More than 80 percent of nursing home residents in United States are age 65 and above. Most of them are in critical care due to chronic illness or disability that requires supervision from nurses, aides, and nursing home staff. Some residents simply stay there for assistance in daily living activities since they are no longer capable of moving around and taking care of themselves.priority of funding nursing homes offers excellent info on this.
Many of nursing home residents are called long term care patients – they suffer from critical illness that prevents them from doing normal activities and hamper them from going back home. Long term care patients are destined either to die in the nursing home or to be moved in to a hospital where they will die. In fact, the average stay of elderly patients is just two years.
Nursing home has a typical hospital environment and facilities. The residents stay in rooms that are similar to hospital rooms with little or no privacy. They use hospital pricing model wherein residents are charged daily flat rates for either semi-private or private room, while additional services and supplies are charged to the bill.
Medicare is a nationwide health insurance program granted to eligible elders age 65 and older. There are approximately 40 million Medicare beneficiaries throughout United States.
Medicare is one option in paying for nursing home care, but not the best alternative. It only pays for the full cost of the first 20 days of $114 per day. Medicare can pay for the next 80 days if the person has private Medicare supplement, but usually stops before the 100th day. When Medicare stops, the supplemental coverage also stops. An individual must stay for at least three days in a hospital or undergo skilled care. The transfer from hospital should happen at the same time period.
Most people assume that Medicare can pay the entire 100 days for nursing home stay; however, that’s not the case. In fact, not all nursing home stay automatically signs on to Medicare coverage.
In 1998, Medicaid paid for almost 46.3% of the $88 billion received by all US nursing homes. Medicaid only divvies out its budget for nursing home care either on semi-private room or private room and only few left for home care. However, a state legislature is compelling Medicaid to fund home care and assisted living.
Individuals who want to avail home care or alternative community services must be evaluated for 90 days in nursing home. Also, a person should have $2000 worth of total assets to qualify for Medicaid. In fact, there have been lots of horrible stories from people who have lost their cars, houses, and properties to qualify for Medicaid.
Private Long Term care Insurance
Private insurance is another alternative funding for long term care nursing home care. The government also pushes programs that will help people finance their own long term care rather than Medicare and Medicaid bear the brunt of funding such expensive care. These efforts all started from Pepper Commission in 1992 and HIPAA legislation in 1996 that offered long term care insurance for federal workers, military, retirees and their families.
You can now purchase LTC insurance coverage in your state. All LTC insurance is medically underwritten that is a basis for the insurance company to accept or refuse the application. The cost and type of coverage normally depends on the person’s age and medical condition.