Financial Arrangements

Admissions will access care and medical needs, while helping with paperwork.

The staff at the skilled nursing center you choose can give you specific details on payment arrangements. As a point of comparison, the U.S. Department of Health and Human Services reports this breakdown of how nursing home care is paid for nationwide:

• 44% out of pocket
• 43% Medicaid
• 1 % private health insurance
• 4% Veterans’ Administration and other sources

Please note that these percentages are global and do not apply to each facility. Please check with the individual facility to see if it is certified for Medicare and Medicaid. Medicaid is a cooperative federal-state program designed to provide assistance to low-income people and has become the major funding source for long-term care. The amount paid for room, board and nursing care is determined by each state. Medicaid is based on financial need; spouses of nursing facility residents are protected from what is termed “spousal impoverishment.” This refers to the required depletion of a spouse’s financial resources so that the spouse in a nursing facility can qualify for Medicaid.

Ask for a written agreement

Ask the home for a detailed written agreement about charges and services. This should be an agreement that is signed by someone in the nursing home with authority to make a contract. The agreement should spell out what the regular monthly fee will be and what services are included. The agreement should also say what regular extra charges you can expect to pay (for hair care, personal laundry service, physical therapy, etc.). Beyond this, you should receive a list of charges for all extra services available in the home.

Make careful payment arrangements

The details of this task will vary depending on how you plan to pay. You may, for instance, need to arrange to transfer Social Security payments to the home. You may need to apply for Medicaid on the patient’s behalf. You may want to see a lawyer about setting up a trust account. Or you may need to get agreements from members of the family about sharing in the cost of care. These arrangements should all be in place by the day of the move. The home will expect you to pay in advance for the first month, so you should be prepared to do so.