Nursing Homes and Alternatives: What New York Families Need to Know

Edited by Jean Murphy and Amy Carroll
Published by Friends and Relatives of Institutionalized Aged (FRIA) (, $30
Reviewed by Jay G. Sanders

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This book is a smoothly written invaluable resource for both crisis management and basic eldercare planning. Its primary lesson is simple: Rich or poor, advocacy is an essential ingredient. Effective advocacy requires knowledge, and this book imparts that knowledge quickly and accurately.

The reader will soon realize that this book could have evolved only through firsthand experience with the system. Friends and Relatives of Institutionalized Aged (FRIA) has been through this drill thousands of times during its 28-year history. Each year its helpline assists thousands of New Yorkers navigating the long-term care quagmire. Every suggestion the book offers comes with how-to lists, phone numbers, form numbers, and other relevant information that the reader will need to take immediate action.

The book is organized to help those in an emergency get where they need to go quickly. For those in a preparatory mode, it ushers them through a complete analysis of the relevant issues surrounding long-term care in New York State.

Chapter 1, “Staying Home: Home and Community-Based Health Care,” and Chapter 2, “Adult Homes, Assisted Living and Other Options,” give advice on home care, adult homes, assisted living, and other independent-living options before one requires a nursing home. They discuss different types of home-care services, how to arrange for them, and how to finance them. It also guides the reader on how to get home care through Medicaid. It also discusses adult homes (from resident rights through complaints), assisted living in New York State (an evolving and often-misunderstood option), the New York State Assisted Living Program, and other options and resources.

Chapter 3, “Hard Choices: When a Nursing Home Is Necessary,” alerts the reader to the realities of nursing home admittance. It gives a chilling insider’s look at the scoring systems that nursing homes use to decide whether to admit someone. It also describes the time-critical nature of the hospital discharge process. In most cases, the advocate needs to select a nursing home as soon as the relative or friend is admitted to the hospital. If the advocate doesn’t heed the discharge timetable, the hospital will choose the nursing home.

Chapter 4, “Coping with Costs: Paying for Long-Term Nursing Home Care,” gives an excellent overview of the financing choices available to pay for eldercare. It walks the reader through the basics of Medicare, Medicaid, asset transfer, private pay, and long-term care insurance.

Chapter 5, “Informed Choices: How to Select a Nursing Home,” provides the tools needed to evaluate nursing homes. It defines the types of homes in New York State and how to evaluate them, and it highlights key placement decisions that need to be considered.

Chapter 6, “Expectations: Regulations, Right and Required Services,” describes the care one can reasonably expect to receive, the comprehensive care plan, and the way nursing homes are organized and regulated. The reader will also find detailed analyses of admissions agreements, patient rights, a typical nursing home’s organizational structure (both administrative and medical), and grievance procedures.

Chapter 7, “Solving Problems: Becoming an Advocate for Your Relative,” instructs the reader on effective advocacy. It discusses how to solve problems in a nursing home environment, explains what nursing home family and resident councils do, and describes what can be expected in terms of support. Finally, it describes how to lodge effective complaints.

Chapter 8, “When My Relative Cannot Act for Himself: Legal Arrangements,” deals with the basic legal tools for incapacity planning, such as powers of attorney and health-care proxies. It also explains how to handle problems when there has been no advance planning.

This book can be read cover to cover in two to four hours, a real benefit when one is in crisis mode. It’s comforting to know that resources like FRIA and Nursing Homes and Alternatives exist to help. This book is a must-read for any practitioner who has clients 50 or older. Families not in crisis, or those outside of New York State, should read this book for the fundamental tried-and-tested advice that is relevant anywhere.

Jay G. Sanders, CPA, CFP, CSA, is a member of the NYSSCPA’s Estate Planning and Personal Financial Planning committees.




















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