Background: A 75 year old previously healthy relative was diagnosed with a small cancerous brain tumor which was successfully removed via surgery. Under his medicare insurance (Medicare Advantage version of medicare ), his wife was advised that he was covered for 20 days of skilled nursing care after surgery for recovery. So after the surgery, the hospital moved him into a care facility within the hospital. Physical therapy was started, however, due to an unrelated infection that arose while in the hospital, as well as a couple other complications, he became too weak to continue the physical therapy. A nurse made a note on his chart that he wasn’t participating in physical therapy, and the insurance company immediately notified the hospital that they wouldn’t pay for any skilled nursing care because he wasn’t participating in physical therapy. The hospital explained to his wife that he should be moved to another facility of her choice. Since he is incapable of even sitting up in bed at this point, his wife had him moved to a different skilled nursing facility. That facility costs $12,000 per month, and if I understand his wife correctly, no part of the cost of this care is covered by insurance.
Since he may need care for at least a couple of months or more, does anyone have any suggestions on what other options are available? His wife is 75 and they don't have children or relatives that live nearby. If hiring a live in nurse would be less expensive, does anyone have any suggestions on how to find a qualified person who provides this sort of care.
A skilled nursing facility does not equal an assisted living facility. Either way, $12,000/month is too much, but varies based on location $5,000-$7,000 / month is more nominal.
Basically, if the condition is recoverable, ie. after the infection goes away, that the patient will be able to do resume and do daily activities on their own, the insurance should pay for the short term skilled nursing care. The insurance however will not pay for extended long-term nursing care, where there isn't any improvement or expectation for improvement. Basically, if you need assistance on a long-term basis, health-insurance will not cover it, long-term care insurance would. As always, read your insurance policy, and good luck.
JudyJFLA
Member
posted: Feb. 1, 2010 @ 3:23a
Usually Medicare will not pay for another 20 days of skilled care unless there is another hospital admission. They will pay for home physical therapy, bathing, and occupational (daily living) therapy for so many visits is the person is homebound. $5-7K a month is average but could be more due to location and level of care. Live in home care is almost as expensive at around $200 a day, and some companies offer help at around $20-$25 an hours with 4 hr minimum if you need to get out and scream for awhile, this is of course not an RN.
To get on Medicaid in most states you have to have exhausted assets or transferred property 5 years ahead of getting sick. Medical is the leading cause of Bankruptcy. We had Dad in a nursing home for 7 years and wrecked us. Now Mom has dementia, so I am full time with her. If at all possible keep him home for care, as infections and quality of care at home sure beats lying in a facility waiting for the next meal for the rest of your days.
$12,000/month for a nursing home stay is the going rate in my neck of the woods, too. Depending upon how much help you want to provide your relative and his family, it can be an easy process if you just let the chips fall were they may and accept whatever unfolds, or on the other hand it can be a nightmare if you want the best possible outcome for your relative and are willing to fight for it. Most of us faced with these decisions will fall somewhere in the middle.
I live in NY, and my advice is based on my experience.
First of all, unless your relative qualifies for Medicaid right now, contact a lawyer. It's almost never too late to shelter some or most of the assets at risk.
See if you can get your relative admitted to the hospital again. If he stays for at least three days, and if the doctor in charge believes, or at least makes it known, that your relative has improved to the extent that the doctor believes he can now participate in rehabilitation...then the cycle will start all over again and Medicare will cover it for up to 20 days, assuming he can participate in rehabilitation. This hospital to nursing home, and back, etc. can go on pretty much indefinitely under the right circumstances . However, if he deteriorates to the point where they do not think he will improve, Medicare will not cover it. At that point it's private pay or Medicaid (and a lawyer).
I cared for my Parents at home for several years. In the beginning I provided almost all the care myself, but later had to hire private help. It may be tempting to hire an agency, and although it's counter intuitive, based on my experience I'd say avoid agencies if at all possible. They generally hire the worst people and even though they claim backup people are available in case the 'regular' can't make it, that never works. And even if they have someone else who can fill in, by the time they find a replacement, half the day will be gone.
Advertise on craigslist and check their ads. I posted an ad and received about forty replies in a three day period. Non-agency private duty aides run anywhere from $8-$30/hour in my area. I was able to find several very experienced and reliable people for $12/hour. Of course they all wanted to be paid in cash: "under the table."
First thing you should do is consider the implications of Medicaid, your relative's assets, and how much they want to protect. See if you can have your relative re-admitted to the hospital. This would take some of the pressure off and give everyone involved more time to make arrangements.
The real cost of the assisted living facility is $7k per month. Medicaid strong arms the facility into accepting $2k per month - because it's so "efficient." Thus they must charge private people $12k per month to make up for the losses associated with accepting medicaid payments.
blueeyed782002
New Member
posted: Feb. 1, 2010 @ 9:02a
you can all a home health agency and compare the prices and c what they offer in terms of care and then ask them if the can direct u with info on senior services in ur county or state programs that can help with payment and other types of services
tripleB said: The real cost of the assisted living facility is $7k per month. Medicaid strong arms the facility into accepting $2k per month - because it's so "efficient." Thus they must charge private people $12k per month to make up for the losses associated with accepting medicaid payments.If the OP's relatives are not getting any help from Medicare or Medicaid and are paying $12k/month out of their own pocket, then the real cost to them is $12k/month. If it's covered by Medicare or Medicare, it's of no practical concern to them what the 'real' cost is to the government, etc. Yes, you could argue we're all footing the bill for the government's assistance, and therefore we should all be concerned, but that would be a different kind of argument.
This is a dog eat dog world we live in. Especially as regards assisted care and health costs in general, especially for those of in the middle. By that I mean the lower income, no asset people and the very rich don't care about assisted care costs. The former because Medicaid kicks in immediately and the latter because they have enough money to pay for care themselves. It's everyone in the middle who's getting shafted by the skyrocketing assisted living costs.
Best thing I suppose is to live in a state where nursing homes, for example, are 'only' $4k-$6k/month because there are lots of senior citizens with government and private pensions (plus assets) financially able to handle most of that cost on their own.
arch8ngel
Senior Member - 1K
posted: Feb. 1, 2010 @ 11:52a
Sounds pretty high.
I was of the impression that $60k/year was the going rate for good care at a nursing home.
cga said: If the OP's relatives are not getting any help from Medicare or Medicaid and are paying $12k/month out of their own pocket, then the real cost to them is $12k/month...
tripleB was talking about cost for Nursing home and not for patients.
For example, when you buying shirt for $50.00 it have different costs: for you ($50.00) for retail store ($25.00) for apparel company ($15.00) and for manufacturer ($10.00)
Thank you everyone for your posts. Your information is very helpful since I have had no experience with medicare, nor dealt with this type of situation before. Frankly this has been a wake up call for me. I now realize how important it is to fully understand the process beforehand. Seeing his wife having to make snap decisions while she is under such stress is bad enough, and I don't think she has even fully considered the potential long term financial impact.
svap said: cga said: If the OP's relatives are not getting any help from Medicare or Medicaid and are paying $12k/month out of their own pocket, then the real cost to them is $12k/month...
tripleB was talking about cost for Nursing home and not for patients.
For example, when you buying shirt for $50.00 it have different costs: for you ($50.00) for retail store ($25.00) for apparel company ($15.00) and for manufacturer ($10.00)If I'm looking at a $12k/month bill from a nursing home, I don't care why the nursing home wants $12k/month for private pay. What I care about is they want that $12k every month, regardless of how they come up with that amount. Knowing why or how they determine their costs won't help me in a practical way.
If I were in the OP's shoes and if her family were faced with such a scenario, I would have far too many other more pressing matters to deal with, and would have neither the time nor emotional energy to devote to tangential issues. But I'll concede that how the facility determines its prices may interest others looking in. But not so much those of us on the inside looking out. I've been through this nightmare myself. If not handled properly, this situation can be both a financial and emotional killer. Even worse is the potential deleterious effect on the family's health.
svap said: cga said: If the OP's relatives are not getting any help from Medicare or Medicaid and are paying $12k/month out of their own pocket, then the real cost to them is $12k/month...
tripleB was talking about cost for Nursing home and not for patients.
For example, when you buying shirt for $50.00 it have different costs: for you ($50.00) for retail store ($25.00) for apparel company ($15.00) and for manufacturer ($10.00)
Also, one of the tenets of the free market is that in the absence of bulk ordering, every customer is charged the same for the same service. Bulk ordering reduces the costs of selling because you have the same overhead whether the order is small or large. Although the government may have "buying power", they are not purchasing in bulk (how exactly can one purchase assisted living in bulk). In fact, the paperwork and associated overhead in taking government funds versus cash is likely higher, therefore negating the government discount.
ecjjones
Senior Member
posted: Feb. 1, 2010 @ 2:32p
My Mother is in an adult family home.
When she first went in there, seven years ago, she was paying $4600 per month for a single room.
She exhausted all of her money, and now it is paid through Medicaid, with my Mother paying $565 per month out of her social security check.
We are in Washington state.
Before she entered the adult family home, she had help come to her condo several times a week. That cost her $3600 per month, and of course the cost for upkeep on her condo.
I suppose it depends on the area you live in, the services they provide, how nice it is, the level of care, etc etc.
tripleB said: The real cost of the assisted living facility is $7k per month. Medicaid strong arms the facility into accepting $2k per month - because it's so "efficient." Thus they must charge private people $12k per month to make up for the losses associated with accepting medicaid payments.
That was about right when a family member exhausted his money and became a Medicaid patient. They also took the entire monthly SS disability payment minus $30-40 a month for personal spending. Together he was receiving the basic level of care. Pay more and you get more care. I think the facility he was in has 3 levels of care above the basic one depending on how much you are willing to pay.
A provider got $18,0000 for one month of skilled care for my Mom in a nursing home recently. It's unbelievably expensive.
biomedeng
Senior Member
posted: Feb. 1, 2010 @ 6:47p
bighitter said: Thank you everyone for your posts. Your information is very helpful since I have had no experience with medicare, nor dealt with this type of situation before. Frankly this has been a wake up call for me. I now realize how important it is to fully understand the process beforehand. Seeing his wife having to make snap decisions while she is under such stress is bad enough, and I don't think she has even fully considered the potential long term financial impact. I cannot emphasize enough the need for planning prior to a crisis. Medicaid planning and financial asset reviews are an ongoing process that should begin years out, even before the first sign of a problem. OP, your senario is quite possibly the worst situation IMHO, because the wife may have to spend down their assets before the husband becomes medicaid eligible. This potentially leaves her living the rest of her life on minimal assets. You can visit nursing homes well in advance of a problem. For one relative we visited nursing homes as soon as she was admitted to the hospital to identify which homes were best for her discharge. We had to make sure the home was close to the primary caregiver, make sure the home took medicaid in the event of a long stay, and make sure the facility was appropriate for and friendly to our relative. For another relative in a rural area we have investigated the 1 facility in the area to get an idea of the cost and feasiblity in case a fast decision has to be made. Most facilities operate near 100%, so having a ready-to-go list of 2-3 acceptable facilities can be a lifesaver in the midst of a crisis.
biomedeng
Senior Member
posted: Feb. 1, 2010 @ 7:10p
tripleB said: The real cost of the assisted living facility is $7k per month. Medicaid strong arms the facility into accepting $2k per month - because it's so "efficient." Thus they must charge private people $12k per month to make up for the losses associated with accepting medicaid payments. No nursing home is required to accept medicaid patients. There are some issues with "evicting" a private pay patient when they become medicaid eligible. To avoid these issues many private pay only facilities will require you to demonstrate enough assets to pay the bill for 1-2 years. No smart business sells their product at a loss (loss-leaders do not apply to nursing facilities). Most facilities I have delt with are for-profit and are not charity or non-profit. It does not make sense to take medicaid patients if you lose money--it would be more profitable to have empty beds. Therefore I am guessing that medicaid accepting facilities make a small (1-2%) profit on medicaid patients, and an enormous (60-100%) profit on private pay patients. If they have empty beds they will take medicaid patients because it is at least bringing in a little bit of money. Maybe at the end of the day the total returns across all patients are something like 10-20%. Obviously no one would build a nursing home for 1% returns, so in a sense the private pay patients are subsidizing the profits.
ninjaman said: For that amount of money, he could have 25 people looking after him in Mexico. If that's not enough, he could have 400 people looking after him in one of these countries, where many people subsist on less than $1 a day:
Bangladesh Cambodia China Costa Rica Dominican Republic El Salvador Honduras Indonesia Nicaragua Vietnam
catanpirate
Senior Member
posted: Feb. 1, 2010 @ 7:43p
bighitter said: due to an unrelated infection that arose while in the hospitalThought about doing anything about this?
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