Paying for Nursing Home Costs: A Guide to Medicare, Medicaid and More

Navigating the myriad of ways to pay for nursing home care can be overwhelming. However, with a clear understanding of nursing home costs and the options available, it becomes manageable.

Understanding Nursing Home Costs

Nursing home costs nationwide can be daunting. In 2021, a semi-private room in a nursing home averaged $7,908 per month, with private rooms at $9,034. Even assisted living facilities, which offer a lesser level of care than nursing homes, can run upwards of $4,500 a month. Most people who enter nursing homes start by paying for their care out-of-pocket by using their savings or accessing equity from large assets like real estate. It’s clear that understanding these costs is crucial for anyone considering nursing home care.

What are the Nursing Home Care Private Pay Options?

Private pay remains a choice for those who either don’t qualify for Medicaid or prefer not to use it. This method involves tapping into personal assets or savings to pay for nursing home care. It provides more flexibility in terms of choosing the facility or level of care. However, it can quickly deplete one’s assets.

Does Medicare Pay for Nursing Home Costs?

Medicare is a federal program and primarily focuses on medical care, not long-term care. Medicare will not pay for long-term care in a nursing home facility. It will pay for a limited amount of time for skilled nursing care following a hospital stay but not for extended nursing home stays. Seniors also still need Medicare coverage for hospital care, doctor services and medical supplies while living in the nursing home. Understanding the specifics of what Medicare covers can help families plan better.

What kind of nursing home care does Medicare cover? Medicare primarily covers skilled care, which is care that can only be delivered by trained professionals. It doesn’t typically cover custodial care, which is personal care, like bathing or dressing.
How much does Medicare pay for skilled nursing home care? Medicare will cover the first 20 days of skilled nursing care at 100%. Beyond that, up to 100 days, a co-payment is required. After 100 days, Medicare will no longer pay for skilled nursing care.

Using Medicaid to Pay for Nursing Care

Medicaid is a popular option for many seniors needing nursing home care. It caters to those with limited income and assets. It is the primary payer for long-term care coverage nationwide.

Who’s eligible for Medicaid nursing home coverage? Medicaid is a joint federal and state-run program. Eligibility varies by state but generally requires meeting specific income and asset limits. Most states also have a look-back period of five years to ensure that assets weren’t sold or given away to qualify for Medicaid.
How does one apply for Medicaid, and what does Medicaid cover? Applying requires detailed financial documentation. Medicaid can cover a large portion of nursing home care costs. However, it might limit the choices of facilities. Working with an experienced elder law attorney to apply for Medicaid is not required. However, it can increase your chances of success by providing guidance, ensuring accurate documentation, and addressing any issues or appeals that may arise.
Do all nursing homes accept Medicaid? Not all nursing homes accept Medicaid. It’s essential to research and find facilities that both provide the level of care needed and accept Medicaid as a payment option.

Long-Term Care Insurance: Is It Worth It?

Long-term care insurance is designed to cover long-term care costs that Medicare and private health insurance don’t cover. This might include nursing home care, assisted living, or home care. However, the coverage depends on the policy details, and premiums can be high. In addition, the older one is, the harder it is to be considered insurable.

If long-term care insurance is an option, be sure to start planning early. Insurance companies are known to reject more applicants the older they get. Reviewing insurance plans each year to ensure that the policy still meets anticipated needs is essential. Make changes if necessary, and never stop paying the premiums so that the insurance does not lapse.

The Role of VA Nursing Homes in Elder Care

For veterans, VA nursing homes can be an option. These facilities are dedicated to providing care to veterans and may be more affordable than private facilities.

Making the Right Decision: Private Pay vs. Medicaid vs. Medicare

The decision often comes down to personal finances, care needs and eligibility. Understanding the differences between these payment methods can lead to more informed choices. As the demand for senior care services grows, it’s predicted that the cost of nursing home care will continue to rise. Planning ahead becomes even more essential.

Working with an Elder Law Attorney: The Best Way Forward

Consulting with an elder law attorney can provide invaluable insights and assistance in navigating the complexities of nursing home costs and payment options.

Planning ahead is crucial. The more you know, the better decisions you can make for yourself or your loved ones.

What Should I Know About Parkinson’s Disease?

Parkinson’s disease is a progressive disease of the brain and nervous system that impacts an individual’s ability to move. However, those with the disease can have a range of symptoms, some unrelated to movement. Not everyone with Parkinson’s will have the same symptoms or experience them to the same degree.

VeryWell Health’s recent article, “Researchers Find 2 New Early Signs of Parkinson’s,” notes that common Parkinson’s symptoms include the following:

Motor symptoms
Muscle stiffness
Slowness of movement
Tremors
Non-Motor Symptoms
Constipation
Low blood pressure
Sexual dysfunction
Frequent urination, incontinence, or difficulty emptying the bladder
Mood or Cognition Problems
Apathy
Memory problems
Depression, anxiety, and
Psychosis.

Other Symptoms include:

Drooling
Pain
Decreased ability to smell
Speech problems
Changes in vision
Sleep problems
Excessive daytime sleepiness; and
Fatigue.

The timing of when a person starts having symptoms that could be a sign that Parkinson’s can also impact when they will be diagnosed. The new study found that many common symptoms of Parkinson’s—like tremors and memory problems—may appear many years before the diagnosis.

“Tremor, which is one of the most recognizable symptoms of Parkinson’s, was seen ten years before eventual diagnosis in our study,” Cristina Simonet, MD, a neurologist and a PhD candidate at Queen Mary University of London and the lead author of the study, told Verywell. “This is too long for patients to wait.”

Primary care providers play a critical part in recognizing the symptoms of Parkinson’s sooner. If they do, they can refer a patient to a specialist to diagnose or confirm it. There’s no cure for Parkinson’s. However, an earlier diagnosis is the key for ensuring that patients can access support sooner.

Reference: VeryWell Health (March 30, 2022) “Researchers Find 2 New Early Signs of Parkinson’s”

What Is Elder Law?

The U.S. population is aging, and baby boomers, the largest generation in history, have entered retirement age in recent years. Yahoo Finance’s recent article, “Elder Law Is More Important Than Ever. Why? Baby Boomers,” says that medical care has extended life and physical ability and grown more sophisticated.

“Questions surrounding mental competence, duration of care, and nature of treatments have become increasingly difficult to answer. The result has been a medical system that often implicates legal questions of individual autonomy, with some of the highest stakes that the courts recognize,” the article explains.

Estate Planning. Trusts and estates is the area of the law that governs how to manage your assets after death. You create trusts to hold, oversee and distribute assets according to your instructions. While they can be created when you’re alive, most establish trusts for handling their property after they’ve passed away.

Disability and Conservatorship. As you get older, your body or mind may fail. This is known as incapacitation. It is generally defined legally as when someone is either physically unable to express their wishes (such as being unconscious) or mentally unable to understand the nature and quality of their actions. If this occurs, you need someone to assist with activities of daily living. Declaring an individual mentally unfit or incapacitated is a complicated legal and medical issue.

Power of Attorney. Most seniors use power of attorney to plan for two main situations: (i) a medical power of attorney for family members to assume your care in the event you’re physically incapacitated for some reason, and (ii) a general power of attorney allows you plan for someone to manage your affairs, if you’re judged mentally incapacitated.

Medicare. Every American over 65 will most likely deal with Medicare, which provides no-cost or low-cost healthcare for those 65+. Almost all seniors enroll to receive at least some medical benefits under this program. Health care becomes an increasingly important part of your financial and personal life as you age. It’s important for the elderly to know their rights and responsibilities regarding healthcare.

Social Security. This is the retirement benefits program to help ensure that U.S. seniors have money on which to live. For senior citizens, understanding how these programs work is often essential. This is particularly true given the increased footprint that medical care plays in the lives of senior citizens and the complexities brought on by increasingly mobile seniors.

Reference: Yahoo Finance (Sep. 13, 2023) “Elder Law Is More Important Than Ever. Why? Baby Boomers”

What’s the Latest Problem with Veteran Benefit Claims?

“VA.gov has gaps, and veterans are falling into them,” said Rep. Matt Rosendale, R-Mont., who chairs the House Veterans Affairs subcommittee on technology, during a hearing recently. “This is a situation where the VA is badly in need of independent oversight.”

Military Times’ recent article, “Lawmakers demand accountability after VA loses track of vets’ claims,” reports that in August, VA leaders announced they’d found roughly 32,000 veterans’ disability claims delayed. Some of these cases date back years because of technical flaws in the department’s VA.gov filing systems. Two weeks later, officials acknowledged 57,000 more similarly delayed cases involving veterans trying to add dependents to their accounts.

VA officials said they would backdate veterans’ pay as soon as possible. However, the errors may have delayed potentially thousands of dollars in monthly payouts to individuals suffering from military-related illnesses or injuries.

Veterans Affairs Chief Information Officer Kurt DelBene noted that the errors are just a small portion of the more than seven million cases filed since early 2018. However, he also acknowledged that any mistake that causes financial harm to veterans is unacceptable.

“VA will resolve these issues, prevent them from happening again, and address them more quickly when needed,” he told lawmakers. “And most importantly, we’ll make sure that all impacted veterans get the benefits and services that they deserve as quickly as possible.”

However, several lawmakers said those promises aren’t enough.

“I think we have a problem with addressing the major issues in leadership and officials not being held accountable for things that they do or do not do in upholding their responsibilities to veterans,” said Rep. Morgan Luttrell, R-Texas. “My concern is that no one is holding [anyone] responsible for this.”

Earlier this month, in a letter to VA leadership, committee Chairman Mike Bost, R-Ill., commented that the problems are “just the latest in a string of electronic filing issues that continue to plague the department.”

Reference: Military Times (Sep. 26, 2023) “Lawmakers demand accountability after VA loses track of vets’ claims”

Should I Consume Olive Oil Every Day?

A study presented at NUTRITION 2023, the annual meeting of the American Society of Nutrition, looked at how olive oil intake and dementia-related death could potentially be connected. Prevention’s recent article, “Olive Oil Linked to Lower Risk of Dying From Dementia, Study Shows,” reports that researchers looked at data from more than 90,000 Americans—60,582 women and 31,801 men. The study took place over 30 years in which 4,749 participants died from dementia.

Researchers found that participants who consumed more than ½ a tbsp of olive oil each day had a 28% lower risk of dying from dementia than individuals who never or rarely consumed olive oil. They also saw that switching 5 g (or about 1 tsp) a day of margarine or mayonnaise for olive oil was linked to an 8–14% lower risk of dementia-related death.

The study noted that those who died of dementia were more likely to be APOe4 carriers, a gene that increases the risk of Alzheimer’s disease. However, they said the results were still consistent after adjusting for the genetic risk factors.

These findings suggest that olive oil may have beneficial properties for brain health and may play a part in lowering the risk of dementia-related death.

With its antioxidants and powerful anti-inflammatory compounds, olive oil has many health-protective benefits. Generally, olive oil may help reduce the risk of heart disease, boosting gut health, protecting brain health, and improving health parameters, like A1C levels associated with type 2 diabetes.

Diets like the Mediterranean diet that are rich in unsaturated fats have been found to have cardiovascular health benefits. Plus, studies have found that this diet plays a role in reducing the risk of cognitive decline in individuals at risk of dementia.

“Because olive oil is a source of unsaturated fat and a major component of the Mediterranean diet, incorporating olive oil into a healthy lifestyle may provide additional cardiovascular and brain health benefits,” the article explained.

Compared with rarely or never enjoying olive oil, having more than 1½ tsp of olive oil a day may be linked with a 25% reduced risk of fatal dementia. So, keep a small bottle of extra-virgin olive oil on the table so it’s available for drizzling onto your meals for its various health-protective benefits.

Reference: Prevention (July 29, 2023) “Olive Oil Linked to Lower Risk of Dying From Dementia, Study Shows”

Can My Barber Help Me Live Longer?

Up to 1 in 5 Americans will develop skin cancer in their lifetime, notes the American Academy of Dermatology.

What’s more, the rates of melanoma, the deadliest form of skin cancer, have increased in recent decades, reports Livestrong’s recent article, “Want to Age Well? Do This the Next Time You Get a Haircut.”

If skin cancer is detected at an early stage, when the cancer cells remain localized to the skin, it can often be cured with a simple procedure like a minor skin surgery or even a prescription cream.

That’s where your hairdresser comes in. In addition to cutting your locks, they can help spot growths on your scalp, ears, or neck.

Your scalp, neck, and ears get extensive exposure to the sun’s UV rays every day. That puts them at high risk for potential skin cancers. However, it’s hard to see these parts of your own body, so a new or unusual growth might go unnoticed for several months.

Hairdressers see our scalps most closely and regularly. They can be the first to spot something growing on these sites.

Since they spend so much time looking at scalps, ears, and necks each day, they often have a keen sense about whether a growth seems out of the ordinary. You can bring up the topic casually at your next haircut.

Before sitting down, let your hairdresser know you’re trying to be more proactive about your skin health. Ask them to let you know if they notice any unusual moles or spots while they wash and cut your hair.

Remember that your hairdresser isn’t a skin expert. However, think of them as an additional tool in your skin cancer prevention tactics arsenal.

They aren’t a substitute for good skin-care habits like wearing sunscreen (and sun-protective clothing) and seeing a dermatologist for an annual skin check.

Reference: Livestrong (June 25, 2023) “Want to Age Well? Do This the Next Time You Get a Haircut”

What Should I Know about Falls?

Over 25% of adults age 65 or older fall each year, and thousands of older adults break a bone, according to Very Well Health’s recent article, “Managing Pain as You Age.” Falls and fractures are common concerns for older adults, especially women with osteoarthritis. About a third of women over age 50 will break a bone related to osteoarthritis.

In addition to injury, this is a major issue for older adults, as people age 70+ have an increased risk of death after a fall. In one study, 4.5% of people 70 or older died after a ground-level fall compared to 1.5% of a younger population. Falls, if not deadly, also affect long-term mobility, overall health, and independence. In the same study, people 70 and older had longer hospital and intensive care unit (ICU) stays than their younger counterparts. Only 22% could function independently once released vs. 41% of the younger adults who had fallen.

However, there are ways to reduce the risks of serious, long-term effects from a fall. After a fall, staying calm and preventing further injury is essential. These include:

Relaxing by taking deep, calming breaths;
Staying still where you land and giving yourself time to recover from any shock the fall may have caused;
Assessing your condition and checking for possible injuries before moving; and
Calling 911 or ask someone nearby to help if there are any injuries.

If there are no injuries, you can roll to one side, rest, move to your hands and knees and transition to a chair. Even if you can get up on your own after a fall, seeing a healthcare provider is important. They can identify possible unnoticed injuries and determine health concerns that may have caused the fall.

If you have a fracture from a fall, treating it depends on the location of the break, the severity and other factors related to the individual and their injury. For example, a hip fracture is a common injury in older adults that may or may not require surgery. Traction is sometimes used to pull different parts of the body to help stretch the area around the broken bone for healing. With most fractures, it’s also important to use a splint or cast to keep the area from moving.

Reference: Very Well Health (Oct. 25, 2022) “Managing Pain as You Age”

How Much Does Medicare Pay for Nursing Home Stays?

How Much Does Medicare Pay for Nursing Home Stays?

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According to the AARP, the median monthly cost to live in a nursing home is $7,908 for a semi-private room. The options for paying for such care are limited. Fortune’s recent article, “Does Medicare pay for nursing home care? An expert helps make sense of the rules,” reminds us that there’s limited nursing home coverage under Medicare.

Medicare won’t pay for nursing home care but for certain stays under specific conditions. The program will pay for a nursing home stay, if it’s determined that the patient needs skilled nursing services, like help recovering after a medical issue like surgery or a stroke, but for not more than 100 days. For the first 20 days, Medicare will cover 100% of the cost. From day 21 to 100, the patient pays a $200 co-payment in 2023, and Medicare pays the balance.

To qualify, the individual would need at least a three-day stay as a hospital inpatient before the agency would approve payment for nursing home care for rehabilitation or skilled nursing care. Getting three days as an inpatient in a hospital is a challenge as hospitals are discharging patients quickly, and most patients aren’t staying for three nights. Hospitals also use what’s called observation status, where a patient is technically not admitted to the hospital. This affects beneficiaries’ ability to access Medicare coverage for rehabilitation or skilled nursing care in a nursing home. Observation status gives physicians 24-48 hours to assess if a patient should be admitted for inpatient care or discharged. This status can be costly for Medicare patients as the agency classifies it as outpatient care. As a result, beneficiaries may have to pay their share of that cost as a deductible, coinsurance, or copayment. Some patients also remain in observation status longer than the typical 24 to 48 hours.

To address this, Medicare has implemented the two-midnight rule. This rule stipulates that when a physician expects a patient to require hospital care for at least two midnights, they should admit them as an inpatient. However, two midnights spent under observation don’t count toward the three-day inpatient stay patients need to qualify for coverage in a nursing home or SNF. It’s not just a matter of the time spent in the hospital; it’s how the patient is classified.

The patient must be formally admitted as an inpatient to be classified as an inpatient.

Because each state regulates Medicaid eligibility differently, ask an experienced elder law attorney to guide you through the process and to help you find the best long-term care option.

Reference: Fortune (Aug. 29, 2023) “Does Medicare pay for nursing home care? An expert helps make sense of the rules”

What Should I Know About Stroke Recovery?

A stroke is a serious medical emergency that happens when blood flow is deficient to an area of the brain or bleeding in the brain. Sometimes, direct stroke intervention is necessary. This may include:

Blood thinners given intravenously (IV) for an ischemic stroke;
Direct injection of blood thinners into a blood clot for certain types of ischemic strokes;
Thrombectomy, where a thin tube (catheter) is threaded through blood vessels to a clot in the brain, and the clot is mechanically removed;
Surgical intervention for removal of blood for a hemorrhagic stroke; and
A craniotomy removes a small area of the skull to relieve severe edema (swelling).

VeryWell Health’s recent article, “Everything You Should Know About Stroke,” explains that close monitoring of neurological functioning, fluid and electrolyte concentration, blood pressure and blood glucose is needed in the first few days after a stroke. Brain damage from a stroke may sometimes cause a seizure, necessitating treatment with antiepileptic medication.

After stabilization, recovery can start, but note that recovery after a stroke is often gradual. Some people fully recover, but most have some impairment after a stroke.

Immediate medical care and consistent therapy can improve long-term outcomes. Patience throughout recovery is important because improvement doesn’t always adhere to a smooth and steady path.

Sometimes, complications can be prevented by taking proactive measures. Choking or pneumonia, possibly due to difficulty swallowing, is an especially concerning risk. Weakness and sensory changes can increase the chances of bedsores and blood clots. Weakness and vision changes may lead to falling after a stroke.

Rehabilitation should be customized to specific deficits that happen after a stroke. For example, many people require physical therapy to help with improving muscle control and strength. Speech and swallow therapy is crucial to avoid choking and aspiration pneumonia.

Recovery can frequently be slow over the next few weeks. For some, recovery continues for up to a year.

Reference: VeryWell Health (Feb. 27, 2023) “Everything You Should Know About Stroke”

How Do I Make a Care Plan for Mom?

Medicare typically doesn’t pay for basic assistance, and families often don’t try to determine how to provide this care until there is a health crisis, which can lead to unnecessary stress, conflicts and escalating costs.

Nerd Wallet’s recent article, “Create a Care Plan for Older Parents (or Yourself),” says that making a care plan well in advance lets families organize, locate appropriate resources and determine ways to pay for care before a crisis hits.

A care plan is thinking through the logistics of what you’ll need as you age, so that you are prepared when the poop hits the fan with aging. A way to cope is to plan for temporary rather than permanent disability. Ask what kind of help you or your loved one might need after a hip or knee replacement. How well is the home set up for recovery? Who would help with household tasks? Contemplating a two- or three-month disability with an eventual return to health is less daunting but involves much of the same planning as a more lasting decline.

Many seniors would like to stay in their current homes as they age, something called “aging in place.” That typically means relying on family members for care, using paid workers, or both. However, if family members will be tapped, discuss the logistics, including whether and how much they will be paid. If home health aides will be hired, consider who will supervise the process.

Look at any savings that can be tapped and whether the senior may qualify for government help, such as veterans benefits, Medicaid, or state programs. Families may want to consult an elder law attorney for personalized advice.

It is important to look at the current home as “aging friendly.” An occupational therapist can suggest adaptations allowing the older person to remain in the home if they’re disabled. The sooner you get this evaluation, the more time you’ll have to prepare. Even if the home supports aging in place, the neighborhood might not. Consider how the older person will socialize, get groceries, and make it to health appointments if they can no longer drive.

An independent living or senior living facility could provide more amenities. However, these typically don’t provide long-term care. Therefore, see if the senior is okay with moving again later or whether they should begin with an assisted living or continuing care facility that can provide more help.

Once you have a plan, capture the details and share it with family members or others who may be involved. Revisit the document periodically as circumstances change. Aging planning is an ongoing process.

Reference: Nerd Wallet (Aug. 24, 2023) “Create a Care Plan for Older Parents (or Yourself)”

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