Frequently Asked Questions
Does Medicare pay for a nursing home?
Medicare sometimes pays for skilled nursing care if there has been a 3-day hospital stay and the subscriber requires skilled nursing upon discharge.
What is medical assistance?
Medical Assistance is a program of the Pa. Dept. of Public Welfare to cover the cost of a nursing home if the client qualifies financially and medically. The family completes a financial application and the Area Agency on Aging determines the medical necessity for nursing care.
How is the transfer made from the hospital to the nursing facility?
The social worker or case manager at the hospital will make calls to the nursing facility/ies of your choice to check on bed availability. He/she will then fax the pertinent information to the nursing facility who will review it and respond to the social worker/case manager. Transportation is arranged by the hospital personnel.
If the nursing home has a bed available on the day of the tour, is there any reason my relative can’t be admitted?
The nursing facility takes many things into consideration in its admission process. A vacant bed will be assigned to the accepted resident who is discharged first. Beds are not held to await a discharge unless a paid bed hold is arranged. Some of the considerations are the sex of the resident, diagnoses, infections, and other medical needs. Even if you see an empty bed, it doesn’t mean that bed is available for a new resident. Perhaps it can’t be used at all or plans are already underway for another admission.
How long does Medicare pay for skilled nursing?
Medicare can cover up to 100 days of skilled nursing, but 100 days of coverage are not guaranteed. Coverage is not the same for 100 days. For the first 20 days, Medicare pays 100%. For the next 80 days Medicare pays all but $124.00/day. That co-pay may be covered by the individual’s secondary insurance. If not, it is paid for from their private funds or they apply for medical assistance.
What’s the difference between a nursing home and a personal care home?
A nursing home provides care to individuals who require continuous monitoring by a nurse. Personal care is for individuals whose medical conditions are stable and who can maintain a level of independence with only minimal assistance.
How do I know which nursing home to to choose?
One of the best ways to know is to visit several homes that are convenient to your home or work. Tours are welcomed and are always a good idea.
What happens when Medicare no longer pays for skilled nursing care?
The resident either pays from his/her own funds or applies for Medical Assistance. Or, if the individual has long term care insurance, it can help pay the cost of a nursing home.
Does Medicare or Medical Assistance pay for a personal care home?
No they don’t. A personal care home is paid for from the resident’s private funds. Some individuals may qualify for money from the Veterans Administration for care in a personal care home and some long term care policies can also assist.
What should I look for on a tour?
You should expect a clean, odor-free, well lit facility with friendly staff. There should be a variety of activities offered to residents and the rehab gym should be large and cheerful with all three therapies available. You will also want to know which physicians practice in the building and which insurances are accepted.