Here are answers to commonly asked questions about long term care and skilled nursing facilities.


What types of care are available in nursing facilities?

Most nursing facilities offer services that include: subacute, rehabilitative, medical, skilled nursing and supportive social services for people who have functional limitations or chronic health conditions, and who need on-going health care assistance with their normal activities of daily living (ADLs). Long term care can also include respite care, adult day care, home and community based care and nursing care. Although most long term care services are used by the elderly, young adults, children and even infants use long term care services due to chronic illness or accident.


Nursing facility care is provided in a health care facility that provides a wide range of services to meet both the short-term rehabilitative and the long-term care patient’s needs. Today’s nursing facilities are staffed by trained professionals who provide essential health and psychosocial services according to a physician’s prescribed patient care plan, and in conjunction with state and national standards designed to assure quality care. There are approximately 245 nursing homes in Alabama providing medical and nursing care, social services, and a home-like environment for Alabama’s convalescent and chronically ill residents. Alabama’s nursing facilities are licensed under the guidelines of and by the Alabama Department of Public Health, Division of Health Care Facilities, to provide a variety of health and rehabilitative care services.

All of Alabama’s long-term care facilities now provide care under the guidelines established for Nursing Care Facilities (NCF). In a Nursing Care Facility, 24 hours of nursing care is provided under a physician’s order through a comprehensive plan of treatment developed by a team of trained professionals. In NCF facilities, continuous care consists of services which require specialized judgment and skill based on trained knowledge provided by qualified staff members (registered nurses, physical therapists, etc.). These skills are often rehabilitative in nature and must be performed effectively. Any medical complications or special services must be documented by the physician’s orders and the nursing notes.


What services are offered to residents of Alabama’s nursing facilities?

Four basic types of services are offered by nursing facilities nationally and in Alabama: nursing care, personal care, residential services and medical care.

  • Nursing Care procedures require that the professional skills of a registered nurse (RN) or licensed practical nurse (LPN) be utilized in nursing home care. Included in the duties of these RNs and LPNs is the administering of medication, injections, catheterizations and similar procedures as ordered by a physician. Post-hospital stroke, heart, or orthopedic care with related services such as physical and/or occupational therapy, dental services, dietary consultations, laboratory and x-ray services and a pharmaceutical dispensary are also available.
  • Personal Care services include help in walking, getting into and out of bed, bathing, dressing, eating and providing special diets as prescribed by a physician.
  • Residential Services include general supervision and a protective environment, such as room and board and a planned program for the social and spiritual needs of the resident.
  • In meeting the Medical Care needs of each resident, nursing facilities work under the overall plan of care provided by the resident’s physician. In most cases, the resident’s personal physician refers him or her to the facility and certifies the need for admission. Once the resident is admitted, the physician writes orders for medication, develops the resident’s care plan (including restorative and rehabilitative procedures, special diets and other treatments) and visits periodically. Every nursing facility usually has at least one physician on staff or on call to handle emergency situations.


When is nursing facility care appropriate?

Typically, the need for nursing facility care increases with age. Statistics show that nursing facility residents tend to have health problems which significantly restrict their ability to care for themselves on a daily basis, such as problems with bathing or dressing. In addition, about two thirds of nursing facility residents have some form of memory impairment or disorientation. Common chronic illnesses affecting nursing facility residents are arteriosclerosis, heart disease, chronic brain disorders and arthritis.


Who assures the quality of care for Alabama’s nursing facility residents?

All Alabama nursing facilities are inspected at least once a year by the Alabama Department of Public Health. The team of inspectors arrive unannounced. State inspectors look at everything – from staff adequacy and the cleanliness of the facility, to food preparation methods and the proper administration of medications and therapies. In all, these nursing facilities must pass over 500 state and federal regulations, making long term care one of the most regulated industries in the United States.


The State of Alabama also has a very active nursing facility Ombudsman Program designed to assist residents with concerns and the achievement of fair settlements or solutions. The program administered by the Alabama Department of Senior Services. A volunteer ombudsman visits nursing facility residents on a regular basis to help resolve any resident concerns.


What is the typical cost of a day of nursing facility care?

The cost of nursing facility in Alabama varies depending on the amount of services a person needs. Services typically included in the cost are room and board, 24 hours a day nursing care, recreational activities, social services and more. Other services, such as physical and speech therapy, are usually billed separately. Ask the nursing facility you are considering for a cost estimate based on you or your loved ones needs.


Who typically pays for nursing facility care?

In Alabama, Medicaid pays for the care of people living in nursing facilities. Medicaid is the state’s medical program for those citizens with limited incomes. It is jointly funded by the state and federal government. The program is governed by federal guidelines, however state programs vary in eligibility criteria, services covered and limitations on services.


Medicare typically covers nursing facility care when a person needs rehabilitation after an accident or illness. See the page about Medicaid and Medicare for more information.


Other sources of payment include private insurance and people paying for the care out of their own pocket.
How do you plan to pay for your long-term care?

If you plan to pay for the care with a particular type of governmental funding (Medicare, Medicaid, etc.), then your nursing home selection should focus on facilities that participate in the program.


To determine if a facility participates in federal and/or state programs, simply contact the facility and ask the following questions:

  • Do you participate in the (Medicare/Medicaid/etc.) program?
  • How many beds which have been specified for this type funding do you have available?
  • If you have a waiting list, how long is it?
  • Then ask to be put on the waiting list and make an appointment to go by and tour the facility.


Will location be a factor in your decision?

For many individuals, location is a prime consideration when selecting a nursing facility. Just as in any other type of facility, where it is located more than likely will reflect the lifestyle of the community…be it urban, suburban or rural. Look for a nursing facility which reflects the location and atmosphere in which you or your loved one would like to reside.


Do you have any special medical/social/psychosocial needs which will require particular attention?

The type of facility you select depends on your individual needs. Not all nursing facilities offer and/or specialize in the same types of services. For example, some nursing facilities offer special therapy programs, some have special programs for people with Alzheimer’s disease and others are equipped to treat people who need to be fed using a tube. If you have any special needs, it is important that you contact a facility and ask if it can accommodate a person with those needs.