Medicare and Continuing Care
Nursing Homes and Housing Options
Serious and chronic illness may create a need for full-time care outside the home. It is a decision you and the person you care for should discuss with the doctor as well as other family members.
There are several categories of care available in most communities, ranging from daytime activities to full-time care. These include independent living facilities, assisted living facilities, continuing care retirement communities (CCRCs), adult day care, custodial care, skilled nursing facilities, and nursing homes. A description of each of these categories of care follows.
Independent Living Facilities
These are settings designed for independent living while offering meals, social and recreational activities, and other support.
Assisted Living Facilities
Assisted Living Facilities
These are residential homes offering a range of services that usually include activities of daily living, supervision, and medication management.
Continuing Care Retirement Communities (CCRC)
A CCRC is a housing community that provides different levels of care based on residents' needs.
Adult Day Care
Adult day care includes daily, structured activities and health-related and rehabilitation services for the elderly who need a protective environment. Care is provided during the day and the individual returns home for the evening.
Custodial care provides assistance with daily activities such as bathing, eating, and dressing.
Skilled Nursing Facilities
These are facilities with 24-hour supervision and medical and rehabilitative services for patients requiring a high level of care. Medicare covers skilled nursing care after a 3-day qualifying hospital stay. Skilled care is health care given when the person needs skilled nursing or rehabilitation staff to manage, observe, and evaluate his or her care. Examples of skilled care include changing sterile dressings and physical therapy. Care that can be given by non-professional staff isn't considered skilled care.
Nursing Homes serve as permanent residences for people who are too frail or sick to live at home because of physical, emotional, or mental problems. Nursing homes provide a wide range of personal care and health services, including helping people with dressing, bathing, and using the bathroom. Nursing home residents usually require daily assistance.
If you are considering nursing home care, you can begin your search at http://www.medicare.gov. You can find many links that can help you gather information about Medicare- and Medicaid-certified nursing facilities and long-term care options in your state. You also can compare the quality of nursing homes in your area. To look at or print a copy of the booklet "Medicare Coverage of Skilled Nursing Facility Care," go to "Search Tools" and select "Find a Medicare Publication." You can also call 1-800-Medicare (1-800-633-4227) to find out if a free copy can be mailed to you. TTY users should call 1-877-486-2048.
Questions to Consider
Here are some questions to ask when considering choosing a nursing home. You may want to make surprise visits at different times of the day to verify conditions.
- Is the nursing home Medicare- or Medicaid-certified?
- Does the nursing home have the level of care needed (such as skilled or custodial care) and is a bed available?
- Does the nursing home have special services if needed in a separate unit (such as a ventilator or rehabilitation) and is a bed available?
- Are residents clean, well groomed, and appropriately dressed for the season or time of day?
- Is the nursing home free from strong, unpleasant odors?
- Does the nursing home appear to be clean and well kept?
- Does the nursing home conduct staff background checks?
- Does the nursing home staff interact warmly and respectfully with home residents?
- Does the nursing home meet cultural, religious, and language needs?
- Are the nursing home and the current administrator licensed?
Paying for Nursing Home Care
Nursing home care can be very expensive. Medicare generally doesn't cover nursing home care. There are many ways people can pay for nursing home care. For example, they can use their money, they may be able to get help from their state, or they may use long-term care insurance.
Nursing home care isn't covered by many types of health insurance. Most people who enter nursing homes begin by paying for their care out of their own pocket. As they use up their resources over a period of time, they may eventually become eligible for Medicaid.
How Medicaid Can Help
Medicaid is a state and Federal program that will pay most nursing home costs for people with limited income and resources. Eligibility varies by state. Medicaid pays for care for about 7 out of every 10 nursing home residents. Medicaid will pay for nursing home care only when provided in a Medicaid-certified facility. For information about Medicaid eligibility, call your state Medical Assistance (Medicaid) Office.
If you have questions about Medicaid, you can call your State Medical Assistance (Medicaid) office for more information. Visit http://www.medicare.gov on the web. (Under "Search Tools," select "Find Helpful Phone Numbers and Websites.") Or, call 1-800-Medicare (1-800-633-4227) to get the telephone number. TTY users should call 1-877-486-2048.