By Kevin R. Albaum, Esq.
A transition from a senior’s home to an assisted living facility or nursing home is never easy for a family. What makes matters even more difficult is for the senior’s spouse or children to have to bear this new large monthly expense for an unknown amount of time. My best advice is to explore your options to help pay for care immediately before continuing to cut check after check to pay for the senior’s care. Alternative options to pay for care are as follows: Long Term Care Insurance, Medicare, Medicaid, and Veteran’s benefits.
Long Term Care Insurance: Ask the Senior if they have long-term care insurance. If they say no, then ask about life insurance (as sometimes life insurance policies have a rider added to them which can cover long-term care needs). Be sure to review all such policies in depth to see if benefits are available and if so, what the triggering event is for the insurance company to begin paying out the benefits. Long Term Care benefits usually do not begin to pay out until a person can prove with medical records that they are in need of assistance with activities of daily living (“ADLs”). ADLs are used to gauge a person’s level of functioning and generally include the following: bathing, getting dressed, transferring, eating, continence and toileting. If assistance is needed with enough ADLs, an insurance company will then begin paying out benefits in accordance with the insurance policy guidelines. The benefits can often be used to pay for home care, assisted living care, or nursing home care.
Medicare: Medicare does not generally pay for assisted living care. However, if a person requires skilled nursing care, Medicare part A generally covers up to 100 days of skilled nursing care for any new benefit period (A person gets a new benefit period if at least 60 days has passed since the person last received care in hospital or skilled nursing facility). For a person to receive the full 100 days of Medicare coverage, they also must be able and willing to participate in the prescribed therapies and must be progressing in treatment. The first 20 days (of the 100 total days) are paid by Medicare in full. Days 21-100 will require a co-pay around $165 daily and Medicare will pay the rest (the co-pay amount varies if a person has a Medicare Advantage plan or supplemental plan). After day 100, Medicare skilled nursing care benefits end and the senior (or their family) will have to pay the entire cost of skilled nursing care with no further help from Medicare. Therefore, Medicare is not a long term solution to paying for long term care.
Medicaid: Medicaid benefits can help to pay for home care, assisted living, and nursing home benefits in Florida. An applicant must be assessed and determined to be disabled and in need for the benefits they are requesting. To become financially eligible for benefits, generally, a person must have countable assets under $2,000 and a monthly income under $2,250. Some assets are non-countable for Medicaid purposes such as the applicant’s home, one (1) car, and prepaid burial arrangements. There are restrictions on the applicant’s spouse’s assets as well. If a person has questions regarding their eligibility or how to apply for the different Medicaid programs, an elder law attorney should be consulted.
There is usually a waiting list before a person can apply for home care and assisted living benefits in Florida, however, there is no wait if a person needs to apply for nursing home benefits.
Medicaid benefits are only retroactive for up to a maximum of three (3) months before application date, so it is important to move quickly to apply for benefits if a person expects to reside in assisted living or nursing home indefinitely. All nursing homes take Medicaid nursing home benefits, however, only about fifty percent (50%) of home care companies and assisted living facilities in Polk County, take Medicaid benefits. Applying for and being granted benefits for either Medicaid program often leads to substantial monthly saving for the senior.
Veterans Benefits: A Veteran, their spouse, or surviving spouse may be eligible to receive Aid & Attendance through the Department of Veterans Affairs (“VA”). To be eligible for this pension program, a person must have limited assets and income, and be permanently or completely disabled according to the VA’s disability requirements. To be eligible for this pension, the veteran must also have been discharged under a condition that was non-dishonorable and served ninety (90) days of service with at least one (1) day in one of the following wars: WWI, WWII, Korean War, Vietnam War, or Persian Gulf War.
The pension comes in the form of additional income each month to the senior and is direct deposited into the recipient’s bank account and can be used to pay a caregiver in the home, assisted living facility, or for skilled nursing care. There are also State Veterans Home that provide nursing home and other services to Veterans. It is important to contact the VA to determine eligibility and availability for such programs.
If you or a family member wants to further explore options to pay for long-term care, it is recommended to discuss your options with an elder law attorney who can help identify possible housing options and benefit programs that may be available in your specific situation.
Kevin Albaum is an attorney in the Elder Law Practice at Clark, Campbell, Lancaster & Munson, P.A. Questions can be submitted online to firstname.lastname@example.org.