What defines "nursing home level of care"?

I'll tell you what I understand to be true, and hopefully other members can make corrections or fill in the details.

A nursing home level of care means that the person needs help with one (two?) or more activities of daily living. These are the most basic activities - eating, toileting, washing, transferring from bed to chair, getting dressed. I'm pretty sure the details vary from state to state. I'm not sure how cognitive impairment figures into it, or whether that varies from state to state. Anyone?

In some states, you don't need to enter into a nursing home. Most or all states have Medicaid waiver programs where services will be provided in the community, in an attempt to keep people out of nursing homes. Also Medicaid can be used to pay for the portion of services in assisted living that exceeds the basic room and board. I'm not sure all states allow this, and I'm sure not all assisted living facilities accept it. Some AL facilities and some nursing homes don't take Medicaid at all.

You need to look into the Medicaid rules in the state where your elder lives. Generally you can get someone from Medicaid come and do a functional assessment to determine eligibility for the functional impairment requirements.

Thank you, Carla. That's a very helpful answer.

One follow-up question: You wrote: "Most or all states have Medicaid waiver programs where services will be provided in the community."

By "community," you mean at home?

I am curious: Where do you live and how much does your state pay for home care with Medicaid? Just for information...

The assisted living where my husband is living now does not accept Medicaid, period. Entirely private pay.

Yes, by community I meant at home. That's jargon I must have picked up reading so many articles about this.

I live in Florida. The Florida program is call the Statewide Medicaid Managed Care (SMMC) program. I don't know what Medicaid pays for home care because my mother doesn't qualify for Medicaid yet. My understanding (which could be wrong) is that they contract with providers and they provide you with x number of hours of assistance per week or month depending on your needs. I don't believe they actually pay cash and let you pick your own providers, but I could be wrong. Anybody know?

I agree about checking with your own state about their requirements. From my understanding of my state, Nursing Home care is for those who need skilled nursing care OR the person cannot transfer with the assistance of one person. So, if they are not able to transfer, that can also mean nursing home care.  I think they have rules about being double incontinent too. 

In our state, the long term care facilities require a doctor or some healthcare professional to complete and sign a form that lists the needs and medical conditions of the resident. In my state, the greater the need, the more Medicaid pays. And, you might check with your state and see if they have their own program that will cover certain disabled people in AL. They do in my state and it's similar to Medicaid, but, is called Special Assistance.

Not all long term care facilities accept Medicaid patients, but, you can call around and also, there should be a list online.