Paying for Nursing Home Care
Few people can afford to pay for nursing home care out of their own pocket for very long (costs range from $3,600 to $10,000 or more a month). Ninety percent of New York State nursing home residents are or become reliant upon state and federal subsidies (Medicare or Medicaid).
It is recommended that you consult an elder care law attorney or your financial advisor to get advice on estate planning, Medicaid, Medicare and long-term care insurance before you apply to a nursing home.
Private Payment
Skilled Nursing Facilities charge a basic daily rate for the services they provide. These daily rates can vary from facility to facility, depending on where the facility is located and the services provided. Some facilities offer all-inclusive rates, which includes many of the daily expenses. Other facilities charged a daily rate for room and board and add additional charges for physician's services, laboratory tests, physical therapy, prescription drugs, etc.
In New York State, private pay rates are not regulated. If you are planning to pay for nursing home care out of your own pocket, be sure to ask for a list of services that are covered by the basic daily rate. Also ask how the rates are adjusted and how residents are notified of adjustments. (Under current New York State regulations, you must be notified in writing, at least 30 days prior to any increase in the daily rate.)
The basic daily rate must cover room and meals, housekeeping, linen, general nursing care, medical records and services, recreation and personal care. There may be extra charges for items that vary from resident to resident, such as physical therapy and medications. Discuss with the SNF's admissions director, administrator or social worker what services are standard and what additional services might be required and what they cost.
Facilities are permitted to ask for a prepayment or a security deposit. The SNF can ask for no more than three months' prepayment. Prepayment used as security must be deposited by the facility in an interest-bearing account. If you leave the home or die, any amount paid to the home over and above the cost of services already provided must be refunded.
Most facilities will require full financial disclosure from residents who will be paying privately. Since many nursing facility residents who enter as private pay residents eventually use up their funds and need to go on Medicaid, the SNF’s need to know how long the resident will be able to pay privately and when to apply for Medicaid. Once you are eligible for Medicaid, you have the right to have Medicaid pay for your care (if the participates in the Medicaid program). When it becomes time to apply for Medicaid, the nursing facility should assist in completing the necessary forms.
In New York State, you may not be moved out of a nursing home because you have exhausted your personal resources. Also, your spouse need not spend all of his/her personal resources on your care if you are institutionalized.
Private Insurance
Private long-term care insurance policies are becoming more and more popular and available. They vary in the coverage and should be carefully examined before purchasing. In New York State, only a few policies are valid. The State Insurance Department publishes materials comparing long-term care policies offered by different companies. Call 1-800-342-3736 or contact the State Insurance Department for more information.
The federal government is now permitting New York State to authorize Medicaid without someone exhausting his/her assets if that person first purchases a long-term care insurance policy sponsored by the state. The New York State Partnership for Long-term Care is a program that combines long-term care private insurance and Medicaid to help New Yorkers prepare financially for the possibilities of needing nursing home or home care. Information on the Partnership can be obtained by calling 1-888-697-7582 or from its website at www.nyspltc.org.
