Part of our elder law practice involves helping people after a change of health, such as their parent or spouse having a medical downturn (stroke, fall, etc.) and going to the hospital. After a hospital stay, an elder is typically discharged to get rehabilitation in a skilled nursing facility. This is a very difficult and confusing time, which we call the “long-term care maze.” Navigating this maze is difficult because:
- You have likely never done this before;
- You and your family may not be prepared (can you ever?);
- People (friends, family, neighbors) come at you with bad advice on things you should be doing;
- You are concerned about Medicare, Medicaid, powers of attorney and more; and
- You do not know what the next steps are.
So now that your loved one went to the hospital and is in the nursing home getting rehab , what should you be looking at?
- How long will they be there?
- What type of health insurance do they have?
- How expensive will rehab be?
- How are they responding to rehabilitation?
- Are the proper incapacity and estate planning documents in place?
- Should we apply for Medicaid?
- Will VA benefits help?
- What will happen next?
Let’s discuss each of these questions in a little more detail:
How long will he/she be there?
Generally, the elder’s ability to stay in rehabilitation is based upon their ability to get stronger and improve. The purpose of rehabilitation at this point is to get as strong as they can or to prevent further decline. At some point, whether through a decline in health, dementia or just general improvement, the elder's health insurance (i.e., Medicare or HMO) will stop paying for their stay in the rehabilitation facility.
What type of health insurance do they have?
This is very important as it may tell us how long the elder will be able to stay in rehab. The elder will likely either have Medicare with a supplement or a Medicare replacement policy (HMO or PPO). Medicare will pay up to 100 days of rehab with a co-pay of $164.50/day (2017) for days 21-100. The co-pays may be picked up by the Medicare supplemental policy. An HMO or PPO will have a similar payment program based upon the individual policy. Generally, Medicare is more generous in allowing rehab days than HMOs. Regardless of health insurance, it is extremely rare that the elder will stay the full 100 days in rehab covered by their health insurance, which means now is the time to start planning on where they will go next.
How is the elder responding to rehabilitation?
Health insurance only pays to get the patient stronger and will not pay if he or she is not willing to participate, is too sick, or cannot participate in rehab due to dementia. The family must work with the facility to make sure the elder is participating and getting stronger. If the elder cannot or will not participate in their therapy, for instance, the health insurance will stop covering the rehabilitation.
How much will skilled nursing cost?
The cost for skilled nursing will vary based upon the health insurance, but it can get very expensive if you are not working with the business office and social worker to keep track of how the elder is progressing, the type of health insurance, and other factors. When the health insurance (i.e., Medicare or the HMO) stops paying, the cost for long-term care is between $250 to $300/day. When the health insurance stops paying for rehabilitation, this generally means that the elder is now in the skilled nursing facility for long-term care.
Are the proper incapacity and estate planning documents in place?
Now is definitely the time to make sure the elder has a last will and testament, durable power of attorney (done by an elder law attorney), designation of healthcare surrogate and living will. It may be time to update these documents if they are over 5 years old, or at least reviewed by an elder law attorney for accuracy, proper execution and relevance. Not all powers of attorney are created equally, for instance, and some do not allow the elder to protect their assets from the high cost of the nursing home.
Will VA benefits help?
A wartime veteran or his/her surviving spouse may be eligible for VA benefits when there are unreimbursed medical benefits. Please see our page on veteran's benefits and long-term care. At this point, it is likely that the VA will not help with nursing home/rehab costs, but it can never be too early to look for the veteran's military discharge paperwork, for instance. We can generally say that VA benefits will provide the most help when a veteran is trying to stay home or looking for help with the cost of an assisted living facility.
What will happen next?
When the rehabilitation portion ends, the elder has three choices:
- Go home if they are well enough;
- Go to an assisted living facility;
- Stay in the nursing home (very expensive!).
The ability to do any one of these may be very difficult. Will they be safe at home? Will Medicaid pay for home care? Will Veterans benefits help? What is the right facility? All of these questions, and more, are a part of the long-term care maze.
Importantly, our law firm is here to help you navigate the long-term care maze. With our health advocate on staff, we help make sure the elder is in the right place, getting the right care and then taking the next steps, through the maze, together.
Should we apply for Medicaid?
This answer will depend on a number of factors such as where the elder goes next, their mental condition, their assets and their income. Now would be the time to meet with our law firm to make sure you are prepared to navigate the long-term care maze, protect assets, apply for benefits, and be prepared for will come next. Also, see the our list of Seven Lies Your Friends Tell You about Florida Medicaid.
What about moving to assisted living?
If the elder has been declining or may not be safe to go home, the family may want to take advantage of the elder's time in the nursing home and apply for Medicaid. Please read our report on obtaining Florida Medicaid for the assisted living facility.
This handout is not definitive, but it is a short look into the process.
When your elder has experienced a downturn in health, our law firm can help you answer all of these questions, and more, to make sure your elder gets the proper care, the assets are protected, and the family gets the help they need in making the right decisions.
People who read this may also want to learn about:
- Can we protect assets now that my loved one is in the nursing home?
- How to Apply for Medicaid in Florida
You may also want to attend one of our free live seminars on Medicaid and estate planning as well.