Nursing Homes Financial Consideration

Cost

The cost of nursing home care varies; however, most facilities charging from $3,000 to $6,500 a month. This cost covers around-the-clock care by professionally licensed and trained staff, room and board. Some therapies require additional charges. Depending on your pay source, there may be fees for laundry, haircuts, personal items and supplies. Prescriptions are not covered in the monthly charges, but may be covered by Medicare D prescription drug program.

The admission contract is an important document that indicates costs and responsibilities of the resident to ensure payments to the facility in exchange for services.

  • Request a copy of the contract prior to admission to review the language and prepare questions.
  • Keep a copy of the signed contract on hand.
  • Facilities are obligated to make sure that residents and their representatives understand their rights, the language of the contract, the programs available to cover services and the limits of these programs.
  • Facilities may not require a “responsible party” to co-sign the contract unless that person has legal authority to handle the resident’s financial affairs.
  • If a resident has been declared legally incompetent, a guardian or Power of Attorney will have to sign all of the necessary papers for admittance. Medicare is a federal health insurance program available to older and disabled persons.
  • The Medicare nursing home benefit is limited to residents admitted to skilled beds in a certified nursing facility – and then only following a three-day stay in a hospital and ONLY if Medicare requirements are met.
  • The physician must determine that skilled nursing care is needed.
  • If eligible, Medicare pays 100% of the cost the first twenty days. The resident pays a co-payment, which could be covered by supplemental insurance or Medicaid, beginning on day twenty-one up to day one hundred, and Medicare pays the remaining approved daily medical expenses.

THERE IS NO GUARANTEE THAT MEDICARE WILL PAY AT ALL! You have a right to appeal the Medicare denial. Contact Medicare directly to learn more about these rights. Medicaid is a State and Federal program that will pay most nursing home costs for people with limited income and assets. Eligibility varies by State. Medicaid will pay only for nursing home care provided in a facility certified by the government to provide service to Medicaid recipients. If you have questions about Medicaid eligibility, the CARE-LINE (1-800-662-7030) Operator can connect you with the Medicaid Eligibility Unit in the North Carolina Division of Medical Assistance.

www.dhhs.state.nc.us/dma

  • The resident pays the facility a “patient liability” payment based on their income. The amount is set by the County Department of Social Services.
  • Residents eligible for Medicaid will receive a small Personal Needs Allowance to purchase personal items.
  • Residents who are private pay may not be discharged from a facility certified to receive Medicaid simply because he or she becomes eligible for Medicaid to cover the daily rate.

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