If you wait, your loved one ends up on the wait list.

Completing admission paperwork well before a loved one might actually transition to that care setting is especially vital in long-term care facilities that offer several levels of care. Let’s say you put your dad’s name in for an independent living apartment. His health is good when he completes the application. But then something happens—he’s diagnosed with a chronic illness—and now, instead of needing an independent living apartment, he needs to be in the assisted living portion of the facility.

When you go to the facility and tell them that your dad needs to be admitted now, they’ll ask when he went on the wait list. If you were proactive and completed admission paperwork as soon as you knew he would eventually be transitioning to the independent living apartment, the facility would most likely have the assisted living room ready when he needed it.

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Two Parts Strategy – One Part Luck

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When it comes to finding a long-term care facility for a loved one, wait lists are just one factor in an increasingly complicated equation. There are many more variables, each representing a series of questions that, if answered incorrectly, could bankrupt the elder, impoverish dependents and expose the family to unnecessary financial liability.

• What kind of care does a loved one really need?
• What facilities in the area offer that kind of care?
• Will the state pay for care?
• What if your loved one doesn’t think he or she needs long-term care and refuses to apply to any facility?

Answering these kinds of questions is what we do at Drazen Law Group. We’ve helped many families through these difficult long-term care transitions.

The best outcomes are always the result of a carefully thought out strategy. Choosing facilities, deciding where to apply, and timing those applications can be tricky. No matter what, it’s always best to know what’s available long before elderly loved ones start to need help. Remember, the earlier you start planning and the earlier you involve us in the process, the more options you will have, and the more affordable those options will be.