Long-Term Care Information
The Ombudsman Program provides advocacy for consumers searching for long-term care services as well as those already accessing long-term care services. As part of our advocacy we can provide advice on how to find services as well as how to
address concerns related to services. This page provides information on how to find a nursing home or other long-term care setting, what to do if you have concerns in these settings, how to access home care and what to do if you have concerns
about your home care services. Contact us if you have further questions.
How to choose a nursing home, residential care or assisted living:
The Ombudsman Program often receives calls from family members who are seeking information about how to find a nursing home, residential care or assisted living when a loved one needs this level of care. Families often do not know how to evaluate
the care provided in the setting they are considering.
While we cannot recommend a particular nursing home, residential care or assisted living, we can be helpful in assisting families/consumers in evaluating a particular setting. Nursing Home Compare at www.medicare.gov is a resource for information
about the quality of care provided in nursing homes. Inspection survey results are posted on this web site and surveys from different nursing homes can be compared. These surveys indicate whether the nursing home has met federal health and safety standards.
In addition, we can provide callers with a copy of a Guide to Choosing a Nursing Home published by the Centers for Medicare and Medicaid. This comprehensive guide provides a detailed list of factors to be considered when choosing a nursing home.
We advise the following whether you are looking for a nursing home, residential care or assisted living:
Visit the settings in your area and ask for a tour of each one. Observe the general appearance and atmosphere of the setting, the interactions between residents and staff, the availability of staff providing care to residents and the quality of meals and
activities provided. Also, ask about the most recent inspection survey and review it with the administrator.
What to do if you have concerns about care:
If you are concerned about the care you or a loved one is receiving in a nursing home, residential care or assisted living, the Ombudsman Program can help. Call the Ombudsman Program to speak with the intake worker who can answer questions and provide some
advice on how to address these issues. The Ombudsman Program is available to help address problems directly, but also can provide suggestions on how family members or residents can address concerns. Here are some ideas for how to address problems in a nursing home,
residential care or assisted living:
- Contact the Ombudsman Program to discuss possible resolutions.
- Address your concerns directly with staff such as the Director of Nursing, Social Worker, Residential Care Director, Charge Nurse or Administrator. If you are uncomfortable addressing the concerns directly, with consent, the Ombudsman Program can help.
- Residents in a nursing home, residential care or assisted living may take their concerns to the Resident Council. If other residents have the same problems, it may be beneficial to address them as a group.
- Family members of residents in nursing home have the right to form a Family Council to address concerns. Family members could attend a meeting if the nursing home has a Family Council or may want to start a council.
- Call the Department of Health and Human Services, Division of Licensing and Certification complaint line (800) 383-2441 to report the issues. Licensing and Certification is responsible for investigating complaints in hospitals, nursing homes, assisted housing
(residential care and assisted living) and licensed home care agencies.
What home care services are available and who provides them?
A variety of services are available depending on your needs and payment source. You may pay for the services yourself, or you may be eligible for financial assistance that will help you pay for the services you need. For more information about available services,
contact the Department of Health and Human Services Office of Aging and Disability Services at (800) 262-2232.
How do I apply for home care services?
If you know what services you want and are paying privately for your care, you can contact the home care agency directly to arrange for services. If you need financial help to pay for home care or are not sure what services you need or what services are available,
contact KEPRO for a free medical eligibility determination assessment.
KEPRO does assessments for the elderly and other consumers who are seeking home care services, including disabled adults who want to live independently. The assessment is confidential and free of charge. Call them at (833) 525-5784.
An assessor from KEPRO will come to your home for the assessment. At the end of your meeting, the assessor will decide whether you are eligible or ineligible for home care. If you are eligible for home care, you will be given a written "Plan of Care".
This plan will include the number of hours and the kinds of services you are eligible for each day, week, or month, as well as the names of the programs for which you qualify. You may also be instructed to complete a MaineCare application that will ask for information
about your income, your savings, and your property.
Depending on the program you qualify for, you will be referred to a care coordination agency such as EIM or Alpha One. These agencies coordinate home care services for clients statewide; they will find your caregivers for you and implement your plan of care that was
designed by KEPRO.
Some people chose to direct their own care, meaning they hire and manage their own caregivers. Both EIM and Alpha One have consumer-directed options depending on the program you are on, please ask your care coordination agency about this option if you are interested
in learning more.
If you have Medicare and you are being discharged from a hospital or nursing facility, your doctor can order skilled services to be provided in your home. The discharge planner at the hospital or the social worker at the nursing home can help coordinate these services.
If you or a family member would like to learn more about available home care services, here are some other options:
- Contact a home care agency directly.
- If you are in a hospital or nursing home, talk with the social worker.
- Contact the Maine Department of Health and Human Services (DHHS) Office of Aging and Disability Services at (800) 262-2232.
- Call your local Area Agency on Aging. If you call, toll-free, (877) 353-3771 you will be connected with the agency that serves your area. They can also tell you about other resources such as Meals on Wheels and transportation assistance.
- Call the Ombudsman Program at (800) 499-0229.
What do I do if my home care services are reduced, terminated or denied?
You will receive a written notice if your home care services are being denied, reduced, suspended, or terminated.
If you are currently receiving services and those services are going to be terminated or reduced, you have the right to advance notice before the services change or stop. How much advance notice you get depends on the rules of the program that approved your services.
There are some limited exceptions to this advance notice rule: for example, if workers will be endangered coming into your home, or if you have provided false information in order to get care.
The written notice must include the following:
- The reason for the denial, termination or reduction in services;
- The date the change will happen;
- Information about your right to appeal;
- How to request a hearing on your appeal;
- How to get help with an appeal hearing; and
- If services will continue if you appeal the agency decision.
It is very important that you not miss any filing deadlines, so the first thing to do is request an appeal hearing in a timely manner. Generally you have 60 days to appeal any decision. If you are currently receiving services under a MaineCare or state program and you
request a hearing within 10 days of the date of the action to reduce or terminate your benefits, in most instances you will continue to receive services while the hearing is pending. The written notice you receive should include specific information on how to appeal the
The rules for home care programs can be complicated, and it is a good idea to get assistance with an appeal. Contact the Ombudsman Program at (800) 499-0229 or (207) 621-1079 for assistance in requesting a hearing or in preparing for your appeal. We work
cooperatively with legal services agencies such as Legal Services for the Elderly, Disability Rights Maine, and Pine Tree Legal Assistance if you should need someone to represent you at your hearing.