You may not need to go to a nursing home now, but maybe a loved one needs nursing home care more urgently. I am sharing some valuable information, applicable to retirees, and those who are advising retirees and seniors.

A nursing home is the same as a skilled nursing facility. This does not include an independent living facility, a personal care home or assisted living facility. This distinction is important, because nursing homes or skilled nursing facilities are the only care centers which are paid for by Medicaid. When someone needs long term care, they often pay privately, which means that you have to pay for every aspect of care from your own pocket.

However, if you are in a nursing home, you can get Medicaid to pay for care. This unfortunately happens after you go broke. While the sick spouse needs long term care, the healthy spouse is still living in the family home. They can’t afford to go broke paying for long term care, because the healthy spouse needs money to live. This is when Medicaid is the best option to pay for care.

Long Term Care Costs

I have had family members and clients go broke over the years due to long term care expenses. This is avoidable, by putting some assets into a trust, to protect yourself from long term care expenses. When you end up in a skilled nursing facility, the average cost is about $13,000 per month. This equates to $160,000 a year, which most people can’t afford to pay for too long before going broke. Most people who end up in nursing homes, don’t go “nursing home shopping”. They don’t have the benefit of time to assess which facility is appropriate for them. 

With nursing home admissions, a senior who has been getting their care at home or in a personal care home, may suffer a potentially serious health care issue. They may have been admitted to hospital for care, and the hospital subsequently discharged them to a skilled nursing facility for rehabilitation. The rehab stay may last a couple of weeks, after which a decision must be made regarding the senior’s need for care. The social workers, care planners and discharge planners attempt to find this senior a nursing home to do rehabilitation. The family agrees on the decision based on it being a short term stay.

They may not realize that their loved one may actually need long term care. The family may not have had the opportunity to review the nursing home’s contract, but they also don’t want to move their loved one to another facility. With their loved one settled in the nursing home, there is paperwork for the family to sign. 

What to Look Out For

Nursing homes are licenced in two different ways in Pennsylvania. There are standalone skilled nursing facilities, and there are also facilities licenced as Continuing Care Retirement Communities (CCRC). A standalone skilled nursing facility cannot require you to sign a contract, to give up your legal rights to apply and qualify for Medicaid benefits. As a result, families have options to rely on for Medicaid planning. In that situation, we can often protect significant assets for the healthy spouse living at home and we can get Medicaid to pay for care. 

In contrast to the standalone skilled nursing facilities, there are the CCRC’s, which require you to sign a contract and agree to go broke in their facility. The CCRC’s have a benevolent care fund whereby they will still take care of you if you go broke. That doesn’t help the healthy spouse living in the family home who is broke, while trying to maintain a house. From my standpoint, I wouldn’t want the benevolent care fund. I want the ability to protect my wife, while getting the care I need. I don’t want to sign a contract giving up my legal rights to pursue Medicaid benefits. 

Finding the right care for Seniors

Some of the CCRCs are prepared to negotiate. We make contact with them and offer to show them how we can protect their bottom line, while my client qualifies for Medicaid benefits. If you are in this situation, perhaps we can negotiate on your behalf. We want to find seniors the care they need without going broke. The nursing homes are not the bad guys – they are providing needed care. I have so much respect for what the nursing homes do for their residents. The problem lies in the broken government system requiring people to go broke before getting financial assistance.

Protecting Assets

We can still protect assets, even after a nursing home admission. Most families assume that all nursing home contracts are the same. If a loved one is already in a nursing home getting the care they need, the family signs the contract. If you know someone currently in a nursing home, or who will need care in a nursing home, they should contact us or another certified elder law attorney, to review the contract. We will help you determine whether to sign the contract or not. Not all attorneys understand the difference between how these facilities are licenced, but at Sechler Law Firm, we are able to advise you.

Be Aware of the Arbitration Clause

If you ever have to sign a nursing home contract, please be aware of the voluntary arbitration clause. The nursing home contract is a legal document, but nursing homes cannot require residents to sign the arbitration clause. Arbitration agreements take away your right to hold your nursing home accountable in court. Should a resident suffer from any negligence or wrongdoing in a nursing home, pleading their case in front of a jury will result in a better outcome. With an arbitration, a private arbitrator decides the outcome of a dispute. Unfortunately this does not often favor the resident.

If you’re in this situation or know somebody who is, please reach out to us for help and advice. Call us at 724-546-4227 or go to sechlerlawfirm.com.