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The Bright Side of Aging
Vol. XX, Issue XI
What the Nursing Home Doesn’t Tell You
What the Nursing Home Doesn’t Tell You
5 Reasons to Get Advice Before You Pay the Nursing Home
5 Reasons to Get Advice Before You Pay the Nursing Home
by Elder Law Attorney Jim Schuster, CELA
Just this past week I met with clients who had asked to consult with me about applying for Medicaid. As it turned out, they had been hit by ALL of the following. why not scroll down and see if any of these happened to you.
1. The nursing home tells the family: “We have no long- term-care beds. Your spouse/parent will have go to another nursing home.” (False)
This reason occurs when the person is discharged from the hospital for skilled care (rehab) in a nursing home. It is often a nice, expensive-looking facility. After a few weeks the family is told the Medicare rehab is over and you will have to find another.
Why get advice? Because most nursing homes in Metro Detroit have long term Medicaid beds. There are two reasons why the corporate office tells its admission employees there are no Medicaid beds, when in fact the whole facility may be licensed for Medicaid. (It happened last week.)
about their right to
part of the savings and resident income.
Under Medicaid a
spouse is
allowed a
share of the
money (assets) and the income of the nursing home resident. Let’s use a hypothetical Smith family. They have $40,000 in savings. Mrs. Smith has social security and pension income of $2,700. His wife has Social Security income of $800.
Savings: In 2019 Medicaid allows a “community spouse” a minimum of $25,284 (and the resident/ applicant is allowed $2,000). The Smiths’ have $40,000 in savings. Their “spend down” is $12,718. They could meet the entire amount by prepaying the resident’s funeral at the maximum allowed by Medicaid. $12,770 (2018). They may more realistically spend about $7,000 and use the other $5,718 on other needs or bills. (Caution, see next paragraph on Income.)
Reason 1: Medicare pays hundreds of dollars a day more per day than the nursing home gets from long term care patient/residents. (That’s true of “private pay” as well.) So the nursing home strategy is to get people in only for the short term Medicare treatment. They have no intention of serving all
residents for long term
careR. eason 2: When it comes to long term care, Medicaid pays “wholesale” not retail. That is Medicaid does not pay the $400 per day the nursing home will charge the resident. It pays perhaps two thirds that rate.
2. The nursing home does not tell spouses
We wouldn’t be walking’ this beach if we hadn’t talked to Jim!
Income: The community spouse is not told about her/his right to income support. Medicaid allows the community spouse a minimum monthly income of $2,057. The spouse is almost always allowed a few hundreds dollars more by “excess shelter expense.” This includes rent or home taxes, insurance, and utility expenses.
So let’s say a wife has social security income of $800 and her husband
Elder Law Attorney Jim Schuster
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Phew. Got that right, Honey!