Monday, December 19, 2011

Ask Us Anything: How Much Will I Pay for Long-term Care?

"I'm concerned that my mom won't have the resources needed to be cared for properly when she is older. She works as a cashier and doesn't have a retirement plan or any savings. She plans to work until she can no longer do so.

Are there any programs available for persons who are not able to pay out-of-pocket for nursing or adult homes? Is there anything that I should be doing now to prepare?

She probably won't need long-term care for another ten or fifteen years, but I don't want to be blindsided by the costs when it does happen."

Patricia Weeks O'Connor, Executive Director of the OLV Senior Neighborhood, Responds:

Your mother will likely qualify for Medicaid, assuming that she has limited resources at the time that she needs long-term care.

If she needs skilled nursing care, Medicaid will require her to use whatever income she has (with the exception of $50 per month) toward her care and Medicaid will pay the balance to the facility.

She would be required to "spend down" her savings toward her care until she reached the resource limit and then Medicaid would kick in.

Spending down means that if the value of her resources is over the allowed amount, which is $13,800 at present, she would be expected to use her assets to pay for long-term care, or “spend down” for care until her resources are depleted to the resource exemption amount applicable to her.

Once her resources (savings) are at the eligibility requirement, then she would have to apply any income toward her care except for $50 that she can keep for incidentals. So, if she received $1,200 a month from Social Security, $1,150 would go to the nursing home and Medicaid would pay the balance toward the Medicaid rate for that facility. Income from all sources (pensions, etc.) would go toward her care except $50.

The average cost for a nursing home in Western New York can run over $10,000 per month. Adult homes can cost $3,000 to $5,000 per month.

Medicaid will also pay for certain types of home care and services. Catholic Charities can assist you with the application for Medicaid. For additional information, click here to download a PDF of the New York Medicaid Guide.

By the time she needs care, medical care payments may be quite different, depending on how the Affordable Care Act grows or changes, so you will want to keep abreast of changes in this area as they occur and learn how they will impact senior care.

Karen Shalke, Regional LIFE Representative, Adds:

Understanding how long-term care services are paid for is a good place to start.

Whether long-term care services are provided for in the community or are facility-based, the three main payment sources are private pay, Medicaid or through long-term care insurance plans.

In some instances, services may be available for Veterans and their spouses through the Veterans Administration in the form of what is known as Aide and Attendance.

It is very important to understand the difference between Medicare and Medicaid.
  • Medicare is available to people when they turn 65 years old, or at a younger age if they are considered disabled. Medicare will only pay for skilled services on a short-term basis.
  • Medicaid is based on income and resources.
Medicaid pays for a significant amount of long-term care services. To qualify for Medicaid, income and asset limits apply. Those amounts vary based on marital status and the setting in which long-term services are delivered. Skilled nursing facilities and a limited number of assisted living beds may accept Medicaid for payment.

Other options to consider are through community-based providers such as Catholic Health LIFE – Living Independently for Elders. LIFE is a Program of All-inclusive Care for the Elderly (PACE). The cost of the program is covered by Medicare and Medicaid or, Medicaid alone. Although Medicaid “spend downs” do apply for community-based settings such as LIFE, the amounts allowed differ from those of nursing homes. Private pay is also an option and is about half the amount of nursing home care.

Preparing for the future is important because the worst time to evaluate options is during a crisis. An elder law attorney, a geriatric care manager, senior service case manager or social worker who specializes in Eldercare can help with planning.

About Our Experts

Patricia Weeks O'Connor

Patricia Weeks O'Connor is the Executive Director of the OLV Senior Neighborhood and Mercy Nursing Facility in Lackawanna. OLV Senior Neighborhood provides senior housing, nursing home care, LIFE (a PACE program for the elderly) and blood testing.

Karen Shalke

Karen Shalke, Occupational Therapist, is the Regional Representative for Catholic Health LIFE – Living Independently For Elders.

If you have a question about your health, click here to ask our experts.

3 comments:

  1. "Although Medicaid “spend downs” do apply for community-based settings such as LIFE, the amounts allowed differ from those of nursing homes."

    what are the typical spend downs for LIFE, and does the person get to keep more than $50 a month?

    ReplyDelete
    Replies
    1. The Medicaid spend down is different for each individual based on their income and marital status.

      If a person is single, then Medicaid will allow them to keep $812 per month of their income - the rest is subject to spend down.

      It is possible to retain more of the excess income through what is known as a pooled trust, if the individual has a disability. This needs to be set up by a lawyer who understands pooled trusts.

      For a married couple with only one of the two applying for long-term Medicaid (not to be confused with general Medicaid), the 'well' spouse can ask for a spousal allowance waiver of up to $2,739 per month, and the spouse who needs the Medicaid can retain up to $350 per month ONLY if they remain living in the community. The pooled trust may also be available.

      If both of the married couple are applying for Medicaid, then the total monthly income allotted to be kept every month is $1,179, and their excess income would be subject to spend down. Pooled trust is again another option to keep more of their income.

      Delete

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