Resources for General Information and Assistance
Your state or local department on aging: Look for “aging” or “human services” in your local government blue pages of the phone book for the number. Specific resources to ask for include State Health Insurance Assistance Programs, and in many states Aging and Disability Resource Centers (ADRCs).
The Administration on Aging's national Eldercare Locator provides information including where to find specific services and supports in your community. Contact: 1-800- 677-1116, weekdays 9:00 a.m. to 8:00 p.m. (ET) or contact the Eldercare Locator website.
Women’s Health/Health and Human Services (HHS) provides a range of information from caregiving to end of life and advance directives.
Resources to Assist with Caregiving
Administration on Aging (AoA)/Elders and Caregivers
The Caregiver Resource Room is where families, caregivers, and professionals can find information about The National Family Caregiver Support Program, including: where you can turn for support and assistance, and finding services for caregivers. In addition, another AoA resource is the Elder Care Locator.
Family Caregiver Alliance
The Family Caregiver Alliance (FCA) operates the National Center on Caregiving (NCC). The FCA provides a central source of information and technical assistance on caregiving and long-term-care for policy makers, health and service providers, media, program developers, funders and families. Their website, www.caregiver.org, contains a wealth of resources for caregivers and providers, including fact sheets, research and policy studies.
Family Caregiving 101
This website, developed by the Family Caregiver Alliance and the National Alliance for Caregiving, provides information and resources for family caregivers.
NIA Booklet on Long Distance Caregivers - The National Institute on Aging (NIA) has released So Far Away: Twenty Questions for Long Distance Caregivers. This booklet focuses on some of the most important concerns caregivers have about providing long distance care. The booklet is free and may be ordered by calling 1-800-222-2225 or going to http://www.nia.nih.gov/HealthInformation.
National Alliance for Caregivng
The National Alliance for Caregiving (NAC) is a coalition of national organizations focusing on issues related to and in support of family caregivers. NAC conducts research, policy analysis, program development and public awareness about caregiving. Their website, www.caregiving.org, provides publications and information including a link to the Caregiving 101 website and surveys on the status of caregiving.
National Family Caregivers Association
The National Family Caregivers Association (NFCA) focuses on public awareness, and caregiver education and support, especially as it relates to helping family caregivers work effectively with healthcare providers. Resources on the site include ways to link and support family caregivers through the stories project and a caregiver bulletin board.
Resources for Healthy Aging
Centers for Disease Control and Prevention (CDC)
This government site provides a wide range of information and resources on health and prevention for all ages and groups. Each specific topic, for example aging, physical activity and exercise, and staying healthy, includes news on related reports, conferences, listservs, statistics, and additional resources. The “aging” topic includes a Healthy Aging for Older Adults web page.
Center for Healthy Aging
This National Council on Aging site provides information on a range of health issues and identifies state and local programs that provide health promotion and disease prevention for older adults. These programs include AoA funded Evidenced-Based Disease Prevention Programs.
Center for Nutrition Policy and Promotion
The US Department of Agriculture (USDA) Center for Nutrition Policy and Promotion (CNPP) works to improve the health and well-being of Americans by developing and promoting dietary guidance that links scientific research to the nutrition needs of consumers.
National Center for Complimentary and Alternative Medicine
The National Center for Complementary and Alternative Medicine (NCCAM) is the Federal Government's lead agency for scientific research on complementary and alternative medicine within the National Institutes of Health (NIH). The Center conducts research, trains researchers, and provides a clearinghouse for information on treatments and therapies.
National Institute on Health: Health Information and Exercise Guide
This government site provides an Exercise Guide and links to additional publications and resources on health and wellness. The Guide provides advice on nutrition, balanced diets, and explains the benefits of exercise and physical activity, including how to get started and how to check your progress.
Resources to Assist with Financial Planning
The Federal Citizen Information Center section on ‘Money’ provides a range of information, fact sheets and resources on money and planning issues including banking, financial security, insurance, and retirement planning.
The My Money.Gov website provides information and resources that include social security benefit information, retirement planning strategies, and guidelines and questions to ask about trusts, IRA and other financial options.
The National Association of Insurance Commissioners' (NAIC) provides shoppers guides for different types of insurance, including long-term care insurance to help individuals understand and compare policies - (NAIC) Shopper's Guide to Long-Term Care Insurance.
Your State Insurance Department will have information about long-term care insurance in your area. They also often offer a shoppers' guide to long-term care insurance. Contact: http://www.consumeraction.gov/insurance.shtml to find your State’s Insurance Department.
Women’s Institute for Secure Retirement (WISER). This website offers a variety of information and consumer publications to help women understand the complex issues in areas such as Social Security, pay equity, pensions, savings and investments, home-ownership, long-term care and disability insurance.
Resources to Assist with Housing Planning
AARP
www.aarp.org/money/revmort
This AARP site provides information on reverse mortgages including a quide to compare reverse mortgage products.
Administration on Aging (AoA)
http://www.eldercare.gov/Eldercare.NET/Public/Resources/Resources.aspx
This AoA site provides information and resources on housing including assistive technology, remodeling and housing with services.
A Guide to Making Housing Decisions: Housing Options for Older Adults
http://www.eldercare.gov/Eldercare.NET/Public/Resources/Resources.aspx
This booklet provides an overview of housing options – from home ownership to rental and housing with services – and the related benefits, challenges, and legal issues to consider.
Alliance for Technology
http://www.ataccess.org/default.html
This site provides a range of information and resources on assistive devices and technology including community resources and vendors.
Fair Housing Accessibility First
http://www.fairhousingfirst.org/information/design.html
This Housing and Urban Development (HUD) website provides a wide range of information on modifications and accessibility including issues related to individuals in rental housing.
National Association of Home Builders (NAHB)
www.nahb.org/directory.aspx?sectionD=686&directoryID=188
This site provides a web-based directory you can search to find remodelers or contractors who specialize in modifying homes to make them safer and more comfortable.
National Resource Center on Supportive Housing and Home Modification
http://www.usc.edu/dept/gero/nrcshhm/directory/il.htm
This site provides information and local and state resources related to housing modifications and financing for modifications.
Rebuilding Together
http://www.rebuildingtogether.org/
This national nonprofit volunteer organization focuses on the home repair and improvement needs of lower income homeowners and includes a search tool to identify local assistance.
U.S. Department of Housing and Urban Development (HUD)
http://www.hud.gov/groups/seniors.cfm
This government website provides information on housing including buying, owning, renting, home modifications, reverse mortgages, and legal issues.
Resources to Assist with Advance Care Planning
Agency for Healthcare Research and Quality (AHRQ) provides research on preferences for care at end of life that can help guide decision making for end of life care.
The American Bar Association provides a tool kit that offers information to help clarify decision-making before a health crisis occurs and resources for legal help in each state including legal services funded through the Older Americans Act: http://www.abanet.org/aging/resources/statemap.shtml. Specific contact for the Consumer’s Tool Kit for Health Care Advance Planning can be found at: http://www.abanet.org/aging/toolkit/home.html.
National Association of Attorneys General (NAAG) are charged with protecting constituents in matters affecting the public interest, including consumer protection of those who are dying. The NAAG End-of-Life Health Care Project includes information on a range of end of life issues.
National Hospice and Palliative Care Association’s Caring Connections website, supported by funding from Robert Wood Johnson Foundation, provides general information on Advance Directives and state specific forms that can be downloaded.
Own Your Future Planning Kit
Order or download the free Own Your Future Long-Term Care Planning Kit. It describes what is and what is not covered by public programs related to long-term care, as well as ways to plan ahead, address legal issues, assess services, and consider private financing options.
This kit is provided by the “Own Your Future” Long-Term Care Awareness Campaign, a joint Federal-State initiative to increase awareness about the importance of planning for future long-term care needs.
Sunday, May 31, 2009
Saturday, May 23, 2009
To air is human
This week, I had the pleasure of participating in the first pledge drive for our local community radio station, KMRE. The low-power FM facility is part of the American Museum of Radio and Electricity, one of the organizations that makes Bellingham such a special place.
KMRE uses a format called "The Golden Age of Radio," with music from the 1920s to 1940s. The Resident Council at St. Francis voted some time ago to have that station playing in the dining room during meals. That indicated to me, as Marketing Director, that the station was targeting the audience we wanted to reach.
Last year, St. Francis began underwriting programming on KMRE. This not only benefits the radio station, it gets the St. Francis name out to the people of Bellingham. It has proved to be a fruitful partnership. The station's radio drama group, the Midnight Mystery Players, will be performing for residents at St. Francis and we are scheduling an outing for our residents to see the museum.
The successful partnership with KMRE defines the kind of win/win situation that St. Francis is building on. We also partner with a number of other organizations in the community and I urge you to view them on the Community Partners page of the Web site. I encourage you to listen to KMRE if you live in Bellingham. If not, you can listen on the Internet by going to www.amre.us. This wonderful community asset deserves your support and you can pledge by calling (360) 738-3886. You can also pledge on the Web site. Do it right now and help KMRE reach its fundraising goal.
Christopher Key
KMRE uses a format called "The Golden Age of Radio," with music from the 1920s to 1940s. The Resident Council at St. Francis voted some time ago to have that station playing in the dining room during meals. That indicated to me, as Marketing Director, that the station was targeting the audience we wanted to reach.
Last year, St. Francis began underwriting programming on KMRE. This not only benefits the radio station, it gets the St. Francis name out to the people of Bellingham. It has proved to be a fruitful partnership. The station's radio drama group, the Midnight Mystery Players, will be performing for residents at St. Francis and we are scheduling an outing for our residents to see the museum.
The successful partnership with KMRE defines the kind of win/win situation that St. Francis is building on. We also partner with a number of other organizations in the community and I urge you to view them on the Community Partners page of the Web site. I encourage you to listen to KMRE if you live in Bellingham. If not, you can listen on the Internet by going to www.amre.us. This wonderful community asset deserves your support and you can pledge by calling (360) 738-3886. You can also pledge on the Web site. Do it right now and help KMRE reach its fundraising goal.
Christopher Key
Sunday, May 10, 2009
Public programs for long-term care
There are a number of public programs that provide help paying for long-term care services. Each program has specific rules for what types of services it covers, how long one can receive services, eligibility for coverage, and, in some cases, cost sharing. For example, some programs, such as the Older Americans Act, focus on home- and community-based services, while the Medicare program only pays for some short-term nursing home stays or home health care. The following section provides information on some of the major public programs that may help pay for long-term care services.
Medicare
Medicare is a Federal program designed to cover health care for people age 65 and older, people under age 65 with certain disabilities, and people of all ages with end-stage renal disease (permanent kidney failure requiring dialysis or a kidney transplant.) It only covers medically necessary care and focuses on medical acute care (doctor visits and hospital stays) or short-term services for conditions expected to improve.
Generally, Medicare does not pay for most long-term care. Medicare does not pay for personal or custodial care (help with Activities of Daily Living), which is the greatest part of long-term care services. Medicare will help pay for a limited skilled nursing facility stay, hospice care or home health care if you meet certain conditions, which are described below.
Medicare will pay for care in a skilled nursing facility when:
you have had a recent prior hospital stay of at least three days,
you are admitted to a Medicare-certified nursing facility within 30 days of your prior hospital stay, and
you need skilled care such as skilled nursing services and/or physical or other types of therapy.
If all these conditions are met, Medicare pays a portion of your costs for up to 100 days. For the first 20 days, Medicare pays 100 percent of your skilled nursing facility costs. For days 21-100, you pay your own expenses up to $133.50/day (as of 2009) and Medicare pays the balance, if any. You pay 100 percent of costs for each day of a skilled nursing facility stay after day 100.
Medicare payments for home health care are limited to medically necessary part-time or intermittent skilled nursing care and home health aide services as well as physical therapy, occupational therapy and speech-language pathology that are ordered by your doctor and provided by a Medicare-certified home health agency. It also includes medical social services, medical supplies, and durable medical equipment (such as wheelchairs, hospital beds, oxygen, and walkers). Unlike nursing home services, there is no co-pay for home health, but for durable medical equipment you pay 20% of the Medicare approved amount. There is no limit on the duration of service as long as services continue to be medically necessary and your doctor requests or reorders these services at least every 60 days.
Hospice care is covered for people with a terminal illness, generally individuals who are not expected to live more than six months. Services include drugs for symptom control and pain relief, medical and support services from a Medicare-approved hospice provider, and other services not otherwise covered by Medicare (such as grief counseling). Hospice care is usually provided in your home (which may include a nursing home if that is where you live) or in a hospice care facility. Medicare does cover some short-term hospital and inpatient respite care to a hospice patient to allow the usual caregiver to rest.
Medicaid
Medicaid is a joint Federal and state government program that helps pay medical costs for some people with limited incomes and resources. People with Medicaid may get coverage for services such as nursing home and home health care, if they meet the eligibility requirements for Medicaid. Who is eligible and what services are covered vary from state to state. Most often, eligibility is based on your income and personal resources, but for coverage of long-term care services, you must also meet certain health or functional criteria to be eligible. The best source for that information is your State Medical Assistance office, whose phone number can be found at the Medicare Helpful Contacts search page. Your state Medicaid agency's website also has more information.
Sometimes you must spend down (or use up) your personal resources (assets) before you qualify for Medicaid. You may want to get more detailed information from your State Medical Assistance office or an attorney before spending down your resources.
A Brief History of Medicaid
The Medicaid program was enacted by Congress in 1965 in the same legislation that created the Medicare program. Medicaid is a state-administered program overseen at the Federal level by the Centers for Medicare & Medicaid Services (CMS). Specific program limits are set through a combination of Federal requirements and options, giving states flexibility in the design of their programs. As a result, standards and rules vary considerably from state to state.
Medicaid was originally designed to provide health care to poor families, children, the aged, and the disabled. Over time, the number of people served, as well as the cost of serving those people, has increased dramatically. A large part of that growth has been the number of people receiving long-term care services and the cost of providing those services.
The most common types of long-term care that Medicaid pays for are institutional care and home- and community-based service.
The following sections provide details about services Medicaid pays for, eligibility rules, rules about transfer of assets, how much you must contribute to the cost of your care, applying for Medicaid, and more.
Older Americans Act
The Older Americans Act is a Federal program designed to organize, coordinate, and provide home and community-based services to older adults and their families to help elders remain in the community as independently as possible.
The Older Americans Act provides funding, through state and local agencies known as the Aging Network, for a range of services that include nutrition programs in the community and for homebound elderly; programs for Native American elders; services for low-income minority elders; health promotion and disease prevention activities; in-home services for frail elders; services that protect the rights of older persons such as the long-term care ombudsman program; and services and supports for family caregivers. While there are no specific financial eligibility criteria for Older Americans Act services, they are generally targeted for low-income, frail seniors over age 60, and minority elders and seniors living in rural areas.
Local agencies, called Area Agencies on Aging (AAAs), in collaboration with State Agencies on Aging, plan and develop service and support programs based on the needs of elders and families in their respective areas. More information on Older Americans Act programs can be found on the Administration on Aging [offsite] website.
Veterans Affairs
The Department of Veterans Affairs (VA) may provide long-term care for service-related disabilities or for certain eligible veterans. In 1999, the Veterans Millennium Health Care and Benefits Act expanded VA health programs to include many that may be of use to aging veterans with long-term care needs. The Act requires the VA to provide long-term care to veterans who meet established disability criteria, or to those who need care because of service-connected disabilities.
This bill expands access to nursing home care and other extended care services to veterans who do not have service-related disabilities, but who are unable to pay for the expenses of necessary care. For those who qualify, the benefits can provide financial assistance for some long-term care costs. Co-pays may apply depending on the veteran's income level. Middle-class veterans who need long-term care for non-service-related conditions may find it difficult to access VA benefits for long-term care.
The VA also has a Housebound and Aid and Attendance Allowance Program that provides cash grants to eligible disabled veterans and surviving spouses in lieu of formally provided homemaker, personal care and other services needed for assistance in Activities of Daily Living and other help at home.
Visit the Department of Veterans Affairs to view available programs and services or download a Veterans Benefits fact sheet. You can call the VA at 1-800-827-1000 to obtain information about available services in your area.
Medicare
Medicare is a Federal program designed to cover health care for people age 65 and older, people under age 65 with certain disabilities, and people of all ages with end-stage renal disease (permanent kidney failure requiring dialysis or a kidney transplant.) It only covers medically necessary care and focuses on medical acute care (doctor visits and hospital stays) or short-term services for conditions expected to improve.
Generally, Medicare does not pay for most long-term care. Medicare does not pay for personal or custodial care (help with Activities of Daily Living), which is the greatest part of long-term care services. Medicare will help pay for a limited skilled nursing facility stay, hospice care or home health care if you meet certain conditions, which are described below.
Medicare will pay for care in a skilled nursing facility when:
you have had a recent prior hospital stay of at least three days,
you are admitted to a Medicare-certified nursing facility within 30 days of your prior hospital stay, and
you need skilled care such as skilled nursing services and/or physical or other types of therapy.
If all these conditions are met, Medicare pays a portion of your costs for up to 100 days. For the first 20 days, Medicare pays 100 percent of your skilled nursing facility costs. For days 21-100, you pay your own expenses up to $133.50/day (as of 2009) and Medicare pays the balance, if any. You pay 100 percent of costs for each day of a skilled nursing facility stay after day 100.
Medicare payments for home health care are limited to medically necessary part-time or intermittent skilled nursing care and home health aide services as well as physical therapy, occupational therapy and speech-language pathology that are ordered by your doctor and provided by a Medicare-certified home health agency. It also includes medical social services, medical supplies, and durable medical equipment (such as wheelchairs, hospital beds, oxygen, and walkers). Unlike nursing home services, there is no co-pay for home health, but for durable medical equipment you pay 20% of the Medicare approved amount. There is no limit on the duration of service as long as services continue to be medically necessary and your doctor requests or reorders these services at least every 60 days.
Hospice care is covered for people with a terminal illness, generally individuals who are not expected to live more than six months. Services include drugs for symptom control and pain relief, medical and support services from a Medicare-approved hospice provider, and other services not otherwise covered by Medicare (such as grief counseling). Hospice care is usually provided in your home (which may include a nursing home if that is where you live) or in a hospice care facility. Medicare does cover some short-term hospital and inpatient respite care to a hospice patient to allow the usual caregiver to rest.
Medicaid
Medicaid is a joint Federal and state government program that helps pay medical costs for some people with limited incomes and resources. People with Medicaid may get coverage for services such as nursing home and home health care, if they meet the eligibility requirements for Medicaid. Who is eligible and what services are covered vary from state to state. Most often, eligibility is based on your income and personal resources, but for coverage of long-term care services, you must also meet certain health or functional criteria to be eligible. The best source for that information is your State Medical Assistance office, whose phone number can be found at the Medicare Helpful Contacts search page. Your state Medicaid agency's website also has more information.
Sometimes you must spend down (or use up) your personal resources (assets) before you qualify for Medicaid. You may want to get more detailed information from your State Medical Assistance office or an attorney before spending down your resources.
A Brief History of Medicaid
The Medicaid program was enacted by Congress in 1965 in the same legislation that created the Medicare program. Medicaid is a state-administered program overseen at the Federal level by the Centers for Medicare & Medicaid Services (CMS). Specific program limits are set through a combination of Federal requirements and options, giving states flexibility in the design of their programs. As a result, standards and rules vary considerably from state to state.
Medicaid was originally designed to provide health care to poor families, children, the aged, and the disabled. Over time, the number of people served, as well as the cost of serving those people, has increased dramatically. A large part of that growth has been the number of people receiving long-term care services and the cost of providing those services.
The most common types of long-term care that Medicaid pays for are institutional care and home- and community-based service.
The following sections provide details about services Medicaid pays for, eligibility rules, rules about transfer of assets, how much you must contribute to the cost of your care, applying for Medicaid, and more.
Older Americans Act
The Older Americans Act is a Federal program designed to organize, coordinate, and provide home and community-based services to older adults and their families to help elders remain in the community as independently as possible.
The Older Americans Act provides funding, through state and local agencies known as the Aging Network, for a range of services that include nutrition programs in the community and for homebound elderly; programs for Native American elders; services for low-income minority elders; health promotion and disease prevention activities; in-home services for frail elders; services that protect the rights of older persons such as the long-term care ombudsman program; and services and supports for family caregivers. While there are no specific financial eligibility criteria for Older Americans Act services, they are generally targeted for low-income, frail seniors over age 60, and minority elders and seniors living in rural areas.
Local agencies, called Area Agencies on Aging (AAAs), in collaboration with State Agencies on Aging, plan and develop service and support programs based on the needs of elders and families in their respective areas. More information on Older Americans Act programs can be found on the Administration on Aging [offsite] website.
Veterans Affairs
The Department of Veterans Affairs (VA) may provide long-term care for service-related disabilities or for certain eligible veterans. In 1999, the Veterans Millennium Health Care and Benefits Act expanded VA health programs to include many that may be of use to aging veterans with long-term care needs. The Act requires the VA to provide long-term care to veterans who meet established disability criteria, or to those who need care because of service-connected disabilities.
This bill expands access to nursing home care and other extended care services to veterans who do not have service-related disabilities, but who are unable to pay for the expenses of necessary care. For those who qualify, the benefits can provide financial assistance for some long-term care costs. Co-pays may apply depending on the veteran's income level. Middle-class veterans who need long-term care for non-service-related conditions may find it difficult to access VA benefits for long-term care.
The VA also has a Housebound and Aid and Attendance Allowance Program that provides cash grants to eligible disabled veterans and surviving spouses in lieu of formally provided homemaker, personal care and other services needed for assistance in Activities of Daily Living and other help at home.
Visit the Department of Veterans Affairs to view available programs and services or download a Veterans Benefits fact sheet. You can call the VA at 1-800-827-1000 to obtain information about available services in your area.
Sunday, May 3, 2009
The cost of long-term care
An important part of planning for long-term care is deciding how to pay for services. This is because long-term care is very expensive, and contrary to what many people believe, their Medicare coverage will not pay for most of the long-term care services they need. While some people may qualify for Medicaid – the major payer of long-term care services, most people won't. There are other federal public programs, such as the Older Americans Act, or state funded programs, that pay some long-term care services, but like Medicaid they target those people with the most functional and financial need. Consequently, if you are one of the 70% of people over the age of 65 who will need long-term care services – there's a very good chance you will have to pay for some or all of your long-term care services out of your personal income and resources.
Paying for long-term care out of your personal income and resources can be challenging. Even if you have a modest need for assistance at home with personal care, say a visit from a home health aide 3 times a week, based on 2008 average costs, you would have to pay about $18,000 a year for those services.
To make the best decisions about how to pay for long-term care you need to understand what services cost, what public programs you are eligible for and what they cover, what private financing options are available, and which ones work best for you.
What Does Long-Term Care Cost?
LTC includes a broad range of health and support services that people need as they age or if they are disabled. The majority of these services are personal care, or assistance with activities of daily living that many families are able to provide all, or some of, free. But, as care and support needs increase, paid care is usually needed to supplement family provided services and supports, provide respite to family caregivers, or to pay for more extensive services in a facility, such as a nursing home or assisted living, when individuals can no longer be cared for in their homes.
There are variations in costs based on the type and amount of care you need, the provider you use, and where you live. Home health and home care services, provided in two-to-four-hour blocks of time referred to as “visits,” are generally more expensive in the evening, or on weekends or holidays. The costs of services in some community programs, such as adult day service programs, are often provided at a per-day rate, but vary based on overhead and programming costs. Many care facilities charge extra for services provided beyond the basic room-and-board charge, although some may have “all inclusive” fees.
The average costs in the United States (in 2008) are:
$187/day for a semi-private room in a nursing home
$209/day for a private room in a nursing home
$3,008/month for care in an Assisted Living Facility (for a one-bedroom unit)
$29/hour for a Home Health Aide
$18/hour for a Homemaker services
$59/day for care in an Adult Day Health Care Center
Who Pays for Long-Term Care?
If you have sufficient income and assets, you are likely to pay for your long-term care needs on your own, out of those private resources. If you meet functional eligibility criteria and have limited financial resources, or deplete them paying for care, Medicaid may pay for your care. If you require primarily skilled or recuperative care for a short time, Medicare may pay. The Older Americans Act is another Federal program that helps pay for long-term care services. Some people use a variety of payment sources as their care needs and financial circumstances change.
Long-Term Care Service
Medicare
Private Medigap Insurance
Medicaid
You Pay on Your Own*
Nursing Home Care
Medicare pays in full for days 0-20 if you are in a Skilled Nursing Facility following a recent hospital stay. If your need for skilled care continues, may pay for the difference between your co-payment of $133.50/day for days 21-100. After day 100 does not pay.
Private Medigap Insurance may cover the $133.50/day co-payment if your nursing home stay meets all other Medicare requirements.
Medicaid may pay for care in a Medicaid-certified nursing home if you meet functional and financial eligibility criteria.
If you need only personal or supervisory care in a nursing home and/or have not had a prior hospital stay, or if you choose a nursing home that does not participate in Medicaid or is not Medicare-certified.
Assisted Living Facility (and similar facility options)
Medicare does not pay
Private Medigap Insurance does not pay
Medicaid in some states, may pay care-related costs, but not room and board
You pay on your own except as noted under Medicaid if eligible.
Continuing Care Retirement Community
Medicare does not pay
Private Medigap Insurance does not pay
Medicaid does not pay
You pay on your own
Adult Day Services
Medicare - Not covered
Private Medigap Insurance - Not Covered
Medicaid - Varies by state, financial and functional eligibility required
You pay on your own [except as noted under Medicaid if eligible.]
Home Health Care
Medicare - Limited to reasonable, necessary part-time or intermittent skilled nursing care and home health aide services, and some therapies that are ordered by your doctor and provided by Medicare-certified home health agency. Does not pay for on-going personal care or custodial care needs only (help with activities of daily living).
Private Medigap Insurance - Not covered
Medicaid - Pay for, but states have option to limit some services, such as therapy
You pay on your own for personal or custodial care, except as noted under Medicaid, if you are eligible.
*See private finance options to learn more about a variety of private financing options to help you pay for your long-term care needs.
National Spending on Long-Term Care
The total amount spent on long-term care services in the United States (in 2005) was $206.6 billion. This does not include care provided by family or friends on an unpaid basis (often called “informal care.”) It only includes the costs of care from a paid provider.
While most information on “who pays for long-term care” presents these national figures, it is important to remember that each person's individual experience will differ. These figures combine the experiences of everyone receiving paid care, but there are significant variations from person to person.
On an aggregate basis, the biggest share, 49 percent, is paid for by Medicaid. On an individual basis, however, “who pays for long-term care” can look very different. This is because people with their own personal financial resources do not qualify for Medicaid unless they use up their resources first paying for care, so-called “spending down”. If you have reasonable income and assets, most likely you will be paying for care on your own.
Also, while Medicare overall pays for 20 percent of long-term care, it only pays under specific circumstances. If the type of care you need does not meet Medicare's rules, Medicare will not pay and you are likely to pay for your care on your own.
Learning more about the “rules” for when Medicare, Medicaid, other public programs or private insurance might pay for long-term care is an important part of understanding “who will pay” if and when you need care.
Paying for long-term care out of your personal income and resources can be challenging. Even if you have a modest need for assistance at home with personal care, say a visit from a home health aide 3 times a week, based on 2008 average costs, you would have to pay about $18,000 a year for those services.
To make the best decisions about how to pay for long-term care you need to understand what services cost, what public programs you are eligible for and what they cover, what private financing options are available, and which ones work best for you.
What Does Long-Term Care Cost?
LTC includes a broad range of health and support services that people need as they age or if they are disabled. The majority of these services are personal care, or assistance with activities of daily living that many families are able to provide all, or some of, free. But, as care and support needs increase, paid care is usually needed to supplement family provided services and supports, provide respite to family caregivers, or to pay for more extensive services in a facility, such as a nursing home or assisted living, when individuals can no longer be cared for in their homes.
There are variations in costs based on the type and amount of care you need, the provider you use, and where you live. Home health and home care services, provided in two-to-four-hour blocks of time referred to as “visits,” are generally more expensive in the evening, or on weekends or holidays. The costs of services in some community programs, such as adult day service programs, are often provided at a per-day rate, but vary based on overhead and programming costs. Many care facilities charge extra for services provided beyond the basic room-and-board charge, although some may have “all inclusive” fees.
The average costs in the United States (in 2008) are:
$187/day for a semi-private room in a nursing home
$209/day for a private room in a nursing home
$3,008/month for care in an Assisted Living Facility (for a one-bedroom unit)
$29/hour for a Home Health Aide
$18/hour for a Homemaker services
$59/day for care in an Adult Day Health Care Center
Who Pays for Long-Term Care?
If you have sufficient income and assets, you are likely to pay for your long-term care needs on your own, out of those private resources. If you meet functional eligibility criteria and have limited financial resources, or deplete them paying for care, Medicaid may pay for your care. If you require primarily skilled or recuperative care for a short time, Medicare may pay. The Older Americans Act is another Federal program that helps pay for long-term care services. Some people use a variety of payment sources as their care needs and financial circumstances change.
Long-Term Care Service
Medicare
Private Medigap Insurance
Medicaid
You Pay on Your Own*
Nursing Home Care
Medicare pays in full for days 0-20 if you are in a Skilled Nursing Facility following a recent hospital stay. If your need for skilled care continues, may pay for the difference between your co-payment of $133.50/day for days 21-100. After day 100 does not pay.
Private Medigap Insurance may cover the $133.50/day co-payment if your nursing home stay meets all other Medicare requirements.
Medicaid may pay for care in a Medicaid-certified nursing home if you meet functional and financial eligibility criteria.
If you need only personal or supervisory care in a nursing home and/or have not had a prior hospital stay, or if you choose a nursing home that does not participate in Medicaid or is not Medicare-certified.
Assisted Living Facility (and similar facility options)
Medicare does not pay
Private Medigap Insurance does not pay
Medicaid in some states, may pay care-related costs, but not room and board
You pay on your own except as noted under Medicaid if eligible.
Continuing Care Retirement Community
Medicare does not pay
Private Medigap Insurance does not pay
Medicaid does not pay
You pay on your own
Adult Day Services
Medicare - Not covered
Private Medigap Insurance - Not Covered
Medicaid - Varies by state, financial and functional eligibility required
You pay on your own [except as noted under Medicaid if eligible.]
Home Health Care
Medicare - Limited to reasonable, necessary part-time or intermittent skilled nursing care and home health aide services, and some therapies that are ordered by your doctor and provided by Medicare-certified home health agency. Does not pay for on-going personal care or custodial care needs only (help with activities of daily living).
Private Medigap Insurance - Not covered
Medicaid - Pay for, but states have option to limit some services, such as therapy
You pay on your own for personal or custodial care, except as noted under Medicaid, if you are eligible.
*See private finance options to learn more about a variety of private financing options to help you pay for your long-term care needs.
National Spending on Long-Term Care
The total amount spent on long-term care services in the United States (in 2005) was $206.6 billion. This does not include care provided by family or friends on an unpaid basis (often called “informal care.”) It only includes the costs of care from a paid provider.
While most information on “who pays for long-term care” presents these national figures, it is important to remember that each person's individual experience will differ. These figures combine the experiences of everyone receiving paid care, but there are significant variations from person to person.
On an aggregate basis, the biggest share, 49 percent, is paid for by Medicaid. On an individual basis, however, “who pays for long-term care” can look very different. This is because people with their own personal financial resources do not qualify for Medicaid unless they use up their resources first paying for care, so-called “spending down”. If you have reasonable income and assets, most likely you will be paying for care on your own.
Also, while Medicare overall pays for 20 percent of long-term care, it only pays under specific circumstances. If the type of care you need does not meet Medicare's rules, Medicare will not pay and you are likely to pay for your care on your own.
Learning more about the “rules” for when Medicare, Medicaid, other public programs or private insurance might pay for long-term care is an important part of understanding “who will pay” if and when you need care.
Subscribe to:
Comments (Atom)
