Skilled Nursing Facilities (SNFs) are establishments that have historically been referred to as “nursing homes” and have provided healthcare and housing for the critically and chronically ill by offering 24 hour oversight and services beyond assistance with activities of daily living. Through the years, the term “nursing home” has developed a negative connotation despite being a necessary provider in the continuum of care for the elderly. The evolution of congregate care has deep roots in nursing homes, the original reimagining of the long-ago asylums and sanitoriums, on its way to the less restrictive care we learned about previously in Assisted Living Facilities.

The Agency for Health Care Administration in the State of Florida defines nursing homes as those establishments that “provide 24-hour a day nursing care, case management, health monitoring, personal care, nutritional meals and special diets, physical, occupational, and speech therapy, social activities and respite care for those who are ill and physically infirm.” These care needs are above and beyond those that can be managed in an assisted living facility and require the watchful presence of licensed and certified staff on a 24-hour basis. 

Ask any aging individual and they will adamantly tell you that they absolutely do not want to go to a nursing home. And not everybody will go to a nursing home. Employing the services of an elder care attorney in Florida is key to formulating a plan that provides for your care and wishes as you age. A family and estate lawyer that is knowledgeable in helping with a financial roadmap may keep you from residing in a nursing home but being proactive is essential. 

Why Would I Need to go to a Nursing Home?

There are a couple of reasons why you would need to go to a nursing home. Specifically, you have had a health event that requires extra medical attention and oversight. There are many kinds of events that may require additional care in a nursing home, including:

  • A cardiac event that resulted in a lengthy hospital stay and your physician wants you to go to a less restrictive facility (nursing home, skilled nursing facility, rehabilitation center) for further treatment and evaluation before returning home.
  • A fall resulting in an injury requiring a hospital stay and your physician wants you to participate in additional therapy programs (physical, occupational, speech) before returning home.
  • Medication management issues that require closer monitoring and stabilization over a short period of time

These short-term stays are typically paid for by Medicare and/or secondary insurance. They are not intended to be a long-term solution and require the patient to demonstrate improvement and positive progress in their therapeutic care plan. In these situations, it is imperative that you stay positive, participate in your plan of care, and plan ahead to be part of the decision-making process when the time comes.

Helpful Resources 

What is the best nursing home in my area? Which facility specializes in the kind of treatment I need? What facility has good ratings, outcomes, and state surveys? The answers to these questions may bring peace of mind to you and your family should you find yourself in need of a short-term nursing home stay. Knowledge is power! Do your research and be ready!

Skilled Nursing Facilities – Statewide Medicaid Managed Care Long-term Care Program

Aging is an expensive adventure. If you envision your “golden years” spent indulging in grandchildren and travel, the time to make a financial plan is now. Probably before now, but better late than never! Conservative estimates from the investment group of Bank of America suggest that individuals who plan to retire at 65 should plan to have at least $1M in savings upon retirement. Healthcare spending rises as individuals age with nearly half of those costs occurring after age 65 (FraserInstitute.org).

Poor or non-existent planning results in few options in later years. The idea that if one runs out of money, the State will foot the bill is not a solid plan. In Florida, funding of the Medicaid Program is tenuous at best each year, with the amount of contribution fluctuating each year and dedicated to programs serving residents of the state of Florida from 18 years of age to 100+.

The Statewide Medicaid Managed Care Long-term Care Program does not guarantee eligibility or funding for all who apply. The Agency for Health Care Administration (AHCA) administers the program, sets coverage policy, and assists in getting those eligible for services enrolled in a LTC plan. The Department of Children and Families (DCF) is responsible for determining financial eligibility for services. The Department of Elder Affairs is responsible for determining medical eligibility and level of care needed.

Three Steps to Application

  • Screening
  • Eligibility
  • Enrollment

Prior to the screening process, it must be determined if the individual meets the requirements for eligibility to apply to receive Long-term Care program services. This includes those who are:

  • Age 65 and over and eligible for Medicaid, or
  • Age 18 and over and eligible for Medicaid due to a disability; and
  • Determined by the CARES Program at the Department of Elder Affairs (DOEA) to be at a nursing home level of care or hospital level of care with cystic fibrosis.

The DOEA decides if an individual is medically eligible while the Department of Children and Families (DCF) determines financial eligibility for Medicaid. Once determined eligible, the individual can be screened.

Screening is completed by a local Aging and Disability Resource Center (ADRC) and consists of an initial phone call that results in a score used for placement on the waitlist to receive long-term care services. Individuals with a low score will not be placed on the waitlist and will be provided with information on community resources for assistance. Individuals with a high score will be notified that they have been placed on the waitlist.

  • Screening Exceptions:
  • An individual aged 18,19, or 20 who has a chronic debilitating disease that makes the individual dependent on 24-hour medical supervision or intervention
  • A nursing facility resident who requests a transition into the community and who has resided in a Florida-licensed skilled nursing facility for at least 60 consecutive days
  • An individual referred for temporary placement in an assisted living facility by DCF and is being funded by DCF
  • An adult with cystic fibrosis

Eligibility is determined by DCF and DOEA while the individual is on the waitlist. Release from the waitlist is not determined by how long an individual has been on the list, but rather by the score assigned and frailty-level ranking. When enrollment becomes available, the ADRC will contact the individual on the waitlist and begin the enrollment process. 

The Comprehensive Assessment and Review for Long-Term Care Services (CARES) Program will assess each person who requests funding from Medicaid. The assessment will determine which level of care will best meet the individual’s needs and is usually done in the person’s home setting.

Enrollment in a Statewide Medicaid Managed Care program begins when a welcome letter and information about how to select a plan is received. The plans available in each region or county are available on the Statewide Medicaid Managed Care website. Once a program is chosen, enrollees have 120 days to change plans or wait to change plans during their once-a-year enrollment period with a State-approved good cause reason.

The process of applying for Medicaid can be overwhelming. The Statewide Medicaid Managed Care Long-term Care Program website is a great resource but there is no need to go through the process alone. Arm yourself with experienced professionals who can help you with a financial plan and walk you through the steps from screening to enrollment. An elder law attorney is invaluable in executing a plan that is tailored to your goals and finances. The time to make that plan is today!

Skilled Nursing Facilities – Who Foots the Bill?

Affordable housing for all people continues to be an issue, and seniors, in particular, are hit hard in their years of decline. When it comes to the affordability of healthcare and living options for seniors, one thing we know for sure is that it pays to plan ahead. Failing to plan can be costly – emotionally, financially, and physically. What ARE the options for paying for a skilled nursing facility?

As discussed in the previous blog, skilled nursing facilities (nursing homes) are often short-term solutions to a medical incident that caused an individual to require more care on a temporary basis. In those situations, the stay is paid for by Medicare and secondary insurance plans. For those who have exhausted all options in finding living arrangements that are less restrictive than a nursing home (assisted living, private home care, living with family), a nursing home stay on a long-term basis is a very expensive living option. Yet another reason that a consultation with an elder law attorney (estate planning attorney) is time well spent and can help with financial planning, including Medicaid and/or Veteran’s benefits, if appropriate.

Options to Pay for Long-term Nursing Home Care

  • Private Pay
  • Long term Care Insurance
  • Medicaid

Paying for long-term care in a nursing home is not impossible, but it is expensive. Current monthly rates for shared rooms in local nursing homes can range from $250 – $425 per day (estimated through quick research). The pricing per facility vacillates depending upon services needed once the person arrives and throughout the stay. Basic room and board are just the starting point with care levels, therapies, and other billable services added on.

Long-term care insurance often covers nursing home care at a pre-determined daily rate as outlined in the specific policy. Depending on the policy, the daily rate can be paid indefinitely or for the period of time that was defined at the time of purchase. Long-term care policies are priced according to the length of time and per day benefit you chose. Typically, the higher the benefit, the more expensive the policy. If you have a parent going into skilled nursing (a nursing home), be sure to ask if a policy was purchased at some point in the past.  These are often forgotten even though premiums have been paid for a very long time!

The last option to help pay for a long-term nursing home stay is the benefit that is commonly referred to as Medicaid. In Florida, that program is the Statewide Medicaid Managed Care Long Term Care Program. (There is a great deal to be said about this program, so that will be the topic of a separate feature you will find posted on this site in the near future!) Medicaid Managed Care is a complex system that offers services to Florida’s most vulnerable citizens through the cooperation of several state agencies. The multi-agency effort includes the Agency for Health Care Administration (AHCA), the Department of Children and Families, and the Department of Elder Affairs.

For any senior that finds themselves in need of a stay in a nursing home – either short or long-term – the anxiety of what to expect regarding costs can be overwhelming. Be sure to make long-term care planning a part of your overall family plan and include research on how to pay for the services you expect while in their care. Knowledge is power! Consultation with an elder law attorney and the creation of a financial plan can go a long way in providing peace of mind when a crisis occurs.

For more information, call our team at 321-345-5945!