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Medicare will only pay for 90 days of skilled nursing in a nursing home (in one year's time). To qualify, you need some type of specialized care such as respiratory therapy, physical therapy, etc. They do not pay just for you to be a resident in a nursing home.
Medicare pays 100% for the first 20 days (after a three day hospitalization) then 80% days 21-100 with your supplemental if you have one paying the rest. BUT you need more than any diagnosis I can count in one hand the number of rehab patients we've had for the entire 100 days. We have to write weekly notes that show progress and show there is still a need. We can't just keep people on therapy for 100 days just because.
So if you go in with COPD or a broken hip, you'll get a month or 2 at most but very, very few get 100 days. If you're back to your baseline 3 weeks after getting there you'll be discharged then and will revert to private pay.
I feel like I have to quantify this because too many think 100 days is common or something they can count on and it's not the case at all.
the statistics were flawed for a number of reasons , which is why insurers got burned when they set premium prices . it took many years for insurers to get premiums to match usage .
statistic's were based on a generation ago that did not live as long for starters . but the biggest flaw was the fact that those who need long term care are not all in a snf . many like my dad were in private homes and cared for by retired caretakers .
so basically all these people fall off the grid . no one ever knew my dad was being cared for 24/7 for 5 years to put him in a statistic .
insurers found this was the case all over and early policies were priced based on much lower usage.
family took on the burden a lot more too . which usually ended in splitting up families as lives were ruined socially and financially .
so don't believe the old statistics for a second .
as the insurers found out ,those with insurance use it .
I can confirm they aren't accurate. I work with many LTC residents who have lived in nursing homes (not assisted living) for multiple years. There are many people now who need help to live home and don't have funds for 24 hour care neither Medicaid nor Medicare will be of help) nor anyone who can live with her daughter is in Colorado son in Tennessee and she just can't go home after rehab but is only 75 and will end up living there for 5-10 years. In poorer areas it's especially true as people end up in homes much much younger.
If you enter a nursing home at 94 you will be one of the stats but for the many who enter while still relatively young you're looking at many years.
Yes they're complicated for sure. Lots of choices like do you want it to kick in right away and pay more or are you able to hold off. I just got a few quotes reviewing mine and I found them all reasonable for my needs. Somewhere capping at $350 per month. That happens to be my HOA fee.
There ARE pre existing "exclusions" or "surcharges" so you want to get the policy before you have those conditions. There are many threads here discussing the particulars.
A better alternative may be to buy into a life care CCRC which has a decades long track record which offers Independent, Assisted, Memory Care and Skilled Nursing - all four stages. It's it's own LTC insurance plan, essentially.
Because even IF you have insurance or CASH you can't always get placement in the better SNF, which happened to my own mother. She had a ton of money enough to last her life at HOME paying for 24 hour RN care but her lawyer wouldn't permit that (!) and there were no openings in the better SNF in our area.
The problem is people don't even think about their senior years until it's too late to save enough equity in their existing homes or savings to buy INTO the CCRC and pay the monthly "rent" which varies by geographic location, CCRC and size of the home or "condo" you buy into.
They range from about $2200 up, and the better ones I'm familiar with in FL where I work as a private contractor average around $4000 per month for a couple in a two bedroom. And I've noticed many are faith based (even if they don't have any requirements for affiliation and act non-denominational)...or started out that way decades ago.
They also have a few different options not just the standard "equity payment and subsequent rent" type of thing.
Weird to me that people who retire at 65 or 70 are still buying big houses, getting MORTGAGES (and car loans for $35K SUVS)...and dismiss the very thought of choosing a CCRC because they think everyone is 85 and vegetating in there. LOL It's simply a community and no different than the HOA they're moving to...and they even renovate your apartment or villa to your specifications...and better because a meal is included and LOTS more amenities! I know a lady who moved with her husband to Independent 20 years ago and is still not even close to going to the Assisted or other options. I know her because she's the first one I see bopping around first thing at 7AM hair and makeup done, dressed and BUSY going out to her car to start her day LOL. She's GOT to be 75 because you had to be 55 to move in there.
I guess there are those who want to research, pick and move into a CCRC at 55 or 60 (OMG!!!!!!!!!!!) and the opposite end of the spectrum who think they'll be in their own home at 100. I guess I want something in between...I'll plan but I sure don't want to commit to a CCRC so early in life...crazy.
Yes they're complicated for sure. Lots of choices like do you want it to kick in right away and pay more or are you able to hold off.
A better alternative may be to buy into a life care CCRC which has a decades long track record which offers Independent, Assisted, Memory Care and Skilled Nursing - all four stages. It's it's own LTC insurance plan, essentially.
Because even IF you have insurance or CASH you can't always get placement in the better SNF, which happened to my own mother. She had a ton of money enough to last her life at HOME paying for 24 hour RN care but her lawyer wouldn't permit that (!) and there were no openings in the better SNF in our area.
The problem is people don't even think about their senior years until it's too late to save enough equity in their existing homes or savings to buy INTO the CCRC and pay the monthly "rent" which varies by geographic location, CCRC and size of the home or "condo" you buy into.
They range from about $2200 up, and the better ones I'm familiar with in FL where I work as a private contractor average around $4000 per month for a couple in a two bedroom. And I've noticed many are faith based (even if they don't have any requirements for affiliation and act non-denominational)...or started out that way decades ago.
They also have a few different options not just the standard "equity payment and subsequent rent" type of thing.
Weird to me that people who retire at 65 or 70 are still buying big houses, getting MORTGAGES and dismiss the very thought of choosing a CCRC because they think everyone is 85 and vegetating in there. LOL It's simply a community and no different than the HOA they're moving to...and they even renovate your apartment or villa to your specifications...and better because a meal is included and LOTS more amenities! I know a lady who moved with her husband to Independent 20 years ago and is still not even close to going to the Assisted or other options. I know her because she's the first one I see bopping around first thing at 7AM hair and makeup done, dressed and BUSY going out to her car to start her day LOL. She's GOT to be 75 because you had to be 55 to move in there.
They operate the same as ALF financially, if you will live longer then your money they won't take you. My mom got declined by several places with about $100,000 in cash and a small house, because their actuaries determined she'd run out of money years before she dies (you're better off with a fatal diagnosis lol). We had to hire a geriatric case manager to find a place. Some of the buy in amounts here can are hundreds of thousands, then you still pay hundreds to thousands per month as well.
medicare pays for a very limited time under certain conditions . nor do they pay for assisted living .
Your comment set me to thinking. Someone in a nursing home still needs to keep up with insurance premiums like Medicare A, B, and D or other health insurance coverage - Right? Now, I want to ignore the Medicare short term coverage for skilled nursing care and focus on someone that is in a long term care facility after exhausting the Medicare allowed short term skilled nursing. So we have resident of a nursing home that charges $100,000/year and lets assume private pay for the home. Does the home charge Medicare (or private health insurance plan) for nursing activities within the home (e.g. flu shots, dispensing drugs, diarrhea treatment, CPR, oxygen management, ...) or is the resident required to visit a private doctor for everyday problems? I guess I am asking what the $100,000/year covers. Room and board, housekeeping, attendance help (dressing, transfer to wheelchair, etc.) and what?
What does the price of the nursing home cover and what needs to be added onto the price to cover what the nursing home price doesn't?
Which pops another question in my brain - Does the nursing home take on some power of attorney (POA) or health care decisions when they can't reach a personal POA?
Not going to a nursing home in Florida...that is my plan...
Sadly there are awful nasty greedy nursing homes everywhere, not just FL.
We refuse to buy into notion that we may end up in one anywhere. Have saved enough for in-home care for as long as needed, here in MX. Recently bought a new home here with separate casita for care givers. House itself is large one story hacienda, built around large swimming pool. Will suit our needs forever, whatever comes our way.
Your comment set me to thinking. Someone in a nursing home still needs to keep up with insurance premiums like Medicare A, B, and D or other health insurance coverage - Right? Now, I want to ignore the Medicare short term coverage for skilled nursing care and focus on someone that is in a long term care facility after exhausting the Medicare allowed short term skilled nursing. So we have resident of a nursing home that charges $100,000/year and lets assume private pay for the home. Does the home charge Medicare (or private health insurance plan) for nursing activities within the home (e.g. flu shots, dispensing drugs, diarrhea treatment, CPR, oxygen management, ...) or is the resident required to visit a private doctor for everyday problems? I guess I am asking what the $100,000/year covers. Room and board, housekeeping, attendance help (dressing, transfer to wheelchair, etc.) and what?
What does the price of the nursing home cover and what needs to be added onto the price to cover what the nursing home price doesn't?
Which pops another question in my brain - Does the nursing home take on some power of attorney (POA) or health care decisions when they can't reach a personal POA?
It covers room and board, daily living care, things like that. Health insurance is always used for physicians, oxygen, medicines and other skilled care. If the patient is private pay they still have to pay their supplemental policy. Once on Medicaid, the state pays for Medicare. Here in NJ, they now make you switch from traditional Medicare to a Medicare Advantage Plan. If you go t the hospital for at least 3 days while a home resident, Medicare will pick up the whole nursing home tab rent included while you're getting therapy when you return, even if you're on Medicaid. Many interchange the 2, but only Medicare is health insurance when it applies to lsong term care. It is not the same as Medicaid that the poor who live in the community get.
The only physicians allowed to treat in the facility are those who are on contract. You can go to any you wish, but at many homes you'll have to pay for transport if a family member can't take you. My moms place has a little bus that takes her everywhere for no extra charge but not all do. Her ALF is up to like $10,000 a month now and they do very little for her, she still has visiting nurses through Medicare to wrap her legs, my mom takes her own meds and doesn't get dressed half the time but stays in a lounge dress. Even at that monthly rate, we have to pay an additional $20 a month to do her laundry. A nursing home would not charge for that btw.
CPR would never incur any charge, anywhere.
As far as everyday illness, it depends. Skilled care is billed to insurance. Wound care is skilled care, for instance. Giving you a hot pack or some simple thing you don't need skilled training or a. License to do would be part of the monthly fee.
That said, if LTCi premium costs were anywhere in line with auto and homeowner insurance, I'd be first in line to buy it.
Not only does my LTCi policy costs less than my auto insurance, it is only 1/4 of the cost of my homeowner's insurance policy. (Of course, auto and homeowner policies are fairly expensive in Florida, especially in Miami.)
The thing with nursing homes that take Medicaid is that they can refuse a patient if they feel that patient will be too much care for the reimbursement. That's what happened with my mom. We went to several wonderful nursing homes and they all said that they took Medicaid patients, but when we toured and explained that my mom was a recent amputee, and was on a feeding tube, they turned her down.
That left us only one nursing home in the county that would accept her. Of course it was the one that smelled of urine and had people just left sitting around in wheelchairs out in the hall. In the first few days there, her personal property was stolen. Half of the staff didn't speak English well enough to interpret the doctor's orders, or to converse with family members regarding her care. We had to be on constant alert for neglect (failure to turn her as needed resulting in bedsores, failure to treat her wounds, failure to clean her and change her bedding according to their own schedule, failure to properly handle her feeding tube, etc.) and we ended up having family members doing shifts around the clock to protect her from the untrained/uncaring staff. Fortunately I had FMLA at work as I had to sit 12-14 hour shifts for 3 weeks to ensure she was not left to sit and rot.
^^^ you are so right. They don't have to take people. a friend whose daughter had end stages of MS but not to hospice stage was rejected too.
Thank God she lived in OR where she was on the state dole for years with 24/7 care. I saw the exact same thing you are describing with my grandma. The smell of a urine smell of a medicaid nursing home, is like the smell of death, you never forget it. Thank God she lasted 2 months, I think she willed herself to death. Wish you'd go on the spending down money to go on medicaid threads and tell your story. Maybe they'll have a wake up call. But doubting it, Its about money first.
Quote:
Originally Posted by ocnjgirl
I saw an interview (by phone) from a patient's daughter from the home. Her mom is currently one of those in the hospital with respiratory distress. She said she is there every single day and that her mom got good care. She said she called Florida Power and Light herself as did other family members and begged them but she said they just told her they'd take care of it and said it sounded like the person was "reading from a script".
I also would not assume for a second that this home has a lot of Medicaid beds. It is a rehab facility as well and doesn't look at all like a Medicaid facility looks, it looks pretty and expensive to me. Level of care has absolutely not one thing to do with whether a place costs a lot or not. I work in all sorts of homes, and some of the worst I have seen care-wise were also the most beautiful and expensive. Some of the best in terms of care are the smaller religious-affiliated facilities, and they have plenty of Medicaid residents. Good to know!
Most people who spend down enter a facility while they still have some money, and then continue to live in the same home once they've spent down and are on Medicaid. It would be foolish to spend down first because you won't have any choices. My mom is in an assisted living facility that has a policy stating you can stay and live there on Medicaid only after you've paid privately for 18 months. Now she gets a bill for over $10,000 a month (she didn't private pay that much, she was more independent until recently and her care level was lower) and I have to send them $1100 a month, with Medicaid filling the gaps (I don't think they get the entire bill amount though).
I also don't think anyone plans to enter a nursing home period let alone plans to spend down. The reality is people end up spending down like it or not once they start needing health care services, whether at home or in a home. 24 hour home care costs $75,000 a year, ALFs and nursing homes in the 10's of thousands...no matter how well I "plan" I have no ability to pay that for long. And long term care insurance only pays a portion, and not forever. My mom has been in her ALF for 4-5 years now, and is healthy aside from leg problems and will probably live another 5-10 years. Who an afford that without Medicaid?
Thank you for your post. It is great when someone works in one of these facilities and tells us what she has seen. But don't assume across this country they all work the same.
There have been threads in here with LOTS of contributors who said they will SPEND down their money so it goes to their entitled offspring, then go into medicaid. They actually want to know look back periods etc. Now maybe they'll listen with your post on why that is not a good idea. If you don't have it, you don't have it. Funny that people on here that are in that position are jumping to conclusions. While the rich try to pass down their money to be in your position. Frankly I think look back period should be longer. Maybe 15 to 20 years.
When a disaster like this hits, its a cluster f**k. Can you imagine how many calls they were getting. FRL probably had a priority list, hospitals etc. We could second guess all day about why this place wasn't put on a priority list.
Medicaid does not pay the difference, of what your home charges and what they make the family pay. It's a flat fee. Used to be around $1200.00 (SIL mom was in one for 11 years! In different units as she got older.)
There are many different types of long term care insurance. I have one combined with life insurance. Its a hefty payment per year, locked in. But I pay for the riders such as 5% increase per year on the LTC part, Forever pay for my care, including if I'm at home. If I don't use it, my heirs get $500,000. I bought it in my 50's and I went through a medical screening. This is what I asked for as a birthday gift one year instead of a bauble. Peace of mind is priceless.
Last edited by foundapeanut; 09-15-2017 at 08:16 AM..
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Frankly I think look back period should be longer. Maybe 15 to 20 years. 
