Unfortunately, this is a situation we find a lot of our patients families in when their loved ones start to decline.
In short, Medicare does NOT pay for room and board for long term stays. They will pay for short term rehab in a skilled nursing facilities. This short term stay is typically limited to several weeks and usually capped at 100 days per year. Please note, this stay still requires you to pay copay, which can be up to 20% of total cost depending on your plan. Medicare advantage plans are by far worse, and usually do not allow patients to stay the full time allocated due to some issue they usually come up with. After all, their purpose is to save money for the corporation (I’m tangenting).
Before we get started, if you haven’t spoken with an elder attorney, do so.
Mostly, the patient and family are responsible for all long term stay options. There is assistance available through the state via Medicaid for those who meet income thresholds. This varies by state. They usually require a spend down of all assets in the patient’s name (which is impractical in cases of the patient being married). However, if this is possible, this is the most financially sound option. Medicaid/Nursing Home will usually consume all of the patient’s social security except for a small amount and then cover the rest for room and board. The patient typically has to meet a medical need as well (physical or cognitive decline).
However, most families and patient usually end up paying out of pocket. I am listing the typical out of pocket costs for different facilities to allow for education. Once this sets in, GET LONG TERM INSURANCE. It is worth it, especially if you or your parents are in good health. The costs of room and board alone (not including healthcare costs) will burn through savings at astounding rates.
Senior Living Communities – Single Room/Apartment – Minimal Assistance to heavy assistance can range from $1000-$4000/month.
Group Homes – Residential Care homes – Semi-private rooms start at $1500-$3000/month.
Assisted Living Facilities – Monthly costs are typically at $4000-$6000/month. Be wary of up sells here. They usually will bring you in with a low rate, then you pay for additional care, dementia care, memory care, extra check ins, medication help, etc. Ask very clearly about other fees they charge and what kind of care you can expect at the price they are quoting.
Nursing Homes – non skilled – long term stays. Semiprivate room starts at $7000 – $10000/month. Nursing homes if you are paying out of pocket are expensive. Let that sink in. These rates are likely on the low end.
Full time Caregivers at home – 24/7 Caregivers at home – known at PAS Agencies (Personal Assistance Services) charge $20-$25/hour. Multiply that by 24 hours x 30 days in a month, and you get the idea. You can hire privately for $12-$15/hour, but you have to figure out what you are going to do when that person calls in sick or doesn’t show up. Yes, it happens a lot.
I hope this article is helpful. Would love to hear other comments on other options people have come across that I may have missed.