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NewAtFoolSchool writes:

<< Nursing homes vary considerably in quality, and the ones that will take you just for what Medicare and Medicaid will pay will likely be at the low end of the range. >>

First of all, obviously, Medicare isn't going to tend to pay for any "high end" care since that's not an acceptable objective . . . is it? Secondly, most people who need or will come under Medicare assistance will NOT have to be in a "Nursing Home". Most of these "homes" are "Assisted Living Care Homes" which is quite different from a Nursing Home. So, just be aware that Medicare is NOT just about paying for Nursing Home care.

Actually, Cptbutton wrote the first part and I was responding to it.

But I have to disagree with your statement that Medicare isn't going to pay for "high end" care. Medicare will pay for the first 90 days after hospitalization in a licensed facility, full payment the first so many days, I think 20, and a copay for the rest. Some secondary medical insurance policies will pick up the co-pay for the last 70 days. Mom's did. Medicare will pay for very nice "high end" nursing homes, Mom's was one. The problem is space availablity when you leave the hospital. There are also really nice nursing homes that are "rehabilitation facilities" that specialize in caring for people being discharged from the hospital who need intensive nursing care and therapy they can't get at home, but who will most likely get better and be able to go home.

Nursing homes and assisted living facilities, at least in Colorado, are very different. My mom lived in both. Assisted Living Facilities (ALFs), in Colorado, can't do much "nursing care" besides dispensing medicine. You can also have aid help with bathing and dressing. Therapy is something that has to be contracted for with an outside source. Nursing Homes are licensed, ALFs aren't (in Colorado). Not all Long Term Care policies cover ALFs. My Mom's didn't, becauses ALFs aren't licensed, but her's was an older policy purchased about 7-8 years ago.

NewAtFoolSchool wrote:

Even if you are already living at a nice place, you will have to change rooms when you go from private pay to a Medicare/Medicaid, the rooms are seperately accredited. This is a government regulation. >>

TTRoberst wrote:

This is NOT necessarily so. I may DEPEND on just what state you are in. I'm not that familiar with any specific requirements for "Nursing Home" situation.

This is true for all nursing homes in all states. When Mom first went to the nursing home, the facility, according to the State of Colorado law, could certify and decertify rooms so that they could change between Medicare and private pay. This way, they didn't have to move patients from room to room as their status changed, but in April of 99 (or 98) the Medicare cracked down and would not let states make their own decision on the recertification of rooms. Colorado fought this and lost.

It actually increased the price of private pay rooms because the nursing home could no longer keep rooms full by changing room status to maximize occupancy. If there were 10 private pay rooms empty and people wanted to come from the hospital (Medicare patients) but all the medicare rooms were full, too bad, you have to go somewhere else. If all the private pay rooms were full, a resident's 90 medicare days were over and they needed to have a private pay room, too bad. They had to go to a different place. If a private pay resident had to go to the hospital and need therapy or extended nursing care requiring a medicare room, but they were all full, too bad, they had to go to another facility. This can cause major upset to residents with dementia who have to go to a strange place with strange people. All these examples happened at Mom's facility.

TTRoberts wrote:

I'm not that familiar with any specific requirements for "Nursing Home" situation. But I do have family myself who are under Medicare benefits and they DO NOT have to share a room. But, they are also NOT in a "Nursing Home". They are in an Assisted Care Facility.

Assisted Care facilities do have various sizes of units. Some of the units have more than one room (e.g. living room + bedroom) along with a kitchenette area. Medicare limits one to a single room unit (still includes a kitchenette area) of certain maximum size (I think is like 520 sq. ft. - enough room to have a bed, a small couch or a chair, a small table and or a small desk, etc.) Be assured that one doesn't have to share such a room with anyone. Such small rooms don't hardly have enough room to be shared.

Are you sure this is Medicare and not Medicaid? Medicare only pays for medical services, not custodial care (an Assisted Living Facility). That's why they only pay for the first 90 days in a nursing home. Any time after that is considered custodial care. Medicare didn't pay for any of the ALF cost. It paid for Dr. visits, Occupational Therayp, Physical Therapy, the usual medical stuff, but not her room.

You are right about the private rooms. In all the ALFs we looked at, all the rooms were private. Size varied greatly with each place. The one Mom was at had a living room with a kitchenette and a seperate bedroom plus a large bathroom. Much larger than even her double private room at the nursing home.

NewAtFoolSchool wrote:

Mom had a double, private room (a room that normally housed two people, we had them take out the extra bed) that overlooked a park and had a wonderful view of the mountains. >>

TTRoberts wrote:

I think this probably explains why this room had to be shared. It was probably not because Medicare required it, but because the room she has was already considered a "double, private room", huh?

No, actually, Mom's room, after she became a private pay patient, was a private double room. For a little extra, (suprising little) one person could have the double room. Yes, there are a few single Medicare rooms, but you will probably have to have used most of your 90 Medicare day to get one. There were long waiting lists, most people wanted one. Medicaid rooms were all double.

NewAtFoolSchool wrote:

<< Medicaid patients get about a $20 a month allowance for personal items: clothes, snack food, trips to the beauty shop/barber shop, long distance phone calls, cable TV (required for any kind or reception where my mom was), etc, etc, etc. Do your parents really want to live on that? >>

TTRoberts wrote:

Again, I think this is the same for all states. I have family members that have more than that for a "monthly allowance" under Medicare.

This could vary by state. Welfare, which Medicaid basically is, is run by each state and vaires state to state.
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