Average Nursing Home Cost $91K/yr

[youbet]

From the same article


Keeping in minds that the nursing home means the patient requires continuing medical care. Dementia patients can live in Assisted Living, which costs much less.

I think you meant to say "Some dementia patients can live in Assisted Living which costs much less."

Others require constant supervision, even more that many nursing home residents with medical needs.

 

[youbet]

You say a "Medicaid nursing home" as if there are scores of non-Medicaid nursing around. This is simply not true. Almost all nursing homes accept Medicaid. If you want to pay the bill yourself fine, but you will get the same care as someone on Medicaid.

You're missing the difference between homes that don't accept Medicaid period, homes that allow clients who run out of private funds to remain on Medicaid and homes that accept Medicaid clients from the start.

I have recent experience NH shopping in the NE Illinois (Chicago and collar counties) area. We found that a lot of NH's here do not accept Medicaid clients who cannot private pay for some significant amount of time (frequently looking for two years). They do accept private pay clients who might outlive their personal resources and eventually switch to Medicaid, but don't accept Medicaid patients from the get-go. Some don't accept Medicaid at all, even if you start private pay. Some accept clients who are Medicaid from the get-go and those NH's tend to be near 100% Medicaid clents. NH's who accept Medicaid folks from the get-go tended to be, uh, crappy.

My MIL could private pay for more than a year. Additionally, she started out with the 100 day Medicare coverage allowance, so close to two years total. Her only ongoing income is SS, which the NH receives. The home we finally got her into reviewed her finances, her health and us. This home has Medicaid clients (MIL is now one) but keeps all Medicaid beds filled with folks who started as private pay. No Medicaid folks admitted off the street. So far, we're happy with this place. MIL has needed a significant amount of medical care and their staff seems very good.

We looked at 3 homes which accepted Medicaid patients from the get-go and did not like them. We're in Illinois where NH's struggle to receive Medicaid reimbursement from our financially destitute state. If you live in a more prosperous state, things might be different.

 

[iac1003]

The above is pretty much true in my experience as a geriatric psychiatrist regarding patients starting out private pay and switching to Medicaid.

Most private pay patients or their families do not pay for physical therapies and rehab out of pocket. It is quite rare. Medicare has changed the rules in the past year or so about who can have "restorative" care, meaning instead of stopping therapy when the patient plateaus, Medicare will now pay for a certain amount of rehab to keep the patient at their current level of functioning and help them not deteriorate further. So more and more patients are getting restorative care and many more patients are getting to walk periodically by therapy aides who brace them with a strap contraption.

Very few people in nursing homes have straight Medicaid without having Medicare Part A and B, although there are some. Part B I think pays for the restorative treatments.

In the many homes I have worked in there is no different day-to-day treatment given to the private pay vs. Medicaid long-term stay patients. A strictly Medicaid home however might have a larger percentage of psychiatrically or developmentally disabled patients who aged out of various group homes or just got too sick for them.

When I consulted to assisted living centers the locked dementia units cost almost as much as a nursing home and none were covered by insurance at that time. The advantage was that these units were small, well-staffed, the residents had a lot of non-stimulating activities and were pretty well taken care of.

Given the ongoing restrictions Medicare, Medicaid and the various states are placing on the use of psychotropic medications, be prepared for a lot more agitated, violent people and incidents in the coming years. It is truly awful what these regulations are doing to my profession and I am glad I mostly retired last week and will be completely done with w*rk by year end. I can no longer reasonably and judiciously medicate patients with compassion and help alleviate their suffering. After 33 years of being licensed to practice medicine I am appalled that "they" think they know so much more than I do about my chosen specialty and have legislated it so narrowly. My hands are literally tied.

Enough of this, off the soapbox for tonight.


Sent from my iPhone using Early Retirement Forum

 

[48Fire]

My mother had a case of dementia. It got so bad at the end that she had to be watched 24/7 for her own safety and those around her. I had no choice but to out her in a home. She had no real assets so Medicaid paid the huge bills.

The dementia units are filled with people who are out of their minds, literally. Horrible places where no one cares. Such a horrible situation for all involved.

MIL "bolted" out the front door yesterday for the first time. Fortunately, we saw her.

 

[48Fire]

Thanks for mentioning this. I've been holding back thus far. This is true. My mother finally decided to go into a nursing home. Private. Decent. More than decent, in fact. Not in the Mitt Romney Class but most here really aren't contemplating THAT level of care and balloons every day. She was completely spent down. They are collecting her SS and a small pension she has. The rest from DAY #1 was paid for by Medicaid. The end.

The moral of the story is, if you want to feel comfortable in this, try to privately find at least one or two years. Probably doable by most here. That will get you into almost any nursing home barring the tippy-top tier. IF you live past that and run out of beans Medicaid will cover it and you won't get "demoted" or wheeled out to the parking lot.

It's a pretty useless time of life to worry about spending money anyway. If there is a spouse involved, THAT will require some planning. Get divorced now.

Great advice, and funny too

 

[48Fire]

When my mom was in the memory care assisted living place (last year and a half of her life), I noticed that nearly everyone there was so engrossed in their own private world that they didn't seem to even notice what anyone else was doing.

It was a pretty nice place ($5,500 a month in 2010, fairly low cost part of the country). Staff was professional and caring (I visited at least twice a week).

So my observation (N=1) is that the folks in these places are not as stressed by the environment as the rest of us are. My mom, for example, never had any complaints about it -- she enjoyed the attention and the opportunity to interact (as much as she could) with others. Actually an improvement (from her perspective) from her former abode in a retirement community where everyone had their own apartment and mostly hibernated there.

Just another thought that might be comforting.

Great points, thanks. My great aunt is in place like this, and she thinks she works there as a nurse. completely happy