In California, nursing homes are considered health care facilities and as such are licensed and scrutinized by the California Department of Health Services. As medical facilities they are allowed to provide services that cannot be dispensed in assisted living or board and care homes. Typically these services involve managing complex and potentially serious medical problems such as infections, wound care, IV therapy, and coma care. They offer both short and long term care options for those with serious problems and disabilities such quadriplegics, MS patients, ALS patients and others who are bedridden and are unable to do anything on their own.
Nursing homes also provide a host of rehabilitation services that are typically utilized on a short-term basis after a hospitalization for injury or illness. Patients can receive almost any kind of rehabilitative therapy in nursing homes these days, most of which will be covered, in whole or part, by Medicare or Medicare HMO's, with the requirement that there is hospitalization for 3 days prior to a discharge to a nursing home. However, the implementation of the Prospective Payment System limits payments to nursing homes and allows them to choose who they admit.
So who needs a nursing home? Only those individuals that have serious disabilities to the extent that the services that they need cannot be found through residential care (aka board and care) or home care. Unfortunately, economics rather than the availability of services often dictate the choice. It works like this; if you're on a limited budget and cannot afford $4,000 to $7,000 a month for 24 hour home care or $2,500 to $5000 for residential care you may have to be placed in a nursing home with the cost paid for by the state under the Medi-Cal long term care program (California's Medicaid program for those with no financial resources of their own). For more information regarding qualifications for this program, contact Senior Advisors Network at 800-640-5626 (California only).
The truth is that most families turn to nursing home care only as a last resort. This is easy to understand. Nursing homes are medical institutions. They look like institutions and patients are treated as patients. There is little or no privacy, each patient must share a tiny room with only a draw curtain to divide his or her space from the other patients in the room (sometimes there are 4 patients to a room). Food is nutritious and plain like all institutional food. Who would choose to live in such a place if they didn't have to?
What Medicare Will Pay
Many people still believe erroneously that Medicare picks up the tab for nursing home stays. This is far from the truth. The truth is that Medicare only pays for your stay while you are receiving actual medical services for 100 days, provided you had met the hospitalization requirement. Once your medical services are over they stop paying for the room. Also no matter what your needs are they will only pay for the first 20 days for skilled care. For days 21-100, for skilled care, Medicare will pay for all allowable costs over a certain amount (changes every year) a day. You will have to pay that amount a day. Most people have no idea how limited the Medicare nursing home benefit is.
If you need long term care in a nursing home it will be you - not Medicare - that will be paying the bills. A five year stay in a nursing home will cost over $250,000. This is terrible financial burden that often wipes out a family's finances. It is easy to see why people fear being placed in nursing homes quite apart from the issue of quality of life. There is no help from the government until you exhaust your savings and have nothing left if you are a single person (married couples are treated somewhat differently under special rules which allow the well spouse to keep some financial resources and the family home).
How to Avoid the High Cost of Nursing Homes
One easy way to avoid the high costs of nursing homes is to take out a long term care insurance policy. It is difficult to say too much on this subject, as it is both complex and legalistic. There are many insurance companies advertising that they can save the family fortune for a fee. This only works if you take out the policy before you need nursing home care. In addition, most companies want you to be relatively healthy at the time they issue the policy.
Some people think that they can beat the cost by getting themselves or their family member qualified under the Medi-Cal program. And there are many attorneys and quasi-attorney like services that advertise that they can get you qualified on Medi-Cal and save your assets. Beware of these promises. There are rule changes happening all the time regarding who qualifies, what they can divest themselves of and what they can keep in their own name and still qualify for Medi-Cal benefits if they are hospitalized in a nursing home. Some schemes that may be legitimate today may not work next month or next year. Your best bet is to seek out someone who has a firm understanding about the laws in this regard. Your family lawyer may not be the best source, but he or she probably knows a lawyer who does know the ins and outs of Medi-Cal laws and regulations. This is one area where solid legal advice is advisable because the financial stakes are high. We recommend you call an agency that deals mostly with Medi-Cal and knows the rules. One such agency is Seniors Advisors Network - 800-640-5626 (California only).