How does Medicare and Medicaid pay for each option?
Medicare does not pay for assisted living room and board. It can pay for a short stay in a certified skilled nursing facility after a qualifying hospital stay, which usually means a three day hospital stay followed by a Medicare covered stay of up to 20 days in a row. Longer stays are paid by Medicaid, which covers nursing home care in every state and covers home and community based services in most states.
That Medicaid waiver is the most useful thing to research early. In many states it pays for a home health aide, a home modification, or an assisted living apartment, which keeps a person at home for less money. The trade in cost is that you must qualify by income and need, and the paperwork takes time. Contact your local area agency on aging, which handles this for free in every state.
Which option is right for a parent who needs help now?
Start with how the day actually goes. If the person can dress, eat, and move around with occasional help, assisted living or home care usually fits. If they need help with most tasks, need memory care around the clock, or have a medical condition that requires skilled nursing, a nursing home is the safer choice.
Memory care deserves its own comparison, because it runs well above the base rate at both kinds of facility. Many assisted living communities run a secure memory wing, and the rate is usually a separate line on the monthly bill. Ask for the memory care rate in writing, not the general rate.
What happens to the bill when savings run out?
This is the part families plan for late and regret. The order that works best is long term care insurance first, because it pays a fixed benefit for a set number of years regardless of the daily rate. Then veterans benefits, which include a pension and a monthly housebound supplement for eligible veterans and surviving spouses. Then Medicaid, which covers nursing home care in every state and covers home and community based services in most states for people who qualify on income and need.
If those do not cover the full bill, families use savings, a reverse mortgage, or a bridge loan that is paid off after selling a home. Our guide to dental insurance for seniors covers another piece of the health budget that families often forget to plan for once they move into a facility.
How do you compare facilities fairly?
Tour more than one, and tour at the same time of day on a weekday. Look at how staff speak to residents and how residents look. Ask about staffing ratios, how long each shift lasts, and what happens when a resident needs more care than they got on Monday. Find out whether the first year rate is locked, what a rate increase looks like, and what happens if the resident needs a higher level of care.
For nursing homes, use the federal Nursing Home Compare tool, which carries quality ratings and inspection history for every certified facility. Staffing is the number to check there. Our guide to the best rated massage chairs covers a different kind of comfort decision, but the rule is the same, that the published rating matters less than what you see in the room yourself.
What should you do before a crisis forces the decision?
Put names on a short list now. Tour two or three facilities while your parent is well and can tell you what they think. Gather the financial documents a facility will ask for, such as two years of statements, insurance cards, and medication lists. And run a benefits check through the local area agency on aging so you know exactly which program pays for what.
Families who plan early rarely face the worst version of this decision, which is making it in a week from a hospital bed with no shortlist and no idea what a month actually costs.
Photo: geralt, Pixabay Content License, via Pixabay (https://pixabay.com/photos/dancing-couple-home-joy-senior-10222176/)
Fazlur Rahman
