Your toughest challenge may be footing the bill. Nursing care facilities of all levels are very expensive, but depending on the type of care you need and the type of insurance you have, you may get some help covering the cost. Skilled nursing facilities run more than $500 per day, although stays there are relatively short and Medicare or private health insurance will usually pick up much of the tab.
Long-term custodial care -- the kind that may last for years -- costs between $4,000 and $12,000 per month. Neither Medicare nor medigap private insurance supplements pay any of the cost of custodial care. Medicaid will pay the full cost of custodial nursing facility care for people with very low income and few assets. Some veterans may also find coverage for custodial care through the Veterans Administration. Long-term care insurance, for those who have it, may also cover some of the cost of custodial care. For more information, see Nolo's article Long-Term Care Insurance: The Risks and Benefits.
If a facility is certified by the federal government, it may be more affordable. The Healthcare Financing Administration has certified about 85% of all nursing facilities; HCFA certification means that the facility is eligible to receive Medicare and Medicaid payments. Some facilities do not meet HCFA standards. Other facilities charge high prices and simply do not want to accept residents who depend on Medicaid payments.
Unless you have an unlimited supply of money to pay for long-term care, make sure that any facility you consider is certified. Certification means that the facility meets some certain minimum health, safety, and care standards. And certification also means that if someday you should need and qualify for Medicaid coverage for your stay, you will be able to receive it without having to move to a different facility.
Also consider "home care" -- medical services provided at home that make it possible for an older person to remain at home rather than enter a care facility. For more information, read Nolo's article Is Home Health Care an Option?
Unfortunately, as we've all heard on the news, some facilities provide substandard living conditions and even a dangerous lack of care. Still others give basic care that meets technical health standards but offers little else, and have an atmosphere that is debilitating or demoralizing to the residents.
However, there are also excellent long-term care facilities that provide high-quality care while assisting residents to maintain active lives with a full measure of dignity. Because there are many levels and types of nursing and personal care, your task is to find a good, affordable facility that is right for you.
Your best bet is to ask around for referrals. Here are some good sources of information and referrals:
Hospital discharge planner. The discharge planner will often be available for advice if you are going straight from a hospital to a long-term care facility.
Your doctor. Ask your doctor about personal experience he or she may have had with facilities in your area.
Organizations focusing on specific illness. Check with organizations that focus on your particular illness or disability, such as the American Heart Association, the American Cancer Society, the American Diabetes Association, or the Alzheimer's Disease Foundation.
National long-term care organizations. A number of private organizations such as American Association of Homes for the Aging specialize in long-term care and give referrals to local facilities.
Government agencies. You can often get targeted referrals from the federal Area Agencies on Aging, or from state and local agencies found through Senior Referral and Information numbers in the white pages of the phone book or your local county social services or family services agency.
Church, ethnic, or fraternal organizations. Ask about long-term care facilities that members have used successfully or that are operated by or affiliated with the church or organization.
Relatives, friends, and neighbors. They may have had experience with a long-term care facility or know someone who has, and are often your best sources of information.
If at all possible, your search for a nursing facility should not be a hurried, emergency procedure. As soon as you begin to see that your current living arrangements may become insufficient and neither home care nor assisted living will provide the care or monitoring you need, begin planning.
Finding out which long-term care facility might be the best in a particular area can take time. Many good ones operate at full capacity, so they may not be able to accept a new resident at short notice.
You must also consider how you will pay the facility. You'll have to calculate family assets and income, along with reverse mortgages and the amounts that might be contributed by Medicare, veterans' benefits, and any long-term care insurance. See the Health Care: Medicare & Long-Term Care area of Nolo's website.
For a complete guide that can help you understand the alternatives to nursing facilities and that shows you how to find the best care you can afford, get Long-Term Care: How to Plan & Pay for It, by Joseph Matthews (Nolo).
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