Living in a Nursing home is expensive. The average cost of Long Term care in The U.S. is enough to break all but the most prosperous of us. On average, a semi private room in a home today runs between $150 and $250 per day. That is only the base cost. Room, board, nursing care and meals. Three hots and a cot, so to speak.Medication, Therapy, Lab work, wound care and other ancillary services are extra.The median cost of a one year stay is approximately $70,000, according to a January, 2006 study by The Center for Medicaid Services.
Sooner or later someone you care for is going to need the services of an Extended Care Facility. Whether the stay is for short term rehabilitation or a long term, here for the duration stay, someone has to pay for it. This article's purpose is to inform you of the different financial avenues that may be traversed when Granny goes to the Nursing home.
Medicare
The first avenue to consider is Medicare. Medicare will pay for a one hundred day Nursing home stay, for qualifying illnesses. They pay 100% of the first twenty days, and 80% of the next eighty. All Medicare recipients are entitled to one hundred days of inpatient skilled nursing care per year. This can be broken into several stays, if necessary.
To qualify for a Medicare stay, the resident must first qualify for Medicare. Most persons receiving Social Security Benefits also qualify for Medicare. Check your loved one's policy however, several of the Medicare HMO's, such as Medigold, will only cover fourteen days per spell of illness.
They must have a three day hospital stay. This means three consecutive nights as an admitted patient.
Even if Granny is taken home after the hospital stay, and is later admitted to the Nursing Home, Medicare will still cover it, as long as it is thirty days or less since the hospital stay, and the cause of the Nursing Home admission is related to the hospitalization.
Once in the home, the criteria for maintaining the skilled Medicare status is simply, show progress in one of the therapies, or maintain an unstable status. This means that Granny cannot be admitted to the home and refuse her Physical Therapy every day in favor of watching TV or sleeping.The idea is to get Granny back home.
Private Long Term Care Insurance
Talk to Granny's provider as to exactly which services are covered. I have found that the majority of private policies are sorely lacking.
Private Pay
This means Granny, or her responsible party writes a check to the Nursing home every month, a big one.
Medicaid
Medicaid will pay 100% of Granny's nursing home stay, if she qualifies. To qualify for Medicaid, Granny can have no assets greater than $1500. She can keep her home if her spouse is still going to reside there, or if the Nursing home stay is expected to be less than six months or so.
Some Grannys transfer assets out of their name and into another's prior to becoming incapacitated, purposely to qualify for Medicaid,The law has changed on this matter. A person must transfer assets a full five years prior to applying for Medicaid Nursing Home services. The law used to be three years, but Medicaid figured out that many families were transferring major assets, homes, cars, property, boats, into their children's names, then entering the nursing home on the government's dime. For some reason, they frown on that.
While I hope that everyone's Granny can remain in her own home, healthy as an ox, forever, I know it happens to the best of us. Someone's someone is going to need full time Nursing care, and
I hope I have helped ease the burden for just one.
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Comments: 24
Sorry, hon, that wasn't my intent, but here, have a tissue...
Jessie,
Better to think of it now, than when a tragedy strikes. Thanks for the input.
To be honest, Cheryl, all but the most substantial homes barely break even, due to the rising costs of medication, salaries, equipment etc.. My choice is a non-profit, hands down, as every nickel that goes into the home must be used within the home. Medicare and Medicaid payments barely cover expenses, let alone, line the coffers. Patients who pay privately are the most lucritive, but they are few and far between. If a home is licensed to accept public funds, then they MUST admit them if a bed is available, even if they lose money on them.
These people did nothing wrong except living beyond being self-sufficient. Some nations, others than ours, place a lot more importance on taking care of their seniors. For some reason, we here in the U.S. seem to think we will never get old, and that the people who are old were born that way.
If I had my way, every nation on this earth would spend a lot less money on the military and a lot more on caring for seniors. It is my belief that this would bring a lot more peace to the world than pointing guns at each other.
Be careful, you just might get what you wish for
Cindy,
I'm sorry about your father in law, I have a Mother in law in the same boat, luckily my late hubby's family can afford home care.
George,
Some of those old folks are absolutely the greatest. I agree with you. The US is the only country that routinely throws away their elderly. Most cultures revere their patriarchs, and keep them at home if at all possible. I know numerous elders who were placed in a facility just because their families were "too busy" to care. As for their giving up all they possess, I had an exercise for my students to demonstrate the losses they face. I would ask them to write down ten things they absolutely cannot live without. Then I tell them to delete three, then another three, and another, leaving only one thing. I tell them that this is only an inkling of what it feels like to lose everything near and dear to move into the home.
The Social Security benefit is on its way out unless we do something about it now, which is an additional piece to this grave dilemma (no pun intended).
First of all, "multiple 100 day stays" in a calendar year is a misnomer. Granny will be entitled to another 100 day stay ONLY if her subsequent illness is not related to illness #1. Also, should Granny require a 3 day hospital stay within the first 30 days of discharge from the SNF, related to the original illness, she can then be readmitted for the remaining days of the first 100.
I am well aware of the co-pay for days 21-100, but in the PPS system, $128 is a base cost. If your MDS nurses are doing their job, their RUGS score will make the actual cost surpass the base.
Also, while, in Ohio, the only state I can base my knowledge on, again, if your MDS nurses are doing their job, $160/d is a pretty low average for an SNF. $160/d from Medicaid is for the lower RUGS groups, PA1-PE2, or so, but I do not have the exact data in front of me.
You do have a point about Medicaid paying poorly, but again, if your MDS nurses are worth their salt, you will have very few lower RUGS in any given quarter.
Also, this article was written OVER a YEAR AGO, as a general guideline for laypersons, not those in the profession. Did you join Gather expressly for looking up this article? As I see it is the only one you have commented on? May I ask why?
FYI, I have been an MDS nurse(spelled G-U-R-U) for 25 years, since it was a two page, hand written document.