Many use the terms nursing homes and skilled nursing facilities interchangeably, but these terms actually determine how the expense is covered for senior citizens.
While most senior citizens are familiar with Medicare and its health benefits to those 65 and older, many people don’t realize that Medicaid is also an important benefit for seniors, particularly when it comes to nursing homes.
Medicaid is a joint state and Federal program that will pay most nursing home costs for some people with limited income and resources. Medicaid will pay only for nursing home care provided in a facility certified by the government to care for people with Medicaid. With the cost of nursing homes in New York averaging $109,000 annually, senior citizens often must turn to Medicaid for assistance with this expense.
Over 50% of nursing home residents pay costs out of their own savings. When these savings and other resources are exhausted, many people who stay in nursing homes for long periods eventually become eligible for Medicaid.
Many mistakenly believe that this cost would be covered by Medicare, the federal program that provides health benefits to those 65 and older. But in reality, Medicare only provides services for skilled nursing facilities (SNFs) for those who require specific skilled nursing care or rehabilitation services. Skilled care is given for a short period of time when you need skilled staff to manage, observe, and evaluate your care, for instance, when physical therapy is needed or an IV required. To be covered for skilled care by Medicare, patients normally need to have a hospital stay of at least three days just before going to a facility.
Conversely, Medicaid covers the long term care needed by seniors for those that require assistance for the activities of daily living, termed ADL, such as bathing, dressing and preparing meals, and enters the picture when other resources are spent.
Understanding the terminology involved can be complex and frustrating for families facing health care issues. Consulting a professional experienced in this area provides easy to understand, timely information regarding senior citizen issues and their challenges.
Michael Robinson, Estate Planning Attorney
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