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Alzheimer's Disease and Nursing Home Care

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How Do We Pay for a Nursing Home?

There are four main choices: MedicareMedicaid, private insurance, and paying out of your own pocket. Not all facilities accept each type of payment. When you’re researching nursing homes, ask them which options they take. It’s important to know how they’re different, too:

  • Medicare is a federal health insurance program that offers health care benefits to all Americans age 65 and older. It offers insurance protection to cover major hospital care, but it allows only some benefits for nursing home care. Also, the program only pays for skilled care in a nursing facility that has a Medicare license.
  • Medicaid is a joint federal/state health insurance program that provides medical care benefits to low-income Americans who qualify. Nursing home care is covered through Medicaid, but eligibility and covered services vary a lot from state to state.
  • You can buy private long-term care insurance to supplement Medicare coverage. Each policy has its own eligibility requirements, restrictions, costs, and benefits.

What Should We Look For in a Nursing Home?

Review this checklist before you visit nursing homes, and take it with you to keep track of your questions.

Facility

  • Does the nursing home provide the level of care your loved one needs, such as skilled care?
  • Does the facility meet local and state licensing requirements? Does the administrator have an up-to-date license?
  • What are the visiting hours?
  • What is the policy on insurance and personal property?
  • How does the staff respond to a medical emergency?
  • Does the facility have a Medicare license?

Admission and Assessment

  • Is there a waiting period for admission?
  • What’s required to get in?
  • Is there a written care plan for each resident?
  • How does the staff decide what services a resident needs? How often do they do that?

Fees and Financing

  • Have fees gone up a lot in the past few years?
  • Is the fee structure easy to understand?
  • What are the billing, payment, and credit policies?
  • How much do different levels or types of services cost?
  • Which services are covered in the quoted fee, and what costs extra?
  • Does the facility accept Medicare, Medicaid, Medicare Supplemental Insurance, Supplemental Security Income, and other government financing options?
  • When can the center terminate a contract? What’s the refund policy?
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