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Managing The Stress ~ Making The Decisions ~ Discovering The Meaning |
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Caregiving |
Solutions To Your Caregiving Situations Throughout Your Caregiving Years |
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Nursing Home Placement What you need to know: Planning ahead Plan for the potential of nursing home placement by budgeting, and if at all possible, saving at least money to pay for one year in a nursing home. It’s much easier to find a good nursing home if you can pay privately for a short period of time. And, when searching for a facility, be sure to understand whether or not a facility accepts Medicare (the federal insurance program, typically for persons 65 of age and older) and Medicaid (the federal program administered at the state level for individuals with a qualifying low income, regardless of age) benefits. A care recipient will be eligible for Medicaid benefits when assets have been exhausted. If you spend assets in a nursing home for a period of time, you want to ensure that your care recipient can remain in that same facility with Medicaid benefits.
Medicare benefits Medicare will pay for short-benefits in a nursing home as long as certain quality criteria are met, including a three-day hospitalization. If your care recipient is hospitalized for at least three days, you can consider nursing home placement (short-term initially, with the possibility of long-term placement). It may be easier for nursing home placement upon discharge from a hospital. Here’s an overview of Medicare benefits in a nursing home: Medicare may pay for up to 100 days (with a co-pay kicking in on Day 21) in a skilled nursing facility after a three-day (three midnights, actually) hospitalization and if the patient has a skilled need as ordered by a physician. A skilled need is treatment that must be administered by a licensed professional, such as a Registered Nurse (but not a LPN or CNA), physical, occupational and/or speech therapist. The patient must show regular improvement in order for the benefits to continue. When progress plateaus, benefits end. There is no guarantee that Medicare will pay for the full 100 days. If your care recipient goes to a facility, receives rehab and then goes home after 27 days of Medicare benefits, is home for 10 days, falls, then she can go back to the facility and pick up where she left off on her Medicare benefit (Day 28 of Medicare benefits) as long as she’s readmitted within 30 days of being discharged from the nursing home. In this case, a care recipient does not need to be hospitalized in order to continue receiving Medicare benefits. A care recipient can only use the 100-day benefit once within a benefit period. Medicare defines a benefit period as: “A benefit period begins the day you go to a hospital (or under special circumstances, a skilled nursing facility). The benefit period ends when you have not received any hospital (or skilled care in a SNF) for 60 days in a row.” Spousal Protection If you place your spouse in a nursing home, you may worry that you’ll have to deplete all your assets to pay for your spouse’s care. Medicaid does protect the spouse who remains at home. The spousal impoverishment rules allow you to retain up to $95,100 (in 2005, levels change annually) in assets, as well as a monthly allowance of up to $2,377.50 while qualifying your spouse to receive Medicaid benefits in the nursing home. In addition, the at-home spouse keeps the residence and any other exempt assets, such as household goods, personal effects and, in some states, IRA’s. Other allowances can be made for an at-home spouse, which differ from state-to-state. An eldercare attorney and financial planner can work with you to ensure you and your spouse are both cared for. In addition, your local Area Agency can provide more details; call the ElderCare Locator at 1-800-677-1116 for a referral to your local agency. As of December 2003: Total number of nursing homes in U.S.: 16,291 Number of patients in a nursing home: 1,450,319 Percentage of Medicare patients: 11.32% Percentage of Medicaid patients: 66.31% Other: 22.36% State with the fewest number of facilities: Alaska, 14 facilities
As of August 2003: The average cost nationwide for a private room in a nursing home is $181 per day. The average nursing home stay is 2.4 years at a total cost of about $159,000, according to the study. Source: MetLife Mature Market Institute
According to the U.S. Administration on Aging, on average, men and women who reach age 65 can expect to live until the age of 81 and 84 respectively. The longer people live, the greater the chance they will require assistance with Activities of Daily Living (ADLs) like toileting, transferring, bathing, dressing and eating. Statistics show that new nursing home residents require assistance with at least four ADLs, making it difficult for them to receive home care.
According to the National Academy for State Health Policy, in 2002, there were 36,399 assisted living facilities (ALFs) in the United States, an increase of 48% from 1998.
In 2003, the average monthly cost of an assisted living facility was $2,379 or $28,548 annually. (Editor’s Note: Additional charges may apply if companions/home care workers must be hired to provide care.) Source: MetLife Mature Market Institute
According to data from the National Center for Assisted Living, the average length of stay in ALFs was approximately three years. Ninety-three percent of ALF residents need and accept help with housework and 86% need and accept help with daily medication management.
Two-thirds of ALF residents pay out-of-pocket; about 13.5% pay with funds from Supplementary Security Income (SSI).
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