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R.I. 10th most expensive nursing home costs in the U.S.

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Rhode Island has the 10th highest nursing home costs in the nation at an average of $94,170 annually, according to Caregiverlist’s August report.

Caregiverlist Inc., which connects seniors and professional caregivers with eldercare options, said Rhode Island bumped Maine for having the 10th most expensive costs in the country. Rankings were based on the daily prices of shared rooms in nursing homes.

Caregiverlist said that with 87 nursing homes, the average cost for a shared room in a nursing home in Rhode Island is about $258 a day. In comparison, Texas has the lowest annual cost – a shared room there costs $115 a day. Alaska, due to its low population and remote location, has the highest daily cost for a shared room at $751, according to Caregiverlist spokeswoman, Julie Northcutt.RI Nursing Home Costs

Rhode Island’s average daily shared room cost also is lower than that of Connecticut and Massachusetts, where average daily costs of semi-private rooms total $321 and $289, respectively.

A private room in Rhode Island averages $263 a day. Hawaii has the highest costs for a private room at $488 a day, followed by the District of Columbia at $371 and Connecticut, $351. The least expensive daily cost for a private room is in Missouri at $145.

Caregiverlist said the Rhode Island nursing home with the highest overall Caregiverlist star rating is the privately-owned, 122-bed Briarcliffe Manor in Johnston, which received 4.6 out of 5 stars. Caregiverlist said five is the best rating for a nursing home, while one is the worst.

It said the cost of rooms at Briarcliffe are slightly higher than the average Rhode Island nursing home at $325 and $300, for single and double rooms, respectively, but are not the costliest in the state.

This story was written by Lori Stabile and published by the Providence Business News on August 9, 2016 www.pbn.com.

Concerned with protecting your life savings from the high costs of nursing homes in Rhode Island?

Learn about the options available. Contact our office for a no-cost consultation to discuss what steps you must take now before it is too late.

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Medicare and Long Term Care

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Doesn’t Medicare Pay for Most Long Term Care Needs?

Drawing of Medicare with Stick Men and Clipping PathNo. Even though many people mistakenly believe that Medicare will take care of most long term
health needs
, it pays for less than 2% of the cost. A survey conducted by AARP (American Association of Retired Persons) showed that 79% of those expecting to need nursing home care incorrectly believed that Medicare would pay.

 

Medicare will pay for long term care in a nursing home only if the following requirements are met:

A. Skilled care is being provided to the individual in the nursing facility. Skilled care is continuous 24 hour per day care provided by licensed medical professionals under the direct supervision of a physician. Only about ½ of 1% of all nursing home residents receive skilled care. Most residents get either intermediate” (4.5% of nursing home residents) or “custodial” care (95% of nursing home residents).

Intermediate care refers to occasional nursing and/ or rehabilitative care under the supervision of skilled medical personnel. It is often referred to as intermittent care and may include physical therapy, occupational therapy, speech therapy, etc.

Custodial care often involves non-medical personnel such as nurses’ aides who provide assistance with the activities of daily living including bathing, eating, toileting, transferring and dressing.

B. The nursing facility is a “Medicare participating” nursing facility. Many nursing homes will not qualify under this requirement.

C. The nursing home care must follow (within 30 days of discharge) at least a three day hospital confinement. Most often those who require nursing home care do not enter directly after a hospitalization. Often individuals are simply aging and finally realize they cannot manage any more at home or in a relative’s home. Since nursing home confinement frequently does not follow a hospitalization, many states now prohibit prior hospitalization prerequisites in long term care policies.

D. In the past in order for Medicare to pay in a skilled nursing facility, the care the individual received had to be “restorative” in nature. The patient had to be getting better. However, on January 24, 2013, the U.S. District Court for Vermont approved a settlement in the case of Jimmo v. Sebelius which states that Medicare provided skilled care may not always have to meet the expectation of improvement. Generally, if an individual meets the four aforementioned requirements (of skilled care, Medicare participating facility, a 3 day prior hospitalization and care that is “restorative” in nature- now a somewhat unclear term-) Medicare will pay all of the costs of the first 20 days and the individual pays $161 for an additional 80 days (in 2016, adjusted annually). (At a current daily nursing home rate of about $250 or more, one obviously cannot depend on Medicare to pay for most of the cost for these other 80 days.) Beyond day 100, Medicare will pay nothing.

Medicare will pay for long term care in a home health care situation only if the similarly stringent and difficult to meet requirements are met. Home health care coverage includes part-time or intermittent skilled nursing care, physical therapy, and speech therapy, through a Medicare Certified Home Health Care Agency. If the patient requires skilled nursing, physical therapy, and/or speech therapy and if the individual is confined to the home and is under the care of a physician, Part A of Medicare can pay for some other services.

A typical individual who requires nursing home or home health care is someone with a physical disability who simply needs help with the activities of daily living -someone who is simply aging. Medicare will not pay for such custodial care. Alzheimer patients, Parkinsonians, stroke victims, and those who have other organically related mental disorders, form another large group of those who need long term care. Typically, since these chronic ailments of aging don’t “get better,” Medicare benefits are not available.

The bottom line is simple: A wise person will not count on Medicare to pay for long term care services.

So what is a person supposed to do? Contact our office to discuss what long term care planning means to you.

Source: This article is an excerpt from LISI Elder Care Law Planning Newsletter #17 (March 3, 2016)

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Myths and Realities of Long-Term Care Planning

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Long Term Care Planning?

True or Falselong term care planning and smiling
1. ________ ________ I will never end up in a nursing home.
Of those Americans reaching age 65 in any year, 24 percent are expected to spend a year or more in a nursing home. Fifty-seven percent will never enter a nursing home and 19 percent will spend less than a year in a nursing home. Nine percent will spend more than five years.

2.________ ________ An average nursing home costs $5,000 a month.
In Rhode Island, typical nursing homes cost $10,000 a month, or more than $120,000 a year.

3.________ ________ Medicare will pay for any long-term costs I may have.
No. It will pay for up to 100 days of skilled nursing facility care if you meet the certain requirements, including: (1) you must have moved to the nursing home within 30 days of a hospital discharge, the hospital stay having lasted at least three days; and (2) you must receive a skilled level of care. Medicare pays entirely for the first 20 days and everything above a copayment of $114 a day for days 21-100. The copayment is generally covered by Medigap insurance. The general rule of thumb if your coverage is denied or terminated due to the lack of need for skilled care is to ask for the bill to be submitted to the fiscal intermediary anyway. This review costs nothing and may result in coverage.
Medicare pays for home health care on a part-time or intermittent basis. Part-time generally means up to 20 hours a week. You must require a skilled component to your care to get this coverage.

4.________ ________ Medicaid is a program only for “poor” people (not me).
In 2010, the total cost of nursing home care was approximately $342 billion. This amount was paid from the following sources:

  • 41% Medicaid
  • 20% Medicare
  • 15% Out-of-Pocket
  • 17% Miscellaneous
  • 7% Private insurance

5.________ ________ To qualify for Medicaid I will have to give up my home
False. In Rhode Island you may keep your home as long as you intend to return to live there, no matter whether you really can or do. However, if the house is in your estate at your death, the state will have the right to recover whatever it has spent on your care

6. ________ ________ If my spouse enters a nursing home all our joint savings will have to be spent on his/her care.
False. You are entitled to keep half of your combined liquid savings up to $119,220 for 2016. In some circumstances, you may be entitled to keep more than this amount.

7.________ ________ If I give money to my children I will be ineligible for Medicaid benefits for 60 months.
Maybe. You will be ineligible for 60 months for every penalized transfer. There are some exceptions to this transfer penalty.

8. ________ ________ If I apply for Medicaid, the Department of Human Services and the nursing home staff will reliably guide me through the process.
Yes, and in most cases their help will be sufficient. However, they may not know the intricacies of spousal impoverishment and other rules. They may not be able to advise you on when to appeal a denial. You should be aware that applications for Medicaid require extensive documentation and can be quite time-consuming.

9.________ ________ Legally I can give away only $14,000 to each of my children each year.
You can give away any amount, but have to report gifts in excess of $14,000 per recipient per year ($28,000 if both husband and wife make the gift). The reporting requirement is not an issue for most people because an estate must be greater than $10.9 million in 2016 to be taxable under federal law (In Rhode Island the reporting requirement is when an estate exceeds $1.5 million). MAKING GIFTS AND UNCOMPENSATED TRANSFERS CONSTITUTE A DISQUALIFY TRANSFER UNDER THE MEDICAID RULES AND SHOULD NOT BE DONE UNLESS YOU ARE ASSURED YOU WILL NOT NEED TO APPLY FOR MEDICAID WITH THE 5 YEAR LOOK-BACK PERIOD.

10. ________ ________ I can wait to do long-term care planning until I or my spouse gets sick.
Yes and no. Usually there are things that can be done even if no advance planning steps have been taken. However, you will be much better off if you have taken planning steps in advance. Here are the steps that we recommend that our clients at least consider.

CONCLUSION:
You cannot predict whether you or a family member will require long-term nursing home care. But if we define “long term” as a year or longer, one in four of you will. That means one in four will face costs of more than $70,000-more than one in four couples will face such costs.
Medicare will not pay these costs, which leaves you with three choices:

  1. Long-term care insurance
  2. Out-of-pocket
  3. Medicaid

Long-term care insurance is great if you can afford it. But follow these ground rules:

  1. Buy an individual policy, not a group policy.
  2. Buy home care coverage.
  3. Get an inflation rider.
  4. Buy enough coverage.
  5. Buy at least three years of coverage.
  6. Tell the agent the complete truth about your current condition and situation.
  7. Make sure you can afford the policy. This means you are paying for it with 5 percent or less of your income or with money you would otherwise add to your savings. Do not change your current standard of living for the policy, or get your kids to buy it.

Key Medicaid rules:

  1. Only $4,000 in countable assets.
  2. Countable assets are everything that you and your spouse own (individually and jointly) other than your home and other noncountable or inaccessible assets. You never need to give up your home in order to qualify for Medicaid.
  3. The at-home spouse is entitled to retain up to $119,220 in total countable assets. In some cases the at-home spouse can appeal for a higher resource allowance.
  4. All income of a nursing home Medicaid beneficiary goes to the nursing home, except for (1) $50.00 a month personal needs allowance, (2) the cost of any health insurance premiums, and (3) any allowance for the at-home spouse or minor children.
  5. The community spouse is entitled to a share of the nursing home spouse’s income if the community spouse’s own income does not meet a minimum guarantee.
  6. The state may recover whatever it pays for the Medicaid recipient’s care from his or her probate estate.
  7. The Medicaid application process is long and cumbersome. Do not expect to get sound advice from health care workers, friends, or anyone but an experienced elder law attorney.
  8. Plan ahead, especially with a durable power of attorney and health care proxy.

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What Are The Top Rated Nursing Homes In Rhode Island?

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Nursing Homes Ratings in Rhode Island

US News and World Report has rated the top of the Rhode Island nursing homes and listed them on their website. Listed are those facilities with a rating of five stars from the federal Centers for Medicare & Medicaid Services for their overall performance in health inspections, nurse staffing and quality of medical care.

Do Rhode Island Nursing Homes Make the Grade?

About 31 percent of all nursing homes in Rhode Island earned an overall five-star rating. Visitors to the site can narrow their search for a Best Nursing Home by clicking on a metro area or region or by entering a ZIP code.

Know what services nursing homes offer.

Like any business or facility, each has its particular strengths and areas of improvement. Research must be done to determine if the nursing home you select offers the best care and expertise in the are your loved one is most in need of. Cognitive Issues, mobility issues, behavioral issues; know which nursing home can best address your loved ones needs.

Want to discuss what is the best nursing home is for you or a loved one and how you can pay for that nursing home? Contact us to schedule a consultation.

Click HERE for the full rankings.

US News Report

What Scares the Government Most About The Cost of Long Term Care

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Long Term Care – the growing expense

For years, federal and state governments have shied away from the problem of providing long-term care for ailing seniors – and for good reason. While mounting costs of Social Security, prescription drugs, and federal health care programs get a lot of attention, the staggering costs of providing community-based social services and nursing home facilities and in-home care to seniors are draining the savings of average Americans and posing frightening long-term fiscal challenges for government officials. “Responsibility for long-term servicfamilye support is shared among seniors and people with disabilities themselves, family, friends, and volunteer caregivers; communities, state, and federal government,” Alice Rivlin, the former Congressional Budget Office Director and an expert on long-term elder care, testified recently before a House committee. “This shared-responsibility system is severely stressed, and will become increasingly unable to cope as the numbers needing care increase.” Moreover, the rapid growth in this spending is forcing policy makers to make tough budget choices between Medicaid and other spending for the elderly and education and other investments in young people, Rivlin added.

Long Term Care Spending Reality

Spending on long-term care for seniors by the federal government, states, families and individuals for those 65 and older will increase from 1.3 percent of the Gross Domestic Product in 2010 to 3 percent of GDP in 2050, according to the Congressional Budget Office. While some private health insurers provide long-term care policies to meet those future costs, the premiums are often astronomical and out of the grasp of middle income and even wealthier families.
Click Here to read The Fiscal Times full article

Nursing Home: Promise You’ll Never Put Me In One

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Nursing Home – A promise that cannot always be kept

nursinghome (1)

The perception of life in a nursing home.

Promise you won’t put me away. It is hard to say no to that request. But it often is even harder to honor it.

For many, the idea of being sent to a nursing home facility implies abandonment. Older Americans remember the poorhouse , where the old and infirm were hidden away to die. But many younger people also are repelled by the idea.

There’s now a wider spectrum of facilities catering to different levels of need, but even the best ones can feel institutional. Daily life is often rigidly regulated, robbing residents of autonomy, and the familiar faces and spaces of a person’s life are gone.

This unfortunately is the perception. With this perception loved ones pressure their family to promise not to let them live there. Seeking to comfort, a promise is made, a promise that cannot always be kept. Nurses are hired, changes to rooms, stairs, ramps and rails are added. All helping for a while, but never fulfilling the promise. What is a family member to do?

Resources exist in Rhode Island to help caregivers aid loved ones during the period of increased need. However, there are limitations as to what unskilled people can provide in their home. Many improvements have been made, but there are still limitation.  When all options are exhausted and the medical professionals recommend your loved one be moved to a skilled facility, the echo of the promise is loud.

Below is a link to a compelling article about making promises that sometimes you cannot keep.

Promise You’ll Never Put Me In A Nursing Home

alzheimers081454604851A photograph album shows Sarah Harris and her husband, Ernie, on their wedding day. Three years later, Ernie, who was 53, was diagnosed with Alzheimer’s disease. (Katherine Frey/The Washington Post)

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Who Receives Skilled Nursing Care and Where in Rhode Island?

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Skilled Nursing Care Demographics in Rhode Island

Nearly 8,000 people reside in Rhode Island’s 84 nursing homes and skilled nursing care facilities at any single point in time.

They are mostly independent facilities (60.7%), although a large minority belong to a multi-facility organization (39.3%). Nearly eight in 10 (78.6%) RI nursing homes are for-profit.

Residents are predominantly female (72.1%) and non-Hispanic white (93.4%).

More than half (55.5%) are aged 75 or older.

In 2012, RI nursing home costs averaged $8,517 per month for a shared room and $9,277 per month for a private room. Source: Rhode Island Journal of Medicine: The Nuts and Bolts of Long-Term Care in Rhode Island: Demographics, Services and Costs (March 2015)

WHAT ABOUT BEING ABLE TO RECEIVE CARE AT HOME UNDER THE MEDICAID WAIVER PROGRAM?

Rhode Island has a program called SSI Enhanced Assisted Living Program that provides up to approximately $1,200 / month to be put toward the cost of assisted living. However, this is not a Medicaid program. RI does have a Medicaid program called RIte @ Home which offers 24/7 personal care in a residential environment but not in assisted living communities. Finally, the state’s Home and Community Care Medicaid Waiver also covers assisted living.

NursingHome

Nursing Home Demographics

Elderly Rhode Island residents can receive a variety of care services and support through the Home and Community Care Program. This program is intended as an alternative to nursing homes.  The services are provided to individuals living at home or “in the community”. By the rules of the program, “in the community” includes assisted living residences. The benefits of the program are designed to support individuals at home. This program provides adult day care, in-home care, meal delivery services and medical alert services.

This program is under the jurisdiction of the Rhode Island Division of Elderly Affairs and is funded through a combination of state and federal monies.

Want to learn more about how nursing home skilled nursing and the Waiver Program may impact you and your family? Contact our office for a free consultation.

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How Do People Pay For Nursing Home Care In Rhode Island?

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What do you mean my health insurance does not pay for nursing home care?

There are 3 major ways on how people pay for nursing home care in Rhode Island:

First is by accessing and using an earlier purchased long-term-care insurance policy. Unfortunately, very few people have them as they are for many people cost prohibitive.

The second way is by private pay, which means you write a check directly to the nursing home from your life savings to pay for the room and board to live there. Per the Rhode Island Department of Human Services, the average cost per month for skilled nursing home care in Rhode Island is $9,113.

The third way to pay for nursing care is to qualify for Medicaid coverage under the Medicaid program. By qualifying for Medicaid, an individual will not be required to spend their life savings on skilled nursing care.

Unfortunately, medical insurance does not pay for long term care. Most plans will only pay a portion of the first 100 days of skilled care. After the 100 days is used, individuals will need be responsible for paying for their own room and board – their medical insurance will continue to pay for doctor visits and prescriptions, but individuals will need to pay for the bed, meals and roof over their head in nursing home.

How do I qualify for Medicaid?

Qualifying for Medicaid is like filing a very complicated tax return over a series of years. For a person to take advantage of the tax rules the taxpayer needs to make decisions as to their assets and income, perhaps transferring assets or claiming some while using others. So too is it with qualifying for Medicaid. As a CPA helps with a Tax Return, and Elder Law Attorney helps with understanding and advising as to what needs to be done to qualify for Medicaid. It is a lengthy process that for it to be optimized requires 5 years!

Want to learn how to qualify for Medicaid? Contact our office and schedule a no-cost meeting!Nursing Home Image

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Leaving Nursing Home During Medicare-Covered Stay

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LEAVING NURSING HOME WHILE STILL BEING TREATED – IS IT POSSIBLE?

Nursing home residents often want to participate in holiday gatherings but may worry they will lose Medicare coverage if they leave the facility to do so. Residents and their families and friends can put their minds at ease. According to Medicare law, nnursing home residents may leave their facility for family events without losing their Medicare coverage.leaving hospital

However, depending on the length of their absence, beneficiaries may be charged a “bed hold” fee by their skilled nursing facility (SNF). The Medicare Benefit Policy Manual recognizes that although most beneficiaries are unable to leave their facility, “an outside pass or short leave of absence for the purpose of attending a special religious service, holiday meal, family occasion, going on a car ride, or for a trial visit home, is not, by itself evidence that the individual no longer needs to be in a SNF for the receipt of required skilled care…Decisions in these cases should be based on information reflecting the care needed and received by the patient while in the SNF and on the arrangements needed for the provision, if any, of this care during any absences.”

Source: Center for Medicare Advocacy

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