In our last blog, we discussed the overall differences between Nursing Homes, Independent Living Communities, and Assisted Living Communities. We covered general topics such as services offered, room layout, and a description of the usual residents.
When making such an important decision, one needs to consider more than just the social aspect of each community.
In this discussion we compare senior living options based on two major factors:
- Level of Care, and
Independent Living Communities
Because Independent Living Communities are generally for 65+ seniors who are capable of taking care of themselves, the level of healthcare and the price differ from other communities.
Health Care Availability
In general, Independent Living Communities do not provide healthcare services. As an exception, some do provide satellite office space to independently owned homecare agencies. These agencies provide on-call services to people who may need non-medical personal care. It is also interesting to note that some Independent Living Communities are now adding “Sister” Assisted Living facilities as they expand in new locations.
Cost and Payment
Fees for Independent Living vary based on region, location, market pricing, square footage, and amenities. The resident pays rent in accord with a lease agreement. Rent approximately ranges from $2,000 to $5,500 per month. Most communities also require a hefty down payment of several thousand dollars and fees are almost always paid privately.
Some communities may have a certain number of units designated for low-income residents who meets the qualification for government subsidy through state and federal programs. Rent is set well below market rates, but these apartments are rare.
Assisted Living Communities
Assisted Living Communities include seniors who may need help with daily tasks, such as cooking or medication management, but are not in dire need of medical assistance.
Health Care Availability
The level of health care provided in this sector is driven by state regulation. For example, Massachusetts does not allow skilled nursing care in Assisted Living Communities, whereas New Hampshire rules do allow such care to be delivered in ALFs. This results in huge differences from state to state in terms of the level of care. New Hampshire ALFs can administer insulin, monitor vital signs, collect samples for lab testing, practice a full range of skilled nursing care while Massachusetts Assisted Living Facilities cannot.
In Massachusetts and nationwide, most Assisted Living Communities do offer around-the-clock personal care services by nurse’s aides. This means that a basic level of care can be provided in a safe environment around the clock by a team of qualified caregivers.
Cost and Payment:
Private payment is the primary payer source for assisted living. The base rate for private pay assisted living ranges from $3,700 to $7,400 per month. The base rate is all inclusive of the room, meals, housekeeping, maintenance, laundry, activities and most utilities. Rates vary depending on apartment size, view, local market, service, and amenities, but base prices for memory care run 25-40% higher.
Many long-term care policies include coverage for Assisted Living up to a certain amount of coverage per day within aggregate dollar limits. Low-income Veterans may also receive partial coverage for Assisted Living, depending on the circumstances. Like Independent Living Communities, some Assisted Living Communities can offer a small number of units designated for low-income residents who meets the qualification for government subsidy.
As a general rule neither Medicaid nor Medicare covers payment for Assisted Living. An exception to this rule may be found in states who participate in Medicaid waiver programs with the US Department of Health and Human Services.
Nursing Homes are designed to have nurses on staff and offer 24-hour care. Residents of nursing homes are unable to care for themselves.
Health Care Availability:
Licensed nurses are on site 24/7 to provide skilled nursing care, assessment, therapy and medication administration. Physicians and nurse practitioners attend to medical needs on an intermittent basis, usually scheduled at least five days per week and on-call. Each facility has a Medical Director, as well as a Nursing Director. Many nursing homes will have additional arrangements for audiology, optometry and dental appointments in the facility.
Cost and Payment:
Without proper planning, the cost of long-term care in any setting can be catastrophic. Nursing home rates range from $9,000 – $12,000 per month. Thankfully, Nursing Home Care may be covered by several different sources.
Many elders who enter nursing homes begin with payment covered by Medicare. Medicare will cover nursing home care for a finite number of days if there is a previous hospitalization of at least three days and certain medical criteria are met. (Medicare does not cover nursing home care for an extended period). When a person transfers to a nursing home from the hospital, Medicare may cover nursing home care for 14-100 days, depending on patient condition.
When Medicare coverage is denied, most people pay privately for their stay in a nursing home. Savings and assets may be depleted swiftly over a period of months or years, depending on individual wealth and strategic planning. When remaining funds approach just $2,000, a Nursing Home Resident may be eligible to apply for Medicaid Coverage.
- Keep in mind that the Medicaid Application and eligibility can be tricky, due to the look-back period. (The look-back period is the time preceding the person’s application for Medicaid during which asset transfers will be scrutinized. Currently, this time is set at five years).
Purchase of long-term care insurance can be an effective strategy for managing variable long-term care cost. Depending on the policy, coverage may include home care, assisted living, and nursing home care. Although premiums for long-term care are relatively expensive, it can be a safe bet depending on individual circumstances and estate planning objectives.
For more information on the all available Senior Living options, please visit our website or call today.