Nursing home care often becomes necessary for people with the later stages of dementia or Alzheimer’s. Before this stage, however, some support services such as adult day care and/or in-home nursing care services might make more sense. Because dementia and Alzheimer’s develop at different rates for different people, the level of care needed varies greatly from person to person; moreover, each person’s situation can change drastically quickly. To add to this difficult situation, the costs of care–anywhere from $6,000 to $10,000 per month–often leaves families feeling overwhelmed and helpless. As a result, many believe selling the family home is their only option to pay for the care their loved one needs. At Elder Fighters, our asset protection specialists want you to know there are other better options for this complex issue.
Why A Will or Trust Cannot Protect Your Home from Dementia Care Costs
Of course, putting a solid will and/or trust in place is an important step to take to protect your assets. These alone, however, are not always enough. While they can help your family avoid probate court, they do not protect your home and other assets should you find yourself in need of dementia care. To understand why not, you need to understand how Medicare and Medicaid work. Below, we explain some of the basics, so you can see why an asset protection plan is needed in addition to your will or trust.
Why Comprehensive Asset Protection Planning Can’t Ignore Medicaid
The rising costs of dementia care means you’ll be faced with bills of $100,000 per year or more. At these rates, most will quickly spend through any savings they have, and many will turn to selling their home to get more funds to continue care. Once those funds are gone and all you’ve worked for is depleted, Medicaid will become and option. Once you qualify for Medicaid, the government then pays for your care.
Sometimes families try to prevent this entire loss by giving away assets to loved ones to qualify for Medicaid. This ill-advised approach, however, leaves you open to look-back penalties and recouping fees.
At Elder Fighters, we know that there is a better path to paying for dementia care. Our asset protection involves a keen understanding of how to protect your home and assets while getting the benefits you deserve.
Medicare versus Medicaid and Dementia Care
Many people get confused between Medicare and Medicaid. Each program offers some dementia care payment, but they are very different. Medicare insurance covers all Americans aged 65 and older. Its coverage limits, as mentioned above, typically only covers short-term nursing home care. Medicaid is health insurance for low-income Americans of all ages. However, even seniors with considerable assets can qualify for Medicaid coverage with the right Medicaid planning. While Medicare only pays for the first 100 days of nursing home care, Medicaid can cover the costs of nursing home care should your loved one’s 100 days lapse and need further support.
If your loved one with dementia is under 65 years of age, Medicare is not part of the equation yet. You can get Medicaid support for them possibly, but you’ll want to consider how to protect your home and other assets with planning before applying for coverage. Once they qualify for coverage, it’s important to understand what may and may not be covered by Medicaid.
Medicaid Benefits and Early Stages of Dementia
Patients who are only beginning to show symptoms of dementia may benefit from home-care services. These services often appeal to the individual and their loved ones because they provide the support they need at more reasonable costs than full-time nursing facility care. The costs can still be significant, however. Medicaid, thankfully, can help with these types of costs.
In other words, a medical professional must deem that without in-home care, the individual with dementia or Alzheimer’s cannot live safely outside of a full-time care facility. Without this documentation in place, Medicaid will not pay for such services.
Similarly, Medicaid pays for adult day care programs when a hybrid solution is necessary and deemed safe for the individual. The day care facility in these situations provide the necessary supervision and/or nursing assistance during the day while caregivers are at work. Then in the evenings, the caregiver lives with and cares for the individual with dementia during non-working hours and days. This keeps costs down for everyone compared to a full-time facility and gives the person suffering with dementia the comforts of a familiar place and people every day.
Of course, before any of these types of services can be covered by Medicaid, an individual must first qualify for Medicaid. Ohio has strict requirements. For starters, and individual must have less than $2000 in assets. While this low threshold makes many people avoid applying for Medicaid, the reality is that with the right financial planning, you can use spend-down methods and estate planning to qualify for Medicaid and keep over $2000 worth of assets.
Types of Nursing Home Facilities and Services Covered by Medicaid
Before we can fully understand what nursing home costs Medicaid will and will not cover, we need to understand examine what type of services a facility provides. Medicaid must certify a nursing facility before you can get Medicaid benefits. If the nursing home you choose for your loved one has Medicaid certification, the facility should already provide nursing services and specialized long-term care services appropriate for dementia patients. Below are the three types of nursing facility services for dementia Medicaid benefits routinely cover:
- Skilled Medical Care Services: Nursing homes employ professional nurses who can provide round-the-clock health-related care and services. Staff who run memory care units especially require specialized training to care for people with dementia.
- Rehabilitation Services: These services are for patients who suffer injuries, disabilities, or illnesses and need help to return to their previous lifestyle as much as possible. For dementia patients, rehabilitation rarely is the main consideration.
- Long-Term Care Services: This type of nursing facility service is for dementia patients. Dementia patients tend to need a level of healthcare services above room and board in order to ensure their safety and well being.
State-Mandated Nursing Facility Services That Medicaid Covers
The complete list of medical services a Medicaid-certified nursing home must provide varies per state. Each state has a unique Medicaid plan, limiting the types of services that your loved one may receive. In general, however, federal requirements specify the following healthcare services that nursing homes must provide without charging residents:
- Nursing Services: All nursing home facilities must have skilled practitioners of nursing and related medical care services.
- Medically-Related Social Services: Nursing facility staff members provide the appropriate services to maintain their patients’ mental and psychosocial health.
- Room and Bed: Nursing facilities must offer room and bed maintenance services, including routine cleaning.
- Personal Hygiene: Nursing facilities must also perform personal hygiene services for residents and provide the personal hygiene items they need.
- Specialized Rehabilitative Services: Nursing facilities must have the appropriate services for specific types of conditions requiring rehab. Note that the state does not provide or arrange the treatment and services that mentally ill or intellectually disabled residents may need.
- Pharmaceutical Services: Nursing facilities must assure their residents that they can acquire, receive, dispense, and administer necessary drugs for their condition. Dementia patients usually take donepezil, galantamine, or rivastigmine to treat Alzheimer’s disease symptoms.
- Individual Dietary Services: Nursing facilities curate their dietary services to each resident.
- Program of Activities: Nursing facilities must have professionals to facilitate recreational activities that maintain each resident’s interests for their well-being.
- Dental Services: Professional dental healthcare practitioners must be ready to provide emergency dental services. Your state’s Medicaid plan may also determine how much routine dental services nursing home residents may receive.
Uncovered Nursing Care Services
Nursing facilities may charge for special healthcare services that are outside of the facility’s Medicaid payment plans. The following services are not federal requirements, which means your nursing facility may charge you extra for them:
- Private Rooms: Nursing facilities may charge residents who use private rooms, unless they need them for medical reasons. Some dementia patients may require private rooms if their condition is in the later stages.
- Special Food: Although nursing facilities require individualized dietary services, they may charge for food they specially prepare outside of their usual arrangements. Individualized preparations may only consider allergies. Special preparations may consider strict diets that residents must follow.
- Telephone, Television, Radio: Recreational activities outside of the professionally facilitated ones count as extra services for which nursing homes may charge you.
- Social Events: Nursing homes may host activities beyond their regular program.
Get Comprehensive Asset Protection Planning with Elder Fighters
No one wants to think about being struck with dementia or Alzheimer’s, but realistically, many will be. The best way to ensure you get help covering nursing care costs for dementia is early dementia care planning. Such planning puts a financial, medical, and legal structure in place before you need services. This approach is particularly useful because Ohio has a five year lookback period for Medicaid. In other words, you need to have your plan to qualify for Medicaid in place before you need it in order to protect your home and other assets.
Let the experts at Elder Fighters help you plan for the unexpected. Even if the unexpected never happens, your financial, medical, and legal plans will ensure you protect your assets and your voice. They will also give your loved ones peace of mind that they do not have to lose everything you’ve worked for while getting you the care you need and deserve.