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Finding and Paying for Nursing Home Care 

 

It’s important to remember that a nursing home is a home – one that provides meals, health care services, personal care, recreation, and other needed services to frail seniors and disabled adults who require daily assistance and care. Deciding which nursing home is best for a loved one can be stressful. Most families don’t know where to begin. The following information can help make this important decision less difficult.

Finding Nursing Home Care:
Where to Begin

Talk with your loved one who will be living in the nursing home. What are their preferences? Including them as much as possible in the conversation and decision is important and can help them better adjust to what is a necessary, but often difficult, change in their life.

Talk with other family members. Ask for their help in finding and selecting a nursing home. Sharing the information-gathering and decision-making with other family members can reduce the stress and increase everyone’s comfort with the final decision.

Talk with trusted people such as your doctor or other health care providers, as well as your family and friends, to get their input on nursing home options.

Narrow your options down to three to six nursing homes to visit. If possible, take another family member or friend with you, and use the Nursing Home Checklist to help you know what questions to ask and for comparison. Remember to include the person who will be living in the nursing home in this process as much as possible. During your visit, be sure to talk to staff (especially the nursing assistants), residents, and their family members if you can.

Visit “Nursing Home Compare” at the Web site www.medicare.gov to compare the nursing homes you have selected. The “Five-Star Quality Rating” system includes health inspection results, nursing home staff data, quality measures, and fire safety inspection results.

Use the “Focus on Excellence Ratings System” at www.oknursinghomeratings.com to view ratings on 10 measures of quality and get the overall rankings for participating Oklahoma nursing homes.

Remember – the nursing home you select is not an irrevocable decision. If necessary, a different decision can be made at a later date.

Family involvement doesn’t end when a loved one enters a nursing home. The family just takes on a new role – making sure others are providing good care.

Note: Nursing home care is not the only option.

Oklahoma’s Medicaid ADvantage Program provides in-home and community-based services to qualifying individuals to help delay or prevent altogether the need for nursing home placement. For more information, see “The ADvantage Program: An Alternative to Nursing Home Care".

Paying for Nursing Home Care: The Options
Most people know nursing home care is expensive, but few know how expensive. The average cost in Oklahoma for a private room is $51,607 a year and rising, but the cost can vary widely depending on where you live. Payment options for nursing home care include:

Private Pay: About one-third of nursing home residents pay for their nursing home care out of their own personal income and savings. Obviously, an extended nursing home stay can rapidly deplete one’s savings. Many people exhaust their personal resources after only six months and must then turn to Medicaid for assistance. That’s why it’s important to contact the Department of Human Services when a person is first admitted to the nursing home – even before Medicaid assistance is needed. Getting correct Medicaid guidance early on helps families understand how best to use hard-earned resources to pay for long term care, and how to protect as many of the assets as possible for the spouse remaining in the home (community spouse).

Long Term Care Insurance: This special premium-based private insurance can help cover the cost of nursing home or other long term care.

Medicare: In certain situations, Medicare will pay for short-term skilled nursing home care. Contrary to what many people believe, Medicare does not pay for extended nursing home care.

Veterans Administration: Assistance with nursing home costs may be available to eligible veterans. Some veterans may be eligible for care at a VA nursing home. For more information, contact the Veterans Administration at (800) 827-1000 toll-free or visit the Web site www.va.gov.

Medicaid: Medicaid helps people pay for nursing home care once they have exhausted their personal resources. To receive Medicaid benefits, the person must require nursing home level of care and meet the program’s income and resources guidelines as outlined below. Medicaid recipients are expected to use their income to pay a share of the cost of the care – minus the cost of health insurance premiums and $50 a month for personal care expenses, and minus any income they are allowed to contribute to their spouse remaining in the community. Medicaid then pays the difference between the recipient’s share and the Medicaid-approved payment rate to the nursing home.

Oklahoma 2009 Medicaid Qualifications
To qualify for Medicaid, an Oklahoma resident must:
• Require nursing home level of care.
• Have an individual monthly income equal to or less than $2,022. Individuals with a monthly income over $2,022, but less than $3,000, may still be eligible through use of a Medicaid Income Pension Trust. (For more information on a Medicaid Income Pension Trust Fund, contact your local Department of Human Services office.)
• Have individual resources below $2,000. Single or unmarried individuals with resources above the limit must “spend down” their assets by paying for their care to qualify for Medicaid assistance. Resource limits for married couples are different; see Spousal Impoverishment guidelines that follow.

Note: Income and asset guidelines may change/increase for 2010.

Medicaid Spousal Impoverishment Guidelines
It’s important to note that the spouse of a nursing home resident is protected from impoverishment by federal law. The spousal impoverishment provisions help make sure that the spouse still at home (the community spouse) will have the money needed to pay for living expenses by protecting a certain amount of the couple’s resources, and, if needed, at least a portion of the nursing home resident’s income.

Resource Eligibility for Married Couples
When a couple applies for Medicaid, an assessment of their resources or assets is made. The couple’s resources, regardless of ownership, are combined as the couple’s “countable resources.”

The couple’s home, household goods, an automobile, and burial funds are not included in calculating the couple’s combined or countable resources. Countable assets may include savings, checking accounts, certificates of deposit, trusts, stocks, bonds, mineral rights, other property, certain life insurance and burial policies.

Note: There are strict regulations that govern the transfer of assets to other family members or others. Transfer of assets can result in disqualification for Medicaid assistance.

If the couple’s combined or countable resources are below $25,000, the community spouse retains the full amount. For assets above $25,000, the following division of asset guidelines apply.

Division of Assets Guidelines
Generally speaking, division of assets guidelines state that a maximum Protected Resource Amount (PRA) of $109,560 is subtracted from the couple’s combined countable resources and retained by the community spouse if the couple had double that amount, $219,120, when one of them enters the nursing home. The remaining half of the assets, as well as any excess assets over $219,120, can then be spent on the couple, and may be used to pay for the needed nursing home care until the resident qualifies for Medicaid.

It is very important to contact Department of Human Services when the individual is first admitted to the nursing home to determine the amount of assets the community spouse may keep and the amount which must be used for the needs of the individual in the nursing home.

Spousal Income Protection
The community spouse may retain up to $2,739 a month in income, which may include a portion of the nursing home resident’s income. The amount of income the community spouse may keep depends on the amount of income received by each person and the cost of monthly health insurance premiums.

For more information on Medicaid coverage for nursing home care or to complete an application, contact your local Oklahoma Department of Human Services office (for a complete listing of offices, click here).

 



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