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Many localities have people who enter private nursing homes as paying customers yet when they are there either a year or two they will accept medicaid assignment ..some states don’t even have Medicaid homes .all homes are private but the homes have a certain amount of Medicaid beds .
So Medicaid does not mean some ratty home or care .
In fact all states today have some sort of partnership plans available...that is where you usually take 3 years insurance and then when it runs out Medicaid will pay the bills .
Our state New York is one of two states that offer total asset partnership plans .
We got 3 years coverage and once the insurance is up Medicaid takes over the bills ...all assets are 100% protected , with no spend down , no look back ,no nothing .in fact there is no income restriction on the stay at home spouse .
The more common partnership plan is called dollar for a dollar ..that means of Medicaid spends 250k on care to pick a number than two hundred k is protected .
So not all Medicaid use is mooching off tax payers
My mom's facility required private pay for 18 months and then they will allow a resident to stay on Medicaid. She ended up being able to pay for about 3 years, was between $150,000 and $200,000 spent at the facility before she went on Medicaid. I think she did pretty good for a secretary with a $400 a month pension. She was no leech, she did her best.
A nursing home is not the only answer. There are board and care homes that serve 5-8 residents and have a on-site staff member at all times. Sometimes it's run by a couple with their own suite on-site and a few day-time helpers. Residents typically have a bedroom and an en suite bath, or a bath shared with one other resident. They have a common living, dining room and yard. 3 meals a day and snacks are provided, as well as medication assistance, assistance with toileting, dressing, etc. It's similar to a very hands on assisted living status, as opposed to a full-fledged, stay in bed most of the time, nursing home. Costs for this type of set-up are much cheaper than an actual assisted living facility with dozens or hundreds of residents. This family like atmosphere, with consistent staff and a small number of clients, is preferable to the typical institutional NH setting and the revolving door staff that changes every shift.
These are not in every state. I haven't heard of any in NJ and I have been working in geriatrics for 24 years.
"Board and Care Homes" may be called different things in different places, but I think that they could be classified as "Adult Family Care" (AFC), class C "Boarding Homes", and "Residential Health Care Homes" (RHCH) in NJ. Not all neighborhoods are zoned for this, but in many places you can apply to the zoning board for a waiver as long as there is no HOA preventing this type of "business" in a residential zone.
"Board and Care Homes" may be called different things in different places, but I think that they could be classified as "Adult Family Care" (AFC), class C "Boarding Homes", and "Residential Health Care Homes" (RHCH) in NJ. Not all neighborhoods are zoned for this, but in many places you can apply to the zoning board for a waiver as long as there is no HOA preventing this type of "business" in a residential zone.
A nursing home is not the only answer. There are board and care homes that serve 5-8 residents and have a on-site staff member at all times. Sometimes it's run by a couple with their own suite on-site and a few day-time helpers. Residents typically have a bedroom and an en suite bath, or a bath shared with one other resident. They have a common living, dining room and yard. 3 meals a day and snacks are provided, as well as medication assistance, assistance with toileting, dressing, etc. It's similar to a very hands on assisted living status, as opposed to a full-fledged, stay in bed most of the time, nursing home. Costs for this type of set-up are much cheaper than an actual assisted living facility with dozens or hundreds of residents. This family like atmosphere, with consistent staff and a small number of clients, is preferable to the typical institutional NH setting and the revolving door staff that changes every shift.
I think what you are describing here is at least sometimes called an Adult Family Home. My wife is now in one, due to Huntington's Disease. They take good care of her, but it's not cheap, so I am continuing to work, and am drawing down some retirement accounts to pay for her care. I have a pension and SS coming to me, so even if she drains all the IRA and 401k accounts (unlikely) I will be OK.
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