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"Early Dementia, Alzheimer’s. My Mom’s health deteriorated to the point she required full-time care. She wanted to live at home, but required regular help with the essentials of daily living (i.e. dressing, bathing, etc.). As her caregiver daughter, the responsibilities fell on me to figure out what to do. Thank goodness for Hanlon Niemann and Mr. Niemann.
He met with me and explained all of my options for my mom, from at home/community care, assisted living, state, county and local programs for the elderly, financial eligibility for benefits, Medicaid qualification, pharmaceutical assistance, utility aid, Medicare and Veteran’s benefits, etc. While I felt overwhelmed by it all, Mr. Niemann clearly was in control of what could be done for Mom. We engaged him to make applications for subsidized at-home care and assistance through available grant programs and as part of his services to us, he is counseling us on a reverse mortgage, income and financial products to enhance Mom’s monthly income and to reduce her expenses. Mom would tell me to let Mr. Niemann make all the decisions although I am her Power of Attorney. I value so much his confident and generally caring manner. If you’re trying to help your Mom, Dad or family member deal with a life changing health condition, call Hanlon Niemann. I’m glad I did and so is Mom."
—Mary Layton, Farmingdale, NJ» Read more testimonials
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Americans are living longer than ever before. As a result, we face more challenges and transitions in our lives.
One of the most difficult transitions people face is the change from independent living in their own home or apartment to living in a long term care facility or “nursing home.”
Most people who make the decision to move to a nursing home do so during a time of great stress. Some have been hospitalized after a serious medical condition such as a stroke, or a fractured hip. Others have progressive illnesses such as dementia, Parkinson’s or multiple sclerosis.
Whatever the reason, the spouse or relative who helps a person transition into a nursing home is faced with the daunting tasks of finding the right facility and securing a payment source for the care and services provided by the nursing home. Both tasks are equally difficult as there are more than 64 nursing homes in Central New Jersey and 364 nursing homes and assisted livings in the state of New Jersey to choose from and the monthly cost for nursing homes in Monmouth County average between $7,500 to $11,000 or more.
How to Pay for Nursing Home Care
One of the things that concerns people most about nursing home care is how to pay for that care. There are basically four ways that you can pay the cost of a nursing home:
1. Long Term Care Insurance. If you are fortunate enough to have this type of coverage, it may go a long way toward paying the cost of the nursing home. Unfortunately, long term care insurance has only started to become popular in the last few years and most people facing a nursing home stay do not have this coverage.
2. Pay with Your Own Funds. This is the method many people are required to use at first. Quite simply, it means paying for the cost of a nursing home out of your own pocket. Unfortunately, with nursing home bills averaging between $7,500 and $11,000 per month in our area, few people can afford a long term stay in a nursing home.
3. Medicare. This is the national health insurance program primarily for people 65 years of age and older, certain younger disabled people, and people with kidney failure. Medicare provides short term assistance with nursing home costs, but only if you meet the strict qualification rules.
4. Medicaid. This is a federal and state funded and state administered medical benefit program which can pay for the cost of the nursing home if certain asset and income tests are met. Since the first two methods of private pay (i.e. using your own funds) and long term care insurance are self-explanatory, our discussion will concentrate on Medicare and Medicaid.
What About Medicare?
There is a great deal of confusion about Medicare and Medicaid. Medicare is the federally funded and state administered health insurance program primarily designed for older individuals (i.e. those over age 65). There are some limited nursing home care benefits that can be available under Medicare. In general, if you are enrolled in the traditional Medicare plan, and you’ve had a hospital stay of at least three days, and then you are admitted into a skilled nursing facility (often for rehabilitation or skilled nursing care), Medicare may pay for a while, with a maximum benefit of 100 days of coverage. Most people do not meet the medical requirements for the 100 day benefit period as most nursing home residents require custodial care.
If you qualify, traditional Medicare may pay the full cost of the nursing home stay for the first 20 days and can continue to pay the cost of the nursing home stay for the next 80 days, but with a deductible that’s nearly $120 per day. Some Medicare supplement insurance policies may pay part or all the cost of that deductible. Even if Medicare does cover the 100 day period, what then? What happens after the 100 days of coverage have been used? At that point, in either case you’re back to one of the other alternatives… long term care insurance, paying the bills with your own assets, or qualifying for Medicaid.
What is Medicaid?
Medicaid is a benefits program which is primarily funded by the federal government and administered by each state. Sometimes the rules can vary from state to state. One primary benefit of Medicaid is that, unlike Medicare (which only pays for skilled nursing), the Medicaid program will pay for long term care in a nursing home once you’ve qualified. You need to demonstrate the need for nursing home care ( not being able to manage in a home environment, requiring assistance with activity of daily living skills for more than 2.5 hours per day) and you need to meet the strict financial requirements established by the state.
Why Seek Advice for Medicaid?
As life expectancies and long term care costs continue to rise, the challenge quickly becomes how to pay for these services. Many people cannot afford to pay $7,500 to $11,000 per month or more for the cost of a nursing home, and those who can pay for a while may find their life savings wiped out in a matter of months, rather than years.
Fortunately, the Medicaid Program is there to help. In fact, in our lifetime, Medicaid has become the long term care insurance of the middle class. But the eligibility to receive Medicaid benefits requires that you pass certain tests on the amount of income and assets that you have.
The reason for Medicaid planning is that without the proper planning and advice, many people spend more than should or are required to, or they transfer finances inappropriately and are faced with months of ineligibility, jeopardizing their family’s financial security.In many cases homes and resources may be maintained if done properly and within the appropriate timeframes and guidelines.
Consultation with the right elder care law professional may save you a significant amount of financial resources and time when applying for Medicaid or when faced with the costs of long term care either now or in the near future.
To speak to a caring, sensitive attorney, ask for our managing partner, Fredrick P. Niemann, at 732-863-9900 or e-mail him at fniemann@hnlawfirm.com to set up an office consultation at your convenience.