May 13, 2019

Choosing and Paying for a Long-Term Care Facility

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Despite significant recent growth in home care and alternative seniors’ residences, nearly one of every two women and one of four men over age 65 will enter a long-term care nursing facility at some time in their lives. Many people would prefer to remain outside a nursing facility. However, some seniors, because of their condition, circumstances, or the unavailability of in-home services or affordable assisted living residences, can receive adequate care only in residential care. With nursing home care becoming a reality for most, choosing the right facility and paying for their services is a necessity. Learn how to find the facility you need and how to pay for it.

Choosing the Appropriate Level of Care

There is a great range in the levels of care available in nursing facilities. Care ranges from intensive 24-hour care for the seriously ill (which is called skilled nursing care) to long-term personal assistance and health monitoring with very little active nursing (often called custodial care). Skilled nursing facilities provide short-term, intensive medical care and monitoring for people recovering from acute illness or injury. Other facilities provide custodial care, long-term room and board, and 24-hour assistance with personal care and other health care monitoring, but not intensive medical treatment or daily nursing.

Finding a good and affordable nursing facility that provides not just care, but the right type of care is the main goal. For someone with severe physical or mental limitations, it is crucial to find a facility that provides the kind of attention and care that meets the individual’s specific needs. For people who need little or no actual nursing care, the task is to find a facility that provides physical, mental, and social stimulation rather than merely bed and board. People with Alzheimer’s disease have special needs when it comes to residential care.

Hospital-Based Skilled Nursing Facilities

Hospital-based skilled nursing facilities, also known as extended care facilities, are departments within hospitals. They provide the highest levels of medical and nursing care, including 24-hour monitoring and intensive rehabilitative therapies. Unlike other nursing facilities, hospital-based facilities are not for permanent residence, but for a short-term stay until a patient can be sent home or maintained elsewhere.

Skilled Nursing Facilities

Nonhospital-based skilled nursing facilities (SNFs) provide a relatively high level of nursing and other medical care, as well as personal care and assistance, for people whose illnesses or impairments require close monitoring. Around-the-clock nursing is available from licensed vocational or practical nurses, with at least one supervising registered nurse on duty at all times. In addition to nursing, most other prescribed medical services can be provided, including various rehabilitative therapies.

Intermediate Care Facilities

Intermediate care facilities (ICFs) provide less nursing and other medical care than SNFs. ICFs are for long-term residents with chronic illnesses or impairments, whose conditions are not as acute as those of SNF residents. Staff is geared as much toward personal care and assistance as to medical care, although there is always a licensed vocational or practical nurse on duty. ICFs generally care for people who need a long recovery period from a serious illness, injury, or surgery, but who no longer need the level of nursing care and high-tech monitoring that an SNF provides.

Custodial Care Facilities

Custodial care facilities provide services that are often lumped together under the heading of custodial care: personal assistance and low-level nursing care, but not intensive medical care. Sometimes referred to as “rest homes,” these custodial care facilities (CCFs) are considerably less expensive than SNFs or ICFs and, in addition to monitoring residents’ physical conditions, they provide social, educational, and recreational activities as well as organized exercise. Because CCFs do not provide extensive medical care, they are appropriate for people whose physical and mental conditions do not require constant attention or intervention.

Paying for Long-Term Care

Your toughest challenge may be paying for care. Nursing care facilities of all levels are very expensive, but depending on the type of care you need and the type of insurance you have, you may get some help covering the cost. Skilled nursing facilities run more than $500 per day, although stays there are relatively short and Medicare or private health insurance will usually pick up much of the tab.

Long-term custodial care, where a stay may last for years, can cost between $4,000 and $12,000 per month. Neither Medicare nor Medigap private insurance supplements pay any of the cost of custodial care. Medicaid will pay the full cost of custodial nursing facility care for people with very low income and few assets. Some veterans may also find coverage for custodial care through the Veterans Administration. Long-term care insurance, for those who have it, may also cover some of the cost of custodial care.

If a facility is certified by the federal government, it may be more affordable. The Healthcare Financing Administration has certified about 85% of all nursing facilities; HCFA certification means that the facility is eligible to receive Medicare and Medicaid payments. Some facilities do not meet HCFA standards. Other facilities charge high prices and simply do not want to accept residents who depend on Medicaid payments.

Unless you have an unlimited supply of money to pay for long-term care, make sure that any facility you consider is certified. Certification means that the facility meets some certain minimum health, safety, and care standards. And certification also means that if someday you should need and qualify for Medicaid coverage for your stay, you will be able to receive it without having to move to a different facility.

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