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How to Pay for a Stay in Long Term Care

Posted on January 4, 2017 at 5:50 PM

When this question comes up, it is usually because of some emergency.  Someone has either had an accident, or surgery, and needs to recover after leaving the hospital.  They usually need more care than staying at home can provide.  Or, they are in an advanced stage of a terminal disease, and need medical care before hospice is necessary.  How does one pay for this kind of 24-hour care?


Until the person is able to be taken care of at home, with less than round-the-clock care, they will need to stay in a skilled nursing facility, otherwise known as long term care.  The average private pay rate for these facilities in 2016 was $8,189 per month.  You can imagine the shear terror some family members face when asking, "How do we pay for that?"  


If the patient has long term care insurance, you can usually breathe a sigh of relief.  One of the great things about this kind of insurance is that it works hard to care for the person in their own home.  The insured will also not need to pay their premium for months spent in a long term care facility in most policies.  If  your loved one doesn't have this insurance, they can rely on Medicare to pay the first 22-100 days of long term care, but if insurance runs out, then what?  


One overlooked area is the Veteran's Administration (VA).  If there is any chance your loved one may have served the U.S. Military, or been the dependent of someone who did, it is well worth the investment of time and energy to apply for VA benefits.  Aid and Attendance and Housebound benefits will help a veteran who needs care at home, is in long term care, or in Assisted Living.  Assisted Living is different than long term care, mainly in that it does not require 24-hour nursing care for it's residences.  Any long term care facility can take VA payments. They do not have to be VA certified.  The patient does not have to be in a VA hospital, or even seen by a VA doctor.  Aid and Attendance is for veterans who need help with activities of daily living (dressing, bathing, transferring, toileting, or eating).  Homebound is for veterans who are substantially confined to their homes because of a permanent disability.  These are benefits that reimburse the veteran, after he/she has paid for the care expenses.


Medi-Cal (Medicaid in the rest of the U.S.) might be able to help for those with little or no assets.  Some assets are exempt, like the home they live in, one vehicle, burial trusts, most household/personal possessions, and most special needs trusts.  Depending on the amount of income the patient has, they will pay the long term care facility a monthly Medi-Cal Share of Cost.  This is usually all of their countable income, minus $35 for a Maintenance Need.  


So breathe a sign of relief, and know there are some avenues to pay for a loved-one's long term care stay.  The word, "long" in "long term care" doesn't usually fit most patient's length of stay in one of these facilities.  If you need help finding payment resources, give Sunrise Fiduciary a call.  We are happy to help ease the stress these moments can bring.



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