Long-term care provided in Ohio's nursing facilities is undoubtedly one of the most cost-effective services provided by the health care profession. Nursing facility care is comprehensive, including room and board, medical care, security, and providing for social, religious and mental health requirements.

Still, to families or individuals faced with placing a loved one in a nursing facility, the prospect of substantial costs for this long-term care can be intimidating. It helps, therefore, to understand what costs can be expected, what kind of care and service this money will provide, and what options are available to persons about to enter a nursing facility.

We have stressed selectivity in the type of facility you choose. As your doctor will tell you, you do not need a higher quantity of services than the situation requires. Applying your choice to the needs of the individual will help keep down your health care costs and allow others in greater need of more services to obtain them. Remember that many nursing facilities have waiting lists.

When meeting with nursing facility administrators and social service personnel, discuss financial conditions in detail. All financial agreements should be in writing, and you should have a copy of the final arrangements. You may wish to cover the following areas in advance:

• How are payments covered, whether Medicaid, insurance or self-pay?
• How are cash and assets entrusted to the home protected? Is a receipt given to the resident? Do signed receipts note withdrawals, so that the resident can keep track of his/her account?
• Are the agreed date of admission and the degree of care to be furnished set forth in the written agreement?
• Will the resident receive a refund of advance payments if he/she leaves the facility?

There are many ways to finance nursing facility care. These might include Social Security payments, your own funds, assets in escrow or as an endowment, assistance from Medicare or Medicaid, or from private organizations such as veterans' groups, trade unions, fraternal organizations, or health insurance plans.

Some insurers provide nursing home coverage and, in addition, specialized long-term care insurance policies are available. Be sure to check with your agent and/or group insurer to see what your benefits are. The administrators of the homes you visit can help in your financial planning under these methods or under Medicaid and Medicare.

It helps to know what your long-term health care dollar buys.

While every situation is likely to be just a little different because of the type of long-term care facility and the service required for each individual resident, there are certain generalities which we can draw.

• 46 percent of the long-term care dollar goes for direct medical care: nursing staff, doctors, therapists, dentists, and other health care professionals.
• About 16 percent of your long-term care dollar goes for housing costs: resident rooms, kitchen, dining and activity areas; utilities; and specific accessibility requirements imposed by the government.
• About 11 percent of your long-term care dollar goes for dietary services: required nutritional levels and monitoring as well as actual food costs.
• About 10 percent of your long-term care dollar goes toward "quality of life:" activity pro-grams; housekeeping, laundry, maintenance, supplies, and infection control; chapels.
• Administrative expenses account for 14.5 per-cent of your long-term care dollar: licensed administrator, record keeping and clerical personnel; equipment and supplies.
• About 3.5 percent of your long-term care dollar goes to profit: Seventy-five percent of Ohio's nursing facilities are owned by a private individual or corporation; profit is the reward for the risk involved in making health care services available.

MEDICARE, administered by the Social Security Administration, is a federal insurance program for 1) persons 65 and over, or 2) persons disabled for at least two years, or 3) persons suffering from chronic kidney disease. Medicare pays for only two percent of the nursing facility care provided nationwide.

If certain criteria are met, Medicare may pay the bill (for covered services only) for the first 20 days in each benefit period. Experts on Medicare determine the amount to be paid, which the nursing facility can accept as full payment. Some of the bill can be paid for covered services for up to an additional 80 days, if the patient qualifies.

The Medicare patient's case is, however, routinely reviewed by the Social Security Administration. When these reviewers determine that the patient no longer requires skilled nursing facility services, Medicare payments are ended.

MEDICAID, on the other hand, is a federal-state financed assistance program for certain needy and low-income persons of all ages. States design their own programs within broad federal guidelines. Thus, Medicaid programs will vary from state to state. Medicaid pays only for basic care needs, excluding amenities such as private rooms, etc.

You may need to complete applications for both Medicare and Medicaid. Please discuss this with your social worker, the facility's administrator, or local aging office.

Data on Ohio's regulations are available from the Ohio Department of Human Services, which administers the program in Ohio, and your county aging, ombudsman or Human Services office.