Not sure what state you are in or how you are defining skilled nursing. If Mom is 88 she may have Medicare. If she has traditional Medicare she is eligible for skilled nursing needs (not custodial care) and needed PT, OT of ST after a 3 night admission to a hospital. Traditional Medicare will pay 100% for the first needed 20 days. After that is she is participating in rehab and is progressing, Mom will have to pay a co- pay (I believe it is 185.50 in 2021 but check on the medicare.gov website) to continue to stay in an SNF facility up to an additional 80 days. If she has a Medicare Advantage plan you will have to read the contract; these plans offer the same services but they have a right to charge differently and stipulate different time frames. Medicare is a health insurance and pays for skilled nursing (examples, IV medication, wound care, injections, catheter care, etc.) but only if it is ordered by a physician and only after the 3 night admission indicated above. A person who requires long term care (LTC) and/or full time custodial care might need admission to a long term care facility. Medicare (a federal program) will never pay for this. In this case, a person who is unable to pay would apply for Medicaid in the state of their residence. Although federally funded, Medicaid is administered by the various states so their requirements and applications are different in each state. In NJ Mom would have to spend down to $2000 in assets ( funeral expenses could be pre paid). In other words, her assets would go towards her support. You would not be expected to pay for her living expenses. I would, if not already set up, definitely get a durable power of attorney (DPOA) and medical proxy for Mom for any needed use in the future. I would check with the state's Office on Aging. They can guide you to someone who can help determine what your Mom's needs actually are and then help you figure how those needs can best be met and secured.
Now to relate all of the above to your statement about Assisted Living (AL), please be aware that most AL facilities do not accept Medicaid because of the very low rate of return per resident on Medicaid. There are a few who have allocated some space for Medicaid however, since their waiting lists are quite long you need to apply for them basically........... yesterday! Again, the Office on Aging will be able to show how to search for those facilities. Also be aware that AL's exist to offer just that... an "assist" to a resident's activities of daily living (ADLs) such as transporting, bathing, toileting, eating and dressing. When a person requires much more than that they generally are no longer considered an AL candidates as their needs have increased and can only be met at the LTC level. This same scenario can also happen when a AL resident runs out of funds to pay the AL privately and there is no Medicaid bed available. Depending on where you are and the level of care requested, ALs monthly costs run from $1500- $4500. LTC monthly costs run from $7500- $10000. The facility that bridges the gap between AL and LTC is a Continuing Care Retirement Community (CCRC) because these communities have all facets of living for those over 55 --- independent living (IL) AL, Memory Care( (MC) for those with dementia related issues), STR and LTC. The sticky wicket is that they usually have a hefty entrance (in the northeast that can be anywhere from $15000.00-$285000.00 plus the monthly fees) but you stay on the same campus as you move through medical stages if necessary. Yes, it is long confusing and sometimes, pricey road but we all manage to shuffle along somehow.
Almost forgot to mention the Programs of All-Inclusive Care for the Elderly (PACE). If your Mom can still stay in her own home, this might be of interest to you. It's not in all areas at this time but the Office on Aging will be able to tell you more about it.
You need to plan to get approved for Medicaid or Medical. How to do it is gong to depend on assets and income, visit your local social service agency or Agency on Aging. If you have a decent amount of assets/income, but not enough for monthly assisted living charges, an elder attorney may be worth paying to set up the transition to Medicaid. Even if you or the person you are caring for is not ready yet for a SNF, it likely will be needed in the future, so be proactive and start planning now. Seek out a State social worker and/or an elder attorney now.
I've read on this forum that some state's Medicaid will pay for AL (but maybe not fully) so I'd contact your county's social services at the Dept of Health and Human Resources to find the answer (call or online). Some states have an Elder Waiver. Or, contact your local area's Agency on Aging for information (maybe Section 8 housing or local charities. I wish you success in finding what you need!
Ggreat question. Unfortunately I am in the same boat as you and have been wondering the same thing. There are excellent experiences and knowledgeable caregivers in this forum that I'm certain will give you great recommendations and wise advice. God bless and know there are always options even though we haven't prepared for this stage in life.
Now to relate all of the above to your statement about Assisted Living (AL), please be aware that most AL facilities do not accept Medicaid because of the very low rate of return per resident on Medicaid. There are a few who have allocated some space for Medicaid however, since their waiting lists are quite long you need to apply for them basically........... yesterday! Again, the Office on Aging will be able to show how to search for those facilities. Also be aware that AL's exist to offer just that... an "assist" to a resident's activities of daily living (ADLs) such as transporting, bathing, toileting, eating and dressing. When a person requires much more than that they generally are no longer considered an AL candidates as their needs have increased and can only be met at the LTC level. This same scenario can also happen when a AL resident runs out of funds to pay the AL privately and there is no Medicaid bed available. Depending on where you are and the level of care requested, ALs monthly costs run from $1500- $4500. LTC monthly costs run from $7500- $10000. The facility that bridges the gap between AL and LTC is a Continuing Care Retirement Community (CCRC) because these communities have all facets of living for those over 55 --- independent living (IL) AL, Memory Care( (MC) for those with dementia related issues), STR and LTC. The sticky wicket is that they usually have a hefty entrance (in the northeast that can be anywhere from $15000.00-$285000.00 plus the monthly fees) but you stay on the same campus as you move through medical stages if necessary. Yes, it is long confusing and sometimes, pricey road but we all manage to shuffle along somehow.
Almost forgot to mention the Programs of All-Inclusive Care for the Elderly (PACE). If your Mom can still stay in her own home, this might be of interest to you. It's not in all areas at this time but the Office on Aging will be able to tell you more about it.
Good luck, peace and blessings on your journey.