Long-term care, be it in nursing home, assisted living facility or continuing care facility, is expensive. The average annual rate for a private nursing home room is about $83,000 (2011 national average).
Many family caregivers and their elderly parents think these costs will be taken care of by Medicare and Medicaid. But the truth is: Most seniors do not usually meet their long-term care needs from any one source. Instead a combination of support—government assistance, private funds and community services is used to foot the bill.
To help caregivers navigate the expensive world of long-term care, here are some highlights of what is – and what is not – covered by public assistance, provided by The National Clearinghouse for Long-Term Care Information ( www.longtermcare.gov )
Medicaid is the joint federal and state program that pays for the largest share of long-term care services, but only if you meet financial and functional criteria. And it varies considerably from one state to another.
Although Medicaid will pay for long-term care, there are restrictions on the qualifications for assistance. First and foremost, Medicaid is a program designed to help those who are impoverished. In order to qualify for long-term care assistance through Medicaid, your elderly parent must spend practically all of his/her own assets before Medicaid will begin to pick up the tab. If the senior has reasonable income and assets, most likely they will be paying for care on their own.
Sometimes you must spend down (or use up) your personal assets before you qualify for Medicaid. However, get more detailed information from your State Medical Assistance office or an attorney before spending down your resources.
Medicaid pays for long-term care services in both institutional settings and in the home. To qualify for Medicaid, you need to meet three categories of requirements:
- General Medicaid eligibility requirements
- Functional requirements
- Financial requirements
Medicaid recipients must:
- Be age 65 or older or permanently disabled or blind; and
- Meet U.S. citizenship or immigration rules; and
- Be a resident of the state where they apply.
To receive long-term care services under Medicaid, an individual must be assessed and determined to be in need of long-term care. A medical specialist in the state evaluates your parent's care needs. As part of this assessment, the specialist determines if the elderly person needs nursing home care or if they are a candidate for home care and community-based services.
The need for long-term care is generally determined by whether he/she can perform the Activities of Daily Living on their own, or whether they need assistance from another person. These activities include bathing, dressing, using the toilet, transferring (to or from bed or chair), caring for incontinence, and eating. If your elderly parent does not meet Medicaid's Functional Eligibility Criteria, they cannot receive long-term care services under Medicaid regardless of how poor they are.