youbet
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DW and I recently placed her mom in a NH here in Illinois. We learned a lot from the process. Here are a few quick observations I made as we waded through the ordeal.
1. Here in northern Illinois, NH's that will accept a patient who is on Medicaid (near zero assets) from the get-go tend to be dumps with bad care and low ratings. When mom left the hospital and went to one of these for two weeks as a rehab patient under Medicare, we found out what being in a bad NH meant. We were really glad to get her home and out of there. Because this was a Medicare, not Medicaid, situation there were plenty of better NHs available for her and we were guilty of not researching and knowing this. We allowed her to be sent to a NH known for accepting Medicaid patients when Medicare and her supplemental policy were paying. Bad, bad kids.
2. Many better nursing homes have Medicaid residents but they are residents who started as private pay but outlived their money and switched to Medicaid. Better NH's have no need to accept Medicaid patients as they attract plenty of folks who can private pay, at least for a while.
3. Better (read "highly rated and likely expensive") NH's want new residents to show that they can private pay for two years before they accept them and guarantee they can stay, with Medicaid paying, if they outlive their money.
In mom's case, she had a second need for rehab NH care (paid by Medicare) following another hospitalization and we had located a much better facility for her this time. Medicare pays for 100 days of NH rehab and at a high enough rate that better NH's readily accept patients. Mom also had the remaining line of credit from her reverse mortgage and a modest monthly SS check. This all added up to being private pay for roughly one year. That is, 3 months of NH rehab paid for by Medicare + supplement and 9 months of NH residency as a private pay.
When it became apparent she wouldn't be coming home from the NH rehab, we applied for her admittance as a resident and she was accepted. Despite falling short of the requested two years of private pay money, they had good knowledge of her due to the 100 days she had spent there as a rehab patient on Medicare. They knew she wasn't a screamer, wanderer or roommate hater. She's just wheel chair bound and needs help getting to the dining room and toileting. Thank goodness.
In her case, having no LTCi hasn't been an issue. There is no spouse to be impoverished. No one needs any inheritance and, regardless, any inheritance would have been a pittance anyway. She had just enough private pay money to get her into a highly rated (think almost $90k/year in a two bed room) NH who will keep her after she moves to Medicaid next spring. We couldn't have gotten her into a better place even with LTCi as far as I can tell.
Her reverse mortgage turned out to be a blessing. We took it out at the peak of the housing bubble. The residual value of the line of credit when we closed it out was greater than the most optimistic current value given us by realtors. The reverse mortgage actually gave her some protection from the housing bust.
Bottom line = a single person with no dependents and few assets doesn't need LTCi. Having enough money to pay for a year or two of LTC before Medicaid kicks in is very helpful in getting into a "better" place. Being in a "better" place relieves your kids from the worry of having you in a poorly managed, poorly ranked/graded dump.
1. Here in northern Illinois, NH's that will accept a patient who is on Medicaid (near zero assets) from the get-go tend to be dumps with bad care and low ratings. When mom left the hospital and went to one of these for two weeks as a rehab patient under Medicare, we found out what being in a bad NH meant. We were really glad to get her home and out of there. Because this was a Medicare, not Medicaid, situation there were plenty of better NHs available for her and we were guilty of not researching and knowing this. We allowed her to be sent to a NH known for accepting Medicaid patients when Medicare and her supplemental policy were paying. Bad, bad kids.
2. Many better nursing homes have Medicaid residents but they are residents who started as private pay but outlived their money and switched to Medicaid. Better NH's have no need to accept Medicaid patients as they attract plenty of folks who can private pay, at least for a while.
3. Better (read "highly rated and likely expensive") NH's want new residents to show that they can private pay for two years before they accept them and guarantee they can stay, with Medicaid paying, if they outlive their money.
In mom's case, she had a second need for rehab NH care (paid by Medicare) following another hospitalization and we had located a much better facility for her this time. Medicare pays for 100 days of NH rehab and at a high enough rate that better NH's readily accept patients. Mom also had the remaining line of credit from her reverse mortgage and a modest monthly SS check. This all added up to being private pay for roughly one year. That is, 3 months of NH rehab paid for by Medicare + supplement and 9 months of NH residency as a private pay.
When it became apparent she wouldn't be coming home from the NH rehab, we applied for her admittance as a resident and she was accepted. Despite falling short of the requested two years of private pay money, they had good knowledge of her due to the 100 days she had spent there as a rehab patient on Medicare. They knew she wasn't a screamer, wanderer or roommate hater. She's just wheel chair bound and needs help getting to the dining room and toileting. Thank goodness.
In her case, having no LTCi hasn't been an issue. There is no spouse to be impoverished. No one needs any inheritance and, regardless, any inheritance would have been a pittance anyway. She had just enough private pay money to get her into a highly rated (think almost $90k/year in a two bed room) NH who will keep her after she moves to Medicaid next spring. We couldn't have gotten her into a better place even with LTCi as far as I can tell.
Her reverse mortgage turned out to be a blessing. We took it out at the peak of the housing bubble. The residual value of the line of credit when we closed it out was greater than the most optimistic current value given us by realtors. The reverse mortgage actually gave her some protection from the housing bust.
Bottom line = a single person with no dependents and few assets doesn't need LTCi. Having enough money to pay for a year or two of LTC before Medicaid kicks in is very helpful in getting into a "better" place. Being in a "better" place relieves your kids from the worry of having you in a poorly managed, poorly ranked/graded dump.
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