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Nursing Home/Long Tem Care Costs

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Putting Mom and/or Dad in a Nursing Home is never an easy endeavor.  On top of all of the emotional turmoil, the truths and un-truths you’re told in the hospitals or by marketers, you have to think of costs. It can feel like a rollercoaster!

First, I would say to take a look at the CMS Five Star Rating of Nursing Homes you are considering. You can get this here:  Five Star Rating .  In my opinion, anything less than a three-star rated nursing home, you should stay away from, no matter what is promised.  Pay particular attention to the Staffing. If the staffing is 3 stars or more, the other ratings tend to be higher. It’s the trend, watch for trends. The higher the staffing ratio, the more care you can see given to the patients and residents and the rest falls into line.

But the area in which CMS fails to measure is how you or your loved one are going to pay for the care and stay in the nursing home.

Let me clarify a few things.

  1. Medicare (Traditional Medicare NOT Managed care/HMO plans) will cover up to 100 days of care. Up to, being the operative words. Only 20 of these (the first 20) are covered at 100% cost. Begining on day 21 all the way through day 100- You or your loved one, are responsible for the copay each day. Medicare determines this rate and it increases every year, it is currently $167.50 per day. There is a couple of ways to cover this cost, have a supplemental insurance that covers this co-insurance portion specifically, and no, the basic C-Plus plan they probably have doesn’t cover it. Look for AARP’s, BCBS Plan F or Tricare for Life to name a few. You could also already be covered by Medicaid. If you don’t have coverage, just know, you will be coming out of pocket for this, and if you signed your loved one into the facility, know that you could be liable for the cost and they will pursue you for it.
  2. Regardless of what you are told by the hospital or any marketer, if you sign the Admission paperwork, you ARE responsible for the costs or assisting in obtaining Medicaid Approval for Long Term Care coverage. And no, just because granny or grampy has Medicaid, doesn’t mean they qualify for Nursing Home Medicaid Coverage. It’s an entirely different program.
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Let’s go over a few items to help. If your loved ones are 60 years old or older, begin planning. There is a five-year look back period for Medicaid, which mean they will check all assets within the last 5 years, including the bank statements and they most certainly will ask why granny pulled out $200 from the ATM, or why is she giving away money at Christmas. Just expect it.

Property: If your loved one owns the property, as in 1 (ONE) property, then it will be excluded, but the state will force a “voluntary” lien on it. It is best to deed it over to a family member(s) at least five years prior to entering into the nursing home. If it is done within the 5 years look back period or when they are already in the nursing home, they will not be eligible for the states Medicaid benefits even if it’s no longer in their name. This means they will be private pay for however long the time is, equal to the value of the property. It can be substantial! Again, if you signed them into the facility, then you could be liable for this cost. This also goes with the same of selling the property within the 5 years look back period. Let’s say you sell granny’s property for 50K but it’s showing a tax assessed value of 100K, then granny, ie (YOU) will be penalized the remaining 50K. You will owe this to the nursing home or the cost of stay until reached. Best not to try any shady business, the nursing home, the state will both come after you. This could fall under the financial abuse of the elderly which is done far more often by family members than it ever is at the healthcare facility, in fact, less than 5% of healthcare companies have financial abuse cases.  If you have multiple properties, sell them and utilize the funds properly, pay for the care. Their money is not your right, it’s not yours, it’s theirs to pay for their care. Do not attempt to plan for Medicaid within the five year lookback period by moving property and funds around, this is against what the states allow all 50 of them.

Granny must also have less than 2K in liquidable assets/4K in some states. If they have life insurance with cash value, you need to take the policies to the funeral home and ask for a pre-need funeral arrangement. This will exclude the values, up to the limit which varies depending on the state.

Another note- your loved one’s income will have to go to the nursing home. This is because the state (if approved Medicaid) will pay the difference between the income of the resident and the monthly rate. The is a caveat to Medicaids agreement to pay the difference, and that is that the income from the resident goes to the facility. You need to understand, that if it doesn’t get paid, then the facility and the state can pursue you if you signed them into the facility, make no mistake about it, they will. Civil as well as criminally, so think before you act.

The best advice I can give is that you prepare for your loved one’s needs. Go and visit an attorney. Not the family attorney either, they will be useless, go to an elder care attorney. They are able to do many things and they can guide you and assist you through this already difficult process. They aren’t expensive and they could save you and your loved one a ton, including your sanity.

Long Term Care Insurance policies are expensive and have many rules, so read them carefully.

white oval medication pill beside blister pack

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It surprises me how many people don’t understand their own basic Medical coverages. Almost as surprising as how many family members take advantage of their loved one’s income. And with all of that, people decide to file frivolous lawsuits. Some are completely reasonable, but most are just people trying to get a quick buck. This is why you see so many ambulances chasers, otherwise known as Attorneys, advertisements on TV.

To help you with the Medicaid Rules in your state, take a look here. Medicaid

In the end, follow some simple rules.

  1. Know your state’s laws and requirements.
  2. Properly plan ahead of time, not when the time comes you need coverage.
  3. Do not, under any circumstances misappropriate funds.
  4. Do not co0mingle your funds and granny’s funds. This usually ends poorly.
  5. Be in the know and be honest with your healthcare Center. They are there to help you because it also helps them. So be honest.
  6. Traditional Medicare over Managed Medicare at this stage no matter what is promised by the insurer. The majority of managed care stays are less than 40 days. It’s their obligation to provide coverage up to the next level, not to bring your loved one back to the level they were prior. They will cut benefits off quickly and you can appeal all you wish but in the end, if you lose the appeal, you will be liable for the costs incurred. Managed care insurers are designed to Manage the Cost of care for Medicare, think about it. If they can reduce paying for the care they will, even at the cost of your loved one’s recovery. Keep this in mind.
  7. Be involved in your loved one’s plan of care. Long-Term Care facilities love to have family involvement. Care is a collaborative effort. Share thoughts and ideas with the facility’s Administrator. Keep in contact with the business office, they will help you steer clear of costs due to errors.
  8. Talk with the marketing department prior to going to the facility, ask questions and request to speak with the Administrator, the Director of Nursing, Director of Therapy and the Business Office. Ask questions. These four department heads can play a large role in reducing your own stress and burden.
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