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Alzheimer's Disease and Nursing Home Care

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How Do We Pay For a Nursing Home?

As you and your family evaluate your long-term care needs, it's important to consider financing options. Payment for nursing home care can be made through Medicare, Medicaid, private insurance, and personal funds. When evaluating nursing homes, it's important to ask the administrative staff what payment options they accept. Here's a brief summary of some of the financing options:

  • Medicare is a federal health insurance program providing health care benefits to all Americans age 65 and older. Insurance protection intended to cover major hospital care is provided without regard to income, but only restricted benefits are allowed for nursing home care. In addition, Medicare only pays for skilled care in a nursing facility that has a Medicare license.
  • Medicaid is a joint federal/state health insurance program providing medical care benefits to low-income Americans who meet certain requirements. Nursing home care is covered through Medicaid, but eligibility requirements and covered services vary widely from state to state.
  • Private long-term care insurance is a health insurance option that, if purchased, supplements Medicare coverage. Private long-term care insurance policies vary greatly. Each policy has its own eligibility requirements, restrictions, costs, and benefits.

What Should We Look For In a Nursing Home?

The following checklist will help you and your family to evaluate different nursing homes. Review the checklist before your visit to the facility. Be sure to take this checklist with you.

Nursing Home Checklist

Facility

  • Does the nursing home provide the level of care needed, such as skilled or intermediate care?
  • Does the nursing home meet local and/or state licensing requirements?
  • Does the nursing home's administrator have an up-to-date license?
  • Does the nursing home meet state fire regulations (including a sprinkler system, fire-resistant doors, and a plan for evacuating residents)?
  • What are the visiting hours?
  • What is the policy on insurance and personal property?
  • What is the procedure for responding to a medical emergency?
  • Does the nursing home have a Medicare license?

Admission

  • Is there a waiting period for admission?
  • What are the admission requirements?

Fees and Financing

  • Are fees competitive?
  • Have fees increased significantly in the past few years?
  • Is the fee structure easy to understand?
  • What are the billing, payment, and credit policies?
  • Are there different costs for various levels or categories of services?
  • Are the billing and accounting procedures understandable?
  • Does the nursing home reveal what services are covered in the quoted fee and what services are extra?
  • What governmental financing options are accepted (such as Medicare, Medicaid, Medicare Supplemental Insurance, Supplemental Security Income, and others)?
  • When may a contract be terminated? What is the refund policy?
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