Understanding aspects of long-term care

Healthcare is, and should be, of great concern to everyone especially in today’s time. One never knows what you will do when a major health issue happens to you or someone in your family. There are so many factors that play into the decisions that a person will have to make especially if it is a life-changing event. At Hillcrest “A Caring Center” we are helping people on a daily basis using love, care, and understanding through these difficult decisions of what to do

The following series of articles is intended to help the readers understand different aspects of the nursing home industry or Long Term Care. A well-known fact for anyone that has chosen Long Term Care as a career knows we are the second heaviest regulated industry; just under nuclear power. WOW! We are regulated by government entities that inspect and identify regulatory shortfalls that determine a “star rating.” The government, both state and federal, also has a big involvement in how to pay for nursing home care. You hear it in the news all the time about Medicare and Medicaid cuts. We as an industry are being pushed harder and harder to do more with deep reimbursement cuts to pay for it.

One of the biggest questions that we are asked is who pays for nursing home care? Some of the basic sources are Medicare, Medicaid, private pay, or other types of insurance depending on your individual circumstances. Everyone is different but every situation and where you fit into the systems determine how or where the money will come from. Most residents are required to pay from their own funds a predetermined amount (unless they have nursing home insurance). However, when they spend down to having only $4,000 in assets, they can apply for Medicaid. This process can be challenging to people applying, and most nursing homes have a Social Services staff member that could help navigate this process. The qualifications to be eligible for Medicaid are multi-pronged and there are many determining factors that are considered. It is very common for 50-60 percent of residents in nursing homes to be on Medicaid. A resident on Medicaid is required to pay their share of the cost to the nursing home, which is determined by Medicaid. For instance, if the resident receives a monthly Social Security check, they will need to put all but $60 dollars towards their care and then the Medicaid program pays the rest. It is a very involved process to qualify as all of the assets are taken into account and how to divide those assets. There are look back periods to determine how liquidated assets were dissolved, and the list goes on.

People can get Medicare and Medicaid confused. Medicare does not pay for nursing home/long-term care, however, if a person qualifies it can be used for services provided in the nursing home short term, usually less than 100 days. Medicare does have a skilled nursing benefit if the beneficiary qualifies; most of the time this relates to some type of therapy that is needed. The average stay on therapy at Hillcrest “A Caring Center” is about 3 to 6 weeks, however, some therapy stays have used the entire 100 days. Residents that use Medicare will be rehabilitated to a point to either go back home or, if the need exists, convert to a nursing home resident. Hillcrest “A Caring Center” is proud to say most of our residents on therapies go back home or where they came to us from. It is important to get the proper information if the need arises as these government programs have requirements and restrictions to qualify for them. As with Medicaid most nursing homes have a social services staff member that can help steer you in the right direction to navigate the government regulations. Some veterans can qualify for VA (Veterans Administration) benefits, and like all of the other government programs, there are qualifying factors.

Private pay simply means the resident is responsible for all of the expenses they acquire at the nursing home. Private insurance or other type insurances have regulations to them as well as to what is covered and for how long, to name a few.

This short overview of some of the “how or who pays for nursing home care” has volumes of rules and regulations written about each payment system, and just as many volumes of restrictions as well. To navigate the systems put into place for these services, contact the right people that have the answers at those departments. The internet is a good source of information about these very important programs. Our Social Service department at Hillcrest will assist current residents and prospective residents on how to access benefits. 308-345-4600.

Future articles will include topics like: how to get adjusted to living in a nursing home, how employees and residents become a new family, aging and how to make the most of changes, to name a few. If you have topics you would like us to write about, please contact the Administrator at Hillcrest “A Caring Center” 308-345-4600.