Can we talk Medicare and nursing homes?

[hedgehog]

Right now, as far as I know, if you go into a nursing home, you have to spend down all your assets before Medicare kicks in. A surviving spouse gets to keep the house, but I think everything else is up for grabs.

You can buy insurance - after you pay off the mortgage, get the kids through school, save for retirement, etc. Hey - your chances are 3 in 4 that you won't end up in a nursing home.

You can move your assets to the kids ahead of time - I'm not sure of the time limits. That's a great conversation to have -
"So, Dad, you aren't looking so spry these days. How about signing over the house and car while you still can?"

The kicker here is that even after you spend down all your assets, you end up on Medicare. So isn't it time to quit kidding ourselves that the government is saving money?

[marybourg]

1. You're confusing Medicare and

Medicaid. And you're fuzzy on a few other points too. Why not do some research first?

[CountAllVotes]

5. Right!!

You are quite correct, you don't qualify for MediCAID until you are broke.

[dkf]

8. Generally you can have a house and $2000 in assets.

[sammytko]

28. And your house can be worth up to $503k

We just went through all this with my mother

[dkf]

32. So in excess of $503k and they require you to sell?

[sammytko]

39. No, that's how much equity. They tell you to take out a line of credit against it to bring it below

You can also put it in a trust. I think that is what someone else was trying to convey when they said that the hospice people were manipulating the will. They were probably just giving options, but people tend to get heated when it comes to matters like this.

Best to talk to the human services department in your county.

[rfranklin]

2. There is a five year "lookback"

Before you qualify for the government nursing home assistance program, there is a 60 month look back to see if and when you transferred your assets for less than fair cash value or you transferred your assets into a trust system or any system of transferring your wealth for the purpose of becoming eligible for the nursing home program depriving the state of all your available resources for your long-term health care.

http://www.ultratrust.com/medicaid-nursing-home-program.html

[CountAllVotes]

3. That is not true

It depends on if you have supplemental coverage (I do and it covers 80% of the costs after you've maxed out the Medicare benefits for nursing home stays).

Such stays don't drain you dry if you get out of one.

If not, then you end up in the spend down situation.

Hopefully, you'll get lucky and die first IMO.

[sinkingfeeling]

4. Medicare doesn't pay anything towards a nursing home for custodial care . Medicaid does and

that's why you have to lose your assets before you can qualify for Medicaid. You are free to 'private pay' for the nursing home. We are currently looking at a nursing home for our 93 yr-old mother in two states.

In Florida the average charge is between $230-260 a day. That's between $6900-7800 a month or $82,800-93,600 a year. In Arkansas, it runs between $155 and $170 a day. That's $4650-5100 a month or $55,800-61,200 a year. Those are average rates so you can go higher with a 'higher' quality of home.

[CountAllVotes]

6. Medicare pays for limited nursing home care

If it goes beyond what they will pay, you'll have to spend it all and go on Medicare unless you have a supplemental policy that kicks in and covers your ass.

That is how it works.

More here:

http://www.medicare.gov/NHCompare/Include/DataSection/Questions/SearchCriteriaNEW.asp

[sinkingfeeling]

12. I should have said Medicare will not pay for custodial care in a nursing home.

http://www.medicare.gov/publications/pubs/pdf/10153.pdf

You must have been in a hospital for at least 3 days before using a Medicare 'skilled nursing facility'. Here's what they will pay and the link above is to the government's write-up on this subject.

Medicare doesn’t cover custodial care if it is the only kind ofcare you need. Custodial care is care that helps you with usual daily activities like getting in and out of bed, eating, bathing,dressing, and using the bathroom. It may also include care that most people do themselves, like using eye drops, oxygen, andtaking care of colostomy or bladder catheters. Custodial care is often given in a nursing facility. See page 20 for ways to get help paying for custodial care. Generally, skilled care is available only for a short time after a hospitalization. Custodial care may be needed for a much longer period of time.

They will pay 100% for 1-20 days. You will then be required to pay $128 a day for days 21-100. After that, they pay nothing.

[CountAllVotes]

20. no they won't

You are right.

They wouldn't pay for my mother who had cancer was briefly in a 24-hr. care situation for the last 3 mos. of her life. Hospice was involved too and they actually tried to manipulate her will along with the home where she was at!

Who paid the bill? I did.

[DJ13]

7. Back when my dad was in a nursing home, Medicare pays the first 30 days

That was in the early 90's, so its likely it has changed since then.

It wasnt uncommon if MediCal was dragging their feet on paying for the daily care of residents to see that home shuffle them to the hospital for several days, where Medicare pays for care, then bring them back to reset the Medicare clock for another 30 days in the hope that MediCal would have their payment structure straightened out.

[dkf]

10. From Medicare...

How much is covered by the Original Medicare Plan (see page 19)?

For Days 1–20
Medicare Pays full cost for Covered Services

21–100
Medicare pays All but a daily copayment*

Beyond 100
Nothing

http://www.medicare.gov/publications/pubs/pdf/10153.pdf

[enough]

13. Good hard facts here. Medcare pays for a limited amount of TEMPORARY nursing home care.

But it will not in any circumstance pay for prolonged or permanent nursing home or assisted living care.

[sinkingfeeling]

16. That's not for custodial care. Nursing home care to me is for those who

require more assistance than can be provided in an ASL (assisted living). I know several elderly women who have resided in nursing homes for years. One has been there for 13 years and is 102 years old. She has been privately paying out close to $100,000 a year.

[CountAllVotes]

18. this is true

If you happen to have supplemental coverage and/or long-term care you might be in luck.

Otherwise not.

My SIL is in a nursing home and her house has been sold and the money from the sale is being used to pay for her stay. The house sold for a load of $$$ and she'd have to live for a very long time to outlive the amount of money it is worth.

Her son is in charge --- that was her BIGGEST MISTAKE (giving him POA).

[dkf]

22. How is the POA messing up?

[CountAllVotes]

26. Well, he tried to kill her first

When that did not work he had to get off his ass and deal with it.

No one trusts him.

If he had sold the house, that was his option not hers. She doesn't know that her house has been sold.

She could have had a reverse mortgage taken out on it (as her family advised her to do) but she didn't do it (or I should say her son didn't do it).

Reason: Simple.

The son is hoping she'll die quickly (which doesn't seem to be happening) so he' d have all of the money left for his greedy self.

This asswhole is hated en mass by his family and me for what he has done to his mother who he refers to as "a bitch".

Nice kid. Real nice.

I hope he rots in hell frankly.

In hell and BROKE!

[dkf]

30. Wow that sounds bad. My sympathies.

[CountAllVotes]

33. Yes, it is really bad

Said son is one of these freaks with a load of guns and waiting, waiting for what I do not know.

In any event, my SIL's main problem is the fact that she is blind almost.

If she'd been able to do the reverse mortgage, she could have hired someone to live w/her and she'd still be living in her home today, not the hell hole that she now resides in.

I thought my BIL was going to kill him as he is so very angry about this as are her other remaining 7 brothers and sisters.



Lesson learned: Be damn careful about WHO you give POA to! You never know ...

[DJ13]

25. I believe thats the same as my dad experienced

I was going by a 20 year old memory, but that 20 days mentioned seems the same time as back then.

In my case, I had to fight the State's MediCal department for nearly two years over my father's house, as it was valued below the (then) limit of $60k valuation they werent allowed to take in recovery after he had died.

My wife and I were even in a feature story (as the example of lower class individuals who get screwed by the system) in the LA Times relating to wealthy individuals who were sheltering their assets in order to circumvent the MediCal restrictions on assets.

With the help of a very good attorney (the Founding Dean of the Texas Tech University Law School) who worked Pro-Bono, we got the state to back down.

So yes, Im very familiar with the games the states will play in their MediCaid systems.

[CTyankee]

40. My husband's stay at an intensive rehab facility was covered 80% by Medicare, but luckily

we had both just signed up for an AARP medicare supplemental policy. That 20% amount was staggering. We way more than made up for the extra cost of the supplemental policy just with that alone! His stay worked wonders for his rehab and I was able to retrofit the house for him when he got home. Plus, the shape he was in, I could not take care of him.

I shudder to think what people do if they don't have the supplemental policy (and they are not eligible for medicaid)...

[sinkingfeeling]

41. Yes, that's the way it works for rehab. Medicare does not pay for

custodial care.

[Hoyt]

9. Your point is valid. Although, technically, MediCARE may cover 100 days of skilled nursing care if

you meet certain qualifications. Then, you look to your assets and when they are sufficiently depleted, you might become eligible for MediCAID (which is a federal and state program).

Again, your point is 100% on target -- the nursing home situation is sad.

And, a lot of states are aggressive going after assets that were transferred by a parent a couple of years before a patient goes into a nursing home. Some states have been rather lax. I do think, at least in some states, a patient can keep their house if there is an expectation the patient will be able to return home at some point. While the spouse can keep the house, other joint assets are up for grabs or have to be used to pay for the nursing home before the patient qualifies for Medicaid.

Makes my head spin thinking about the screwed up rules. Nursing home care is very expensive -- and a quick way into poverty.

[antigop]

11. Why are nursing homes so expensive? Because they are run for profit? n/t

[sinkingfeeling]

24. Partially, but the laws require they have RNs on duty 24/7. Plus you may need 1 CNA for every

couple of residents. They must bath, dress, and feed everybody daily, plus provide medications on time.

[dkf]

31. That is a tough job. I couldn't do it.

[TheMastersNemesis]

14. Medicare Does Not Pay For Nursing Home Long Term Care.

Medicare does not pay for nursing home care. Medicare will take care of very short stays for recovery, but it does NOT pay for long term stays. That expense is paid for through the Medicaid programs once all assets are spent down. The federal mandate under Medicaid is what kicks in and makes sure that the family i.e. the children and perhaps the grandchildren cannot be assessed the bills for long term care.

When my mother went into a nursing home in Illinois Medicaide covered the expense. Except for a small stipend the bulk of her Social Security paid for the monthly fee. The state of Illinois paid the rest. She was in the home for 4 years. In my case I was 10 days short of the look back and the state of Illinois filed a LIEN on her house. Because they improperly filed that lien, they could not force sale of the house after she passed.

My mother had signed her house over to me and there was a 36 month look back on assets being assigned. If the parent went into the home before the expiration of that look back period i.e. a home, the state had a right to file a lien and force the sale after the parent died. The nursing home resident can only have $2000 in total assets before they qualify for Midicaid.

The GOP changed the look back law which makes it almost impossible for the parent to sign over any assets now. I am not sure exactly what the law is now but it is pretty air tight. It is supposedly illegal for any lawyer to help a parent sign over assets to the family that will sequester those assets from the state.

Now in the case of two parents, one parent can stay in the home but the law severely cuts the parent in the home financially.

Before Medicaid and the federal mandate the surviving children of the parents were assessed a monthly payment depending on their income. That fee was just like any other debt and the state could file liens against the children for unpaid nursing home debts.
I know that this assessment is true because my mother's sisters had to pay for my grandmother's nursing home care before Medicaid was passed. They had to turn their financial records over to the Illinois State Department Of Social Services so they could determine how much each sister would be assessed each month. My mom and dad lived out of state so they could not assess them.

The Republicans want to END THE FEDERAL mandate under Medicaide. Ryan's budget cuts would necessitate assessing the children of nursing home residents for the expenses. His budget would cause huge cuts in Medicaid. And I am sure that the GOP has a lot of surprises for the boomers when their parents end up in a nursing home.

Medicare pays for the medical expense while in the nursing home. It does not pay for the other non medical expenses.
In the case of a person who needs hospice I believe Medicare will pay for a resident if it is FOR PAIN RELIEF regimens only. AS far as hospice in general, the family would be responsible for that expense.

The GOP wants to end the federal mandate and send the program back to the states on block grants.

[mainer]

15. A person's assets SHOULD go toward their own care

and not be transferred to the kids ahead of time. Otherwise, you're asking the taxpayer to take care of your mom while you run off with mom's assets.

[KamaAina]

21. How very Republican of you

while you run off with mom's assets.

Repukes love it when middle-class families fail to build wealth. Look at this "reverse mortgage" scam. The banksters have convinced seniors to use their home equity as an ATM. The kids be damned.

[mainer]

27. No, it's DEMOCRATIC of me. I took the principled route with my own mom.

We were advised by numerous people to transfer mom's assets to us early, so that she could spend down to poverty line and then the government would pay for her nursing home. I said that was wrong to take her assets and have the state of Maine (which is already struggling) pay for her care. That is the DEMOCRATIC way to do things.

A Republican would run off with mom's assets and leave the bill with the state.

My mom's lifetime assets were to pay for HER care. Why do children think they can take that money while mom still needs care? Why do her children think that the taxpayer (including many people who are struggling) should pay for mom when mom has the assets to pay her own bills?

[CountAllVotes]

37. A Republican would run off with mom's assets

That's what my SIL's son has done.

And yep, he is a puke no doubt yes sir! alert being he has his arsenal and is waiting .... waiting .... waiting ....

[hedgehog]

35. The problem is that the person's assets are used up very quickly anyways -

then the taxpayer is on the hook.

The difference is that for middle class and lower class families, there is no transfer/accumulation of wealth. For the rich, there is.

[AngryAmish]

17. no

[KamaAina]

19. We're working to improve those odds to as close to 4 out of 4 as we can get!

your chances are 3 in 4 that you won't end up in a nursing home.

From the disability rights perspective, that means that one in four of us will -- and that's unacceptable from both a personal standpoint (would you want to live in one?) and an economic one (home- and community-based services are cheaper).

Also, this discussion isn't just about the elderly. One in four nursing home residents are people under age 65 who have disabilities.

[CountAllVotes]

23. People under age 65 who have disabilities

*ding* *ding*

You are so very right and you have just posted my greatest fear as a disabled person.

I'd kill myself before I'd let them haul me off to one of these stinking hell holes and I do mean that, oh yes I do!

[KamaAina]

29. Welcome to the movement!

As we speak, the radical disability rights group ADAPT is in Washington, D.C. blockading the halls of Congress in an effort to stop the repukes' diastrous Medicaid cuts.

http://www.adapt.org/

And this year, the M$M is actually paying attention to us, because Noah Wyle from "ER" joined in!

[CountAllVotes]

34. what movement?

Seems the rich fucks in Washington could really care less about US and I learned this a long long time ago.

Where have you been?

[davsand]

36. My mom did a rehab stint in a nursing home a couple of years ago. Lots of sadness in those places.

Mom had a quad bypass and needed a recovery/physical therapy stay someplace. She has nursing home insurance along with a decent Medicare supplemental plan. I know there was some discussion about a lifetime limit of the number of days covered under Medicare, and I know she was covered for the 30 days of rehab she needed.

There was another woman there at the nursing home at the same time who'd had a debilitating stroke and she'd maxed out on her coverage from Medicare. They made her move to a different home because the one they were in did not accept Medicaid. There was a very slim chance that she'd ever recover enough function to live independently again, and the home she was forced to move to was not at all well respected. It was pathetic.

My mom was horribly disturbed by it all, and told me that if she EVER faced that situation she'd rather just die. From having seen what some of those places are like, I can't disagree with her. THIS is how we treat some of our most vulnerable? I'm not sure we should ever presume to call ourselves a civilization.


Laura

[Lasher]

38. Here's a link to an article sums up the rules pretty well.

http://www.medicare.gov/nursing/payment.asp

You're right about the 5 year lookback. It was a 3 year period until Junior and his Bush league lapdog GOP Congress increased it in 2005.

Such a transfer of assets is not as simple as many people suppose. For one thing, we often fail to anticipate when we'll need this sort of long term care - partly because it's unpleasant to think about. It's kind of like shopping for coffins.

Another issue is our wish to retain independence. This desire often intensifies as our self-reliance starts slipping away. Elders can therefore react negatively when they are asked to relinquish ownership of all their assets. And let's face it, lots of people steal from their parents when they get the chance.

[jwirr]

42. Okay, first we need to get the terms correct. Medicare pays something like 160 days in the nursing

home and no more. Medicaid is the program that has the regulations you are talking about. It picks up after the 160 days if you are poor enough. That is where the spenddown comes in. If you spouse or your disabled child is living in the home they can stay in the home. Children living outside the home are often allowed to buy the home at market value so you can pay your nursing home costs. As to giving your assets to your children - here in our state it has to be 5 years before you go into the nursing home. You can also have a burial fund set aside.

This last was done because many wealthy parents were handing over everything and then living on Medicaid while complaining about the poor.

These rules may not be totally correct anymore. But I am sure that they have only gotten stricter if they are different.

[sinkingfeeling]

43. Medicare will pay 100% for 20 days of 'rehab/skilled nursing' care. After

that you must pay $128/day until 100 days. This is for people who spent time (min. 3 days) in the hospital and require care after leaving.

Again they pay nothing for custodial nursing home care. Here's the handbook for Medicare and Skilled Nursing Facilities:
http://www.medicare.gov/publications/pubs/pdf/10153.pdf