In my previous blog post, we learned Mr. Smith needed skilled rehabilitation services after his stroke. His son, Paul, selected a facility near his home with the goal of his dad returning home after he received skilled rehabilitation. Mr. Smith was motivated and worked hard on his physical, occupational and speech therapy. After about three months, Paul and his dad were informed by the facility social worker that his dad had reached a plateau. This meant that Mr. Smith was no longer making enough gains or progress with his therapy as required by his insurance to continue receiving therapy services. Paul’s dad continued to require assistance with all aspects of daily living (referred to as ADLs). Mr. Smith and Paul were confused and disappointed as to why the therapy services had to end. They both believed, with more therapy, Mr. Smith would continue to get stronger and improve overall. There was no way at this time Mr. Smith could safely return home.
Unfortunately, as an Aging Life Care Professional® working privately with families through this process, all too often I have experienced the disappointment, frustration and fear families face at this time of uncertainty. What happens next? How much will this cost? Will my loved one ever return home?
Mr. Smith will now require custodial care and will “move” to the facility’s LTC (Long-Term Care) wing, located around the corner from his current room. The difference will be the cost and services. For the first 20 days Mr. Smith was receiving skilled therapy services, his costs were covered 100% under Medicare. From day 21 until day 88, when he was informed he had reached a plateau, he was responsible per his supplemental insurance for 70% of the cost of his room and board. The skilled therapy services (PT, OT & speech) he received five days a week for three hours a day were covered under Medicare.
These costs vary from facility to facility. When making decisions about receiving care and services from any facility, it is especially important to understand and consider costs. The room rates are typically different when an individual is receiving skilled therapy versus custodial care. Remember, Mr. Smith’s supplemental insurance required him to pay 70% of his room and board from day 21 to day 88. Every insurance plan is different, so understanding and verifying each plan is important. For example, the room rate for the skilled rehab for Mr. Smith was $200 per day. Mr. Smith was responsible for 70% of his room rate from day 21-88, meaning he was responsible for $140 per day for the 67 days he was there. He was responsible for $9,380.
Now that Mr. Smith is moving to LTC, he will continue for a period of time to receive therapy services. The therapy will be covered under a portion of Medicare and potentially his supplemental insurance. The therapy services will not be as rigorous or of the same duration he had previously received when in Skilled Rehabilitation. In LTC, his new schedule for PT and OT will now be three to four sessions a week at 45 minutes per session.
In LTC, Mr. Smith is now responsible for 100% of his custodial care costs, including his room and board. The room rates again will vary from facility to facility, based on several different factors including the most common: size of the room and single or shared room. The typical cost in our area for LTC is between $200 to $550 a day. The cost of long-term care can quickly become overwhelming. The big question most families have is, “What happens when we run out of money?” Will their loved one be kicked out? Where will they go? This is important information to understand and know before selecting a facility.
Most LTC facilities accept Medicaid benefits. Medicaid is different than Medicare. Medicare is based on age and/or disability and covers portions of short-term skilled rehabilitation only. Medicaid is based on income and does cover LTC. There are facilities that do not accept Medicaid and families should be aware ahead of time. If a loved one ends up moving to a facility where Medicaid is not accepted, begins privately paying for LTC and runs out of money, the person will need to leave the facility and find one that does accept Medicaid. Moving from place to place at this stage of LTC can be difficult and requires a good transition plan.
It is important to understand how the process works when making decisions about where to go for skilled rehabilitation. For most people, the goal of skilled rehabilitation is to get stronger and return home. Unfortunately, things do not always go as planned. It is worth the time to know what questions to ask from the start.
About the Author: Jennifer Beach, LSW, MA, C-SWCM established Advocate for Elders in Rocky River in 2010. Jennifer has 25 years of experience in working with and advocating for older adults and their families. Jennifer is a licensed, insured Social Worker and an Advanced Aging Life Care® Professional. She has served as the Midwest Chapter President of the Aging Life Care Association and additionally served 7 years on the Board of Directors. In 2018, Jennifer was honored as the recipient of the ALCA Midwest Chapter Outstanding Member of the Year Award. Learn more at advocate4elders.com.
Jennifer is also a monthly contributor and author of Caregiver Corner for Northeast Ohio Boomer and Beyond blog and magazine.