What About Cost?
provided in Ohio's nursing facilities is undoubtedly one of the most
cost-effective services provided by the health care profession. Nursing
facility care is comprehensive, including room and board, medical care,
security, and providing for social, religious and mental health
families or individuals faced with placing a loved one in a nursing
facility, the prospect of substantial costs for this long-term care can
be intimidating. It helps, therefore, to understand what costs can be
expected, what kind of care and service this money will provide, and
what options are available to persons about to enter a nursing
We have stressed
selectivity in the type of facility you choose. As your doctor will
tell you, you do not need a higher quantity of services than the
situation requires. Applying your choice to the needs of the individual
will help keep down your health care costs and allow others in greater
need of more services to obtain them. Remember that many nursing
facilities have waiting lists.
When meeting with
nursing facility administrators and social service personnel, discuss
financial conditions in detail. All financial agreements should be in
writing, and you should have a copy of the final arrangements. You may
wish to cover the following areas in advance:
- How are payments covered, whether Medicaid, insurance or self-pay?
- How are cash
and assets entrusted to the home protected? Is a receipt given to the
resident? Do signed receipts note withdrawals, so that the resident can
keep track of his/her account?
- Are the agreed date of admission and the degree of care to be furnished set forth in the written agreement?
- Will the resident receive a refund of advance payments if he/she leaves the facility?
There are many
ways to finance nursing facility care. These might include Social
Security payments, your own funds, assets in escrow or as an endowment,
assistance from Medicare or Medicaid, or from private organizations
such as veterans' groups, trade unions, fraternal organizations, or
health insurance plans.
provide nursing home coverage and, in addition, specialized long-term
care insurance policies are available. Be sure to check with your agent
and/or group insurer to see what your benefits are. The administrators
of the homes you visit can help in your financial planning under these
methods or under Medicaid and Medicare.
Where the Dollar Goes
It helps to know what your long-term health care dollar buys.
situation is likely to be just a little different because of the type
of long-term care facility and the service required for each individual
resident, there are certain generalities which we can draw.
- 46 percent of
the long-term care dollar goes for direct medical care: nursing staff,
doctors, therapists, dentists, and other health care professionals.
- About 16 percent of your long-term care dollar goes for housing
costs: resident rooms, kitchen, dining and activity areas; utilities;
and specific accessibility requirements imposed by the government.
- About 11 percent of your long-term care dollar goes for dietary
services: required nutritional levels and monitoring as well as actual
- About 10 percent of your long-term care dollar goes toward "quality
of life:" activity pro-grams; housekeeping, laundry, maintenance,
supplies, and infection control; chapels.
- Administrative expenses account for 14.5 per-cent of your long-term
care dollar: licensed administrator, record keeping and clerical
personnel; equipment and supplies.
- About 3.5 percent of your long-term care dollar goes to profit:
Seventy-five percent of Ohio's nursing facilities are owned by a
private individual or corporation; profit is the reward for the risk
involved in making health care services available.
Medicare and Medicaid
administered by the Social Security Administration, is a federal
insurance program for 1) persons 65 and over, or 2) persons disabled
for at least two years, or 3) persons suffering from chronic kidney
disease. Medicare pays for only two percent of the nursing facility
care provided nationwide.
criteria are met, Medicare may pay the bill (for covered services only)
for the first 20 days in each benefit period. Experts on Medicare
determine the amount to be paid, which the nursing facility can accept
as full payment. Some of the bill can be paid for covered services for
up to an additional 80 days, if the patient qualifies.
patient's case is, however, routinely reviewed by the Social Security
Administration. When these reviewers determine that the patient no
longer requires skilled nursing facility services, Medicare payments
on the other hand, is a federal-state financed assistance program for
certain needy and low-income persons of all ages. States design their
own programs within broad federal guidelines. Thus, Medicaid programs
will vary from state to state. Medicaid pays only for basic care needs,
excluding amenities such as private rooms, etc.
You may need to
complete applications for both Medicare and Medicaid. Please discuss
this with your social worker, the facility's administrator, or local
Data on Ohio's
regulations are available from the Ohio Department of Human Services,
which administers the program in Ohio, and your county aging, ombudsman
or Human Services office.