Nursing homes have become an extension of a hospital stay for seniors on Medicare or Medicaid. When choosing a nursing home for rehabilitation, Medicare pays for a portion of the costs. Medicare will pay for the daily fee, for the first 20 days, upon pre-approval by a medical doctor and then may pay for days 21 through 100 days, the maximum stay for reimbursement. This means that Medicare’s full benefit upon doctor approval only pays for a little more than 3 months of a nursing home stay.
Medicaid, the low-income version of Medicare, does pay for on-going stays in nursing homes accepting Medicaid as payment.
Tips for Choosing a Nursing Home
1) Organize the senior’s long-term financial capabilities including monthly income and all assets owned including homes and cars. Review Medicaid financial qualifications for the state where the senior lives. This allows you to financially prepare for long-term nursing home care needs and possible Medicaid-spend down.
2) Find nursing homes in your area who accept Medicare as payment vs. Medicaid as payment. Usually nursing homes primarily accepting Medicare or private pay will allow a senior to stay if they spend-down to Medicaid even though they would not accept the senior on Medicaid as a new patient. As Medicaid reimbursements can be lower, the 100% Medicaid nursing homes may not offer as many amenities.
3) Review Caregiverlist nursing home star-rating which includes the top criteria which impacts quality of care: Overall Medicare Star-Rating, % of Short-stay Residents with Pressure Sores, Certified Nursing Aide (C.N.A.) hours per resident per day, % of Long-term Residents whose need for help with Daily Activities has increased. Make special note of the C.N.A. hours per resident as many times nursing homes suggest hiring a private duty caregiver if more care is needed when the staffing ratio is only 1 C.N.A. to 12 or more residents.
4) Review the ownership of the nursing home. Nursing homes may be owned by hospitals or healthcare groups or equity groups. This will be an indication of what focus is more important: care or profits?
5) Find licensed senior home care agencies in your area to have as an alternative to nursing home care. Senior home care agencies provide one-to-one care and often cost less than a nursing home.