Payment Sources

There are many different payment methods for the care that group homes, assisted livings, rehabilitation facilities and nursing homes provide.  In nearly every case, admission into the facility depends upon the patient’s ability to pay.  

Group Homes

Private Pay Most group homes are paid out-of-pocket.  Group homes are generally less expensive than larger Assisted Living Facilities because in most cases seniors are paying for a room rather than an apartment.  There are different types of group homes; depending upon the license of a group home, the care provided may be comparable to that of a nursing home.  Your local Area Agency on Aging may be able to provide information about the types of group homes available in your state.

SSI Domiciliary Rate Depending upon whether the state in which you reside provides for domiciliary care for low-income residents, it’s possible that a senior’s income will be supplemented up to that amount to pay for group care.  For example, if the domiciliary amount is $1,000 per month and the resident receives $800 per month, that state’s SSI program will pay $200 per month toward his care.  The group home must assist the resident in applying for this payment. In order to qualify for the SSI Domiciliary rate, the resident must be low income and have assets of less than $2,000.

Long-Term Care Insurance Policies Depending upon the long-term care policy a senior chooses, it’s possible that a patient’s room & board may be paid in a group home.  Each policy is different – some adjust for inflation, some pay for in-home care or group care, while others will only pay for long-term care in a licensed nursing home.  

Veteran’s Administration The VA might pay for a group home for veterans depending upon the patient’s needs and disability status.  The VA also offers a program called Aid & Attendance that can be used to supplement a veteran, dependent spouses or widows’ income in order to help pay for group placement.  Additional information about Aid & Attendance can be located at www.veteranaid.org.

State or County Programs Depending upon the social programs offered in your community, it’s possible that there are programs that will pay for group home services.  For information as to what your community offers, check with your local Area Agency on Aging. 

Assisted Living Facilities (ALF’s)

Private Pay Most ALF’s are paid out-of-pocket.  ALF’s are generally more expensive than group homes, because they’re small independent apartments.  

Long-Term Care Insurance Policies Depending upon the long-term care policy a senior chooses, it’s possible that some of a patient’s room & board may be paid in an ALF.  Each policy is different – some adjust for inflation, some pay for in-home care or group care, while others will only pay for long-term care in a licensed nursing home.  

State or County Programs Depending upon social programs offered in your community, it’s possible that there are programs that will pay for some ALF services.  For information as to what your community offers, check with your local Area Agency on Aging.  

Veteran’s Aid & Attendance As mentioned above, the VA also a program called Aid & Attendance that can be used to supplement a veteran, dependent spouse or widows’ income in order to help pay for assisted living.  Additional information about Aid & Attendance can be located at www.veteranaid.org.  

Skilled Nursing Facilities

Medicare Part A Also known as Traditional Medicare, this program pays for up to 100 days of Skilled Nursing and Physical, Occupational, Speech and Respiratory Therapies.  Medicare pays for medically necessary services provided in almost any licensed Skilled Nursing Facility as long as the senior has had a 3-day hospital stay within the past month.  The facility provides the care to the patient and bills Medicare afterward.  

Medicare Part C Also known as Advantage Plans, Part C insurance providers are Health Maintenance Organizations (HMO’s) or Preferred Provider Organizations (PPO’s) that closely manage the care that the seniors receive.  Like Medicare Part A, Part C plans generally provide up to 100 days of rehabilitation services, with the main difference being that the care is only provided in contracted facilities.  All services must be pre-authorized by the HMO/PPO, and in some cases there is no 3-day hospital stay requirement.  

Private Insurance Providers Those seniors who don’t qualify for Medicare might have a private insurance plan that pays for rehabilitation services.  In most cases, these providers require pre-authorization for procedures and services and it’s possible that there is no 3-day hospital stay required beforehand.  As with all private insurers, plans can vary dramatically.  Be sure to check with your provider for specific details.  

Veteran’s Administration The VA does pay for rehabilitation and skilled nursing services in licensed facilities with which the VA has a contract.  All services are closely managed and in most cases the senior’s disability must be service-related in order to qualify for the VA to pay for the care; generally there is no 3-day hospital stay required.

Medicaid Depending upon the state in which the patient is located, it’s possible that Medicaid will pay for a limited amount of therapy.  There is no 3-day hospital stay requirement.  Because the amount that Medicaid pays is so low, it’s often difficult to get a senior accepted into a skilled nursing facility with Medicaid as the only payment.

Other State or County Programs Depending upon social programs offered in your community, it’s possible that there are programs that will pay for services such as respiratory therapy as well as room & board in a skilled nursing facility.  For information as to what your community offers, check with a local skilled nursing facility.   

Long-Term Care Nursing Homes

Private Pay Long-term care is expensive, generally around $6,000 per month.  Those residents who aren’t eligible for Medicaid often pay out-of-pocket until they run out of money.  At that point, they must apply for Medicaid.  An Elder Law Attorney might be able to assist a resident in qualifying for Medicaid without spending every dime he has.  

Long-Term Care Insurance Policies Depending upon the long-term care policy a senior chooses, it’s possible that some or all of a patient’s room & board may be paid in a nursing home.  Each policy is different – some adjust for inflation, some pay for in-home care or group care, while others will only pay for long-term care in a licensed nursing home.  

Veteran’s Administration The VA does pay for long-term care in licensed facilities with which the VA has a contract.  All services are closely managed and in most cases the senior’s disability must be service-related in order to qualify for the Veteran’s Administration to pay for long-term care.  

Medicaid Medicaid is the most common type of payment in nursing homes.  A single patient must pay all of his income to the nursing home except for about $35.00 (amount varies by state); married patients might be allowed to give some of their income to a spouse who remains at home.  

Other State or County Programs Patients who don’t qualify for Medicaid but can’t afford the cost of nursing home care might qualify for another local program.  For information as to what your community offers, check with a local skilled nursing facility.  

Pending Medicaid A patient can’t apply for Medicaid until he’s been admitted into a nursing home, but can’t get into the nursing home until he has Medicaid.  If he applies for Medicaid but it hasn’t yet been approved, a patient is considered to be “pending Medicaid,” with no guarantee that it will be approved.    In some areas, a state or local agency will provide such a guarantee.  Some nursing homes will allow a family member to pay out-of-pocket and reimburse the family for the amounts paid when the Medicaid is approved – or at the very least, begin billing Medicaid when the application is approved. If the patient was already admitted in the nursing home, such as for rehabilitation under Medicare A, the facility is stuck with the patient until the Medicaid is approved.  

“Free” Placement There’s a saying – “Once the head is in the bed…”  This means that a Nursing Home, ALF, Group Home and Skilled Nursing Facility can’t legally evict a patient if there’s no payment source.  They can serve multiple 30-day notices, but unless there’s a safe discharge plan to which the patient agrees, the nursing home can’t evict him.  Nearly every facility encounters a patient whose payment source falls through – and the facility is stuck with the patient; the facility will lose its license if it attempts to “dump” the patient out.  I’ve seen Nursing Home Administrators bully patients and their families – they’re risking their professional licenses if they do so.  If this happens to your family member, contact your local Ombudsman and your attorney for assistance.  

Respite Programs

Respite Care (Hospice) Generally speaking, hospice programs don’t pay for long-term care.  However, the Medicare benefit may pay for a few days in a nursing home or Hospice Inpatient Unit to provide the patient’s family with up to five days of Respite.  After the rest period is up, the patient is either sent home or to a long-term care facility

Respite Care (HCBW) Patients who are receiving assistance from a Home and Community Based Waiver Program may qualify for Respite in a contracted nursing home.  Respite admissions are provided on a short-term basis in order to give the caregiver a rest.