By Molly Wigand
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The
journey from living independently to requiring increasing levels of
care can be emotionally and financially overwhelming for an individual
and their loved ones. When a person can no longer live safely on their
own or begins to need specialized care, their family may seek the
assistance of a nursing home, which can also be called a skilled nursing
facility or skilled nursing community, to help provide care for their
loved one.
Learning about the costs and financial expectations of
nursing home care can help provide focus, clarity and direction as
families navigate this life-changing transition together. Here’s what
you need to know.
What Is a Nursing Home?
According to the National Institute on Aging, nursing homes typically offer residents a range of services, including:
- Nursing care
- 24-hour supervision
- Three meals a day
- Assistance with activities of daily living (ADLs), such as bathing, dressing, walking, using the toilet and eating
- Rehabilitation services, such as physical, occupational and speech therapy
Skilled
nursing communities are able to accommodate “higher acuity situations,”
meaning residents with feeding tubes, tracheostomy tubes and/or
respirators, says Don Minter, a certified senior advisor, certified
dementia practitioner and area owner of Senior Care Authority in the
Kansas City area. He cites these three medical necessities as primary
reasons a resident may require skilled nursing care instead of
independent or assisted living.
Experts
like Minter often prefer the term “skilled nursing community” to
“nursing home” due to the negative connotations of the latter phrase.
Meanwhile, the Centers for Medicare and Medicaid Services (CMS) uses the
term “skilled nursing facility,” which is often abbreviated as “SNF.”
Types of Nursing Homes and Senior Living Facilities
Once
a person is either unable to live on their own safely or elects to
relocate to an environment that provides access to more daily
assistance, they can choose from a variety of community options that
cover the full continuum of care.
Board and care homes
(sometimes called residential care facilities or group homes) are
small, private facilities in which residents receive meals, assistance
with ADLs and 24/7 access to on-call staff 24/7. These facilities
typically do not offer medical services.
Assisted living communities
vary in size and are designed for people who are somewhat independent
but may require assistance with medication management, housekeeping or
laundry. Assisted living communities typically offer various levels of
care, and the price of residency varies based on the amount of care
provided.
In assisted living communities, people may live in
private or shared apartments, rooms or studios and socialize with other
residents in community areas. Assisted living accommodations may include
up to three meals a day, as well as recreational and educational
activities, shopping trips and transportation services.
Both
board and care homes and assisted living facilities are regulated by
states, according to Joseph Shega, M.D., executive vice president and
chief medical officer of VITAS Healthcare and a Forbes Health Advisory
Board member. As a result, the services rendered by these facilities and
their ability to handle acuity and complexity will vary depending upon
state rules and regulations, he adds.
Skilled nursing facilities
offer acute medical care, three meals a day and 24/7 medical staff
support. Short-term skilled nursing facility stays are sometimes
recommended following an injury or hospital stay, with residents
returning home following recovery. Many nursing home residents, however,
have health or cognitive issues requiring ongoing care, most likely
living permanently in these facilities.
Continuing care retirement communities (CCRCs),
sometimes known as life care communities, incorporate various levels of
care in a single campus location. Independent living, assisted living
and skilled nursing care are all available in these communities, and
people can move from one level of care to another as their circumstances
change.
“If a resident is living on the independent living side
of the community and falls and breaks a hip, they can stay in the same
community and rehab back to home in independent living,” says Minter.
However, the costs associated with CCRCs can be prohibitive, with
initial buy-ins averaging from $60,000 up to $750,000, according to
Minter.
Nursing Home Costs and Expenses
Average Costs and Considerations
Because
of the level of care provided in these communities, nursing homes are
expensive. The average cost of a private room in a nursing home ranges
from $280 to $550 per day—approximately $9,000 to $15,000 per
month—depending on the person’s location and level of care required,
according to Minter.
The American Council on Aging publishes a list of average prices of nursing homes
by state and region annually through its Medicaid Planning Assistance
organization. Review this breakdown for a more accurate estimate for you
or your loved one, as cost can vary dramatically based on geography.
Medicare and Skilled Nursing Care
Medicare can cover a nursing home stay if the person meets all three of the following criteria:
- They are enrolled in Medicare Part A.
- They had a qualifying hospital stay of at least three consecutive days.
- Their doctor ordered services in a skilled nursing facility.
Most
daily services in a nursing home are included in a community’s daily
rate. Depending on the resident’s care plan, Medicare can cover
physical, occupational and speech therapies, as well as basic daily
skilled nursing care. Check with your facility’s director to avoid
unexpected charges.
Medicare’s skilled nursing benefits vary according to the length of a person’s stay in each benefit period.
- Days 1-20: Medicare pays 100% of the costs.
- Days
21-100: The resident pays coinsurance in the amount of $194.50 per day
(in 2022), and Medicare covers the remainder of the cost.
- Day 101 and beyond: The resident is responsible for 100% of the costs.
Medicare Advantage plan benefits may also vary.
Ways to Pay for Nursing Home Care
While
Medicare covers short-term skilled nursing stays, longer-term or
permanent residence in a nursing home requires other financing options.
Minter
says residents and their families typically have the following options
when paying for long-term skilled nursing facility care:
- Private pay. Either a resident’s assets or their family’s assets can pay for skilled nursing care.
- Veterans’ benefits. VA Aid and Attendance benefits can contribute up to $1,800 a month to skilled nursing care.
- Long-term care insurance. Accrued benefits can help defray costs.
- Life insurance, depending on the policy.
Some policies can help cover costs associated with skilled nursing
care, but check with your insurance company to ensure this benefit is
provided by your or your loved one’s policy.
- Medicaid.
A common method of paying for skilled nursing care, Medicaid benefits
are determined at the state level, so check your specific benefits
before signing any contracts.
What to Consider When Searching for a Nursing Home
Medicare’s nursing home comparison chart
can help you compare facilities within a specified radius of your
preferred location. The tool aggregates consumer ratings (one to five
stars) for facilities overall, as well as their health inspections and
quality measures. Individual states provide these ratings as well.
Working
with a certified senior advisor (CSA) can also help narrow your search
for appropriate accommodations for yourself or a loved one. Many CSAs
have extensive knowledge of the local market and are trained to help
older adults and their families find the community that most
appropriately suits their specific needs.
It’s a good idea to
visit a nursing home in person, too, as ratings and impressions of a
community “on paper” may not give a complete picture. “When we go into a
community, we’re always looking at the care the residents are
receiving,” says Minter. “How do the residents look? Are their faces
shaved, is their hair combed, do they look clean and are they smiling?
Resident and staff interactions are paramount,” he adds. “It’s
everyone’s goal to have their loved one age in a place where they don’t
have to move again.”
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