A Financial Blog Series about Funding Sources, Payment Programs, and Possible Pitfalls

By Theresa Pichelmeyer, Valley VNA President & CEO

 In my last blog, I wrote about one of the Big Elephants in The Room; that is, how to address the guilt we often feel when we help move a parent or other loved one from his or her longtime home into assisted living.

Another major source of anxiety is how to pay for this new level of care. My next three blogs will cover a number of financial topics. First, a review of what assisted living is versus nursing home care (or skilled nursing):

Rose & Betty

Assisted Living Facts:

  • It is an environment where a person gets daily help to safely dress, bathe, eat, and use the toilet. (The medical term is ADLs, or activities of daily living.)
  • It is a home that is chosen by an older person and his or her family. There is no medical diagnosis required to move into assisted living.
  • The staff at an assisted living home carefully tracks and administers residents’ medications.
  • Some assisted living communities employ registered nurses. Valley VNA does. Our RNs help assess and coordinate the care of our residents. Our primary direct caregivers are resident assistants and CNAs.
  • Residents typically have access to therapy services. Valley VNA welcomes outside therapy providers (physical, occupational, speech), as chosen by the resident, to give therapy sessions on site.
  • Assisted living communities like Valley VNA are private pay. The individual and/or his or her family needs to have the resources to pay for assisted living housing and care. In very specific circumstances, government programs (like Medicaid) might help pay for a senior’s stay in an assisted living facility, but not for sure, not right away, and not entirely.

Nursing Home Care (provided at Skilled Nursing Facilities, or SNFs)

  • Medicare may pay for a short-term rehabilitation stay at a SNF (like recovery from a hip or knee replacement), but it does not pay for long-term personal or custodial care at a SNF. Many people think the government will pay for their long term care straightaway, but this is not true.
  • By definition, a skilled nursing facility is a medical facility. Skilled nursing facilities are required to employ registered nurses and CNAs to provide hands-on patient care to those with complex medical cases. Similarly, nursing staff directly administer medications and therapists are on staff to provide physical, occupational, and speech therapy to residents.
  • Skilled nursing residents often start out as private pay. Long-term residents who later exhaust their financial resources may become eligible for Medicaid to pay for their care. Wisconsin’s state-administered Medicaid program is called Family Care. Once a person qualifies for Family Care, (generally $2000 in remaining assets plus what a spouse needs for his or her living expenses), he or she forwards all remaining assets and income directly to Family Care and the agency manages them on his or her behalf from that point forward.
  • Not all facilities accept Family Care because its reimbursement rates are below the cost of providing care. Some facilities limit the number of Family Care residents they accept.

My next blog will address the private payment sources that many of our Valley VNA residents use to pay for their care. In the meantime, do you have more questions about how choose and pay for assisted living? Call us at (920) 727-5555 and we’ll connect you with a helpful, knowledgeable person to help you navigate the process.