Please talk to me about nursing homes/Medicare

[magdala9]

Here is the Medicare website that breaks down what they tell people.

Assisted living facilities provide some care in addition to housing, usually meals and help with remembering to take pills. Nursing homes generally have full time nurses on staff 24/7. You may want to have a long talk with your grandpa to find out his wishes.

Good luck and I hope this helps.

[BAMFMrsB]

good article about the difference:

newoldage.blogs.nytimes.com/2011/06/10/assisted-living-or-a-nursing-home/

We looked in to a nursing home for FIL that was VERY nice and it did have I think 2 medicare beds, but it was over $5k a month. He absolutely does not have that kind of $$$$. He is in a decent place now. He haaaaaaaaaaaaaaaates it because it is not his home, but he is not independently wealth and therefore CANNOT afford 24-hr in home care. Where he is now is his ONLY option.

Anyways. I believe he has to have a certain amount paid to medicare each month because he has "income" through SSD and a plan through AETNA. I'm not sure on the details, but he is left with VERY little $$$ every month. He is renting out his house but the rent $$$ only pays his house note. He made some very poor $$MM choices prior to going in to the nursing home so his bills eat up a lot of his 'income'. (He took out an interst only mortgage, racked up his CCs on a new HUGE TV and appliances.... and now he doesn't even live in his house )

[gtkim]

I don't think all assisted living places have a buy in. I know the one my Grandmother was in did not. It was over $4K/mo.

[indianchica]

I have also only had experiences with Medicaid, not Medicare. I know that is not what you asked, but you may want to look into that. But the requirements are very low - in 2007 or so, you could only have $5K in your bank account, although personal property such as home or car were not included in the $5K amount. We had a very good experience with it, although the paperwork can be tiring (I did all of it so I know).

Nursing homes in our area were around half the cost of assisted living. Assisted living did not take Medicaid at all and nursing homes did. That, combined with the fact that the level of care needed was a 24/7 type, made us choose nursing home.

Good luck with your situation.

[hockeywife]

Are you in NY?

If so, it is highly unlikely that Medicaid will pay for assisted living. There are none in my general location. Downstate may vary somewhat.

To qualify for Medicaid in NY as a single individual you are only allowed $14,250 in assets (plus a car, a prepaid funeral, and a small life insurance policy).

NHs in NY range from 9-15k per month. All of the Nursing homes in my area accept Medicaid, even the really nice ones.

NHs are for people who require more care, but there can be some pretty high functioning people in NHs, too.

[hlke]

Assisted living/nursing homes/long term care involves a lot of very complicated rules. I do this stuff for a living and still don't feel comfortable counseling people about it. I would first have a conversation with your grandpa about what he wants. Does he want to move somewhere long term? Is he willing to sell his house, or does he want the option to go back? If in the future he needed a higher level of care, would he be willing to move facilities or does he want a place that he can stay for the rest of his life?

Then I would find a financial planner or lawyer who specialized in long term care and estate planning. They will understand the federal laws, your state's laws, and any assets tests or spend-down requirements.

Medicare pays for long term care in very specific circumstances, and almost always in connection with being discharged from the hospital. The most common arrangement for people with high assets is for them to pay out of pocket. The most common arrangement for people with few assets is to spend down their assets until they are eligible for Medicaid, which pays for long term care if it is medically necessary.

Here's the Medicare website about long term care:

www.medicare.gov/LongTermCare/Static/Home.asp

and the page about paying for long term care:

www.medicare.gov/LongTermCare/Static/PayingOverview.asp

Assisted living is usually not covered by Medicare or Medicaid, but nursing home care can be covered by both in specific situations.

Edited for spelling and clarity.

[panicked]

I know when my grandmother went into a nursing home about 5 years ago, they had a hell of a time getting Medicare to pay. Even though she had very few assets, Medicare had a 5 year look back. Five years prior to her needing care, she had a fair amount of money and assets.

[expatpumpkin]

Is he a wartime veteran? If so, he'll most likely eligible for $1,703/month to help pay for private assisted living. He does not need to be broke for this program. Also, I would NOT recommend a buy-in assisted living facility. Let me know if he's a wartime vet, and I can give you a lot more info.

[5thofjuly]

Medicare would only pay for 99 days or rehabilitative nursing home care for my grandfather. After that, he had to spend down his assets so that Medicaid would pay.

[lys]

Medicare only pays for a shorter rehab period of time. For someone poor you are talking about Medicaid - and that is only if you NEED to be in a nursing home. Nursing homes tend to limit the number of beds available to medicaid since the reimbursement is so low.
There are income and assett limits and lots of guidelines. You would be wise to talk with an Elder Law Attorney for advice on how to proceed to qualify for assistance financially. There is generally a "look back" period to see how much money was gifted, donated etc and he is only allowed a limited amount of assets so might need to sell house etc.

[SusanBAnthony]

We just went through this with my Grandma. She was initially paid for by medicaid for the 90 days of rehab. After that, my uncle pad for it with her money (she was in no way handling her own finances at this point). Once she ran out of cash, the nursing home was paid her monthly pension and SS (which was less than the total bill) and her house was put on the market. Once her house sold, the back bill to the nursing home was paid, and then monthly my uncle paid the bill from the house money. She died before all the house money was spent, but if she had lived longer, medicaid would have payed the full bill once she spent down all her money.

A few years before she went to the facility my uncle (her POA) saw the writing on the wall and started gifting himself the maximum legally allowable amount. He saved it so that if it got to the point of her having no money left, he would have 5 or 10K in the bank for whatever she needed. Stuff like, she needed a wheelchair, and medicare will pay for a basic model. So he payed a few hundred for her to have a nicer chair. Etc.

Her home had private pay beds and medicare beds. If you were already a patient, you could stay once you switched over to medicaid but they did not accept new medicaid patients. A lot of homes around here are like that. For that reason, I would put my family member in a home and pay OOP to exhaust their money, rather than paying OOP for in-home care.

[imojoebunny]

My grandfather lived in assisted living until recently. He has been there for about 7 or 8 years. There was no buy in. He had a nice two bedroom 2 bath apartment with a living room and kitchenette, and a very large balcony. With 3 meals a day and cleaning, he paid about $36k a year. The smaller places, effiencies or 1 bed 1 baths are about 6-10K less. His assisted living also provided regular transportation to doctors, grocery, and off site activities, like plays, church, visits to various points of interest, as well as, on site activities daily. He was quite happy there. He was recently moved to a nursing home because he now has an irrevokable feeding tube due to health problems, but he is 94, and was doing well until that had to be put in several month ago.

His nursing home is $6k a month plus additional cost for any services he receives like PT or doctor care. He is self pay, so I don't know about Medicare.

[pugz]

medicare will not pay for any kind of long term care, it is only for rehabilitation stays after 3 midnights in a hospital after illness/injury/surgery. 20 days at 100%, 80 days at 80%, and they renew after 60 days.

medicaid is based on assets (with a 5 year look back) so there is a spend down before they will pay for long term care. Not all facilities take medicaid. Some nursing homes do, some do not. Not all assets have to be liquidated but all social security & pension checks go towards the cost of care and then medicaid pays the remainder.

as far as I know assisted living has to be paid for privately, medicaid only pays for long term care in a nursing home. Some people have long term care plans that will pay for assisted living facilities.

my best advice is for the family to meet with a lawyer specializing in elder care law, they can walk you through all the financial pieces regarding to medicaid. Also look for a facility that has multiple levels of care, assisted living, medicare beds, and long term care beds that qualify for medicaid. This is the least disruptive option as the individual can move around as needed to the different levels of care and still be in the same "community"

[pugz]

Another option is independent living or senior housing. They are for people that are still very independent. Basically handicap accessible apartments for seniors that are typically pretty reasonably priced. There are no services available but there are pull cords in the bathroom/bedroom/etc. to call if they fall.

Medicare will pay for home health services after an illness/surgery/hospitalization for a limited amount of time. This includes visits from a nurse a couple of times a week, PT/OT/speech therapists, a bath aide, and a social worker.