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Sometime in the future, the odds are high that you or someone in your family will require skilled nursing care. The costs of such care vary widely from person to person and from location to location. A skilled nursing stay can be of a short duration following hospitalization, injury, surgery or a significant decline in health such as a stroke or heart attack. Approximately 25% of skilled nursing stays last less than three months.
For the majority, however, their stay in a skilled nursing facility will be for a longer duration, becoming their long-term or permanent home for the remainder of their life. These residents receive assistance with activities of daily living (ADLs) and round the clock complex medical care provided by professionally licensed personnel. According to the American Association for Long-Term Care Insurance, of those older adults requiring long-term care, approximately 30% have substantial long-term care needs.
Residents in a skilled nursing facility generally share a semi-private room, although private rooms may be available at a higher rate, and they eat their meals in a common dining area.
According to the Centers for Medicare and Medicaid Services, almost half of all older adults will eventually require care in a nursing home for some period of time. According to the National Nursing Home Survey, the average nursing home stay is more than two years. But almost ten percent of residents in nursing homes remain there for five or more years. This means that many people are searching for answers and want to know what they can expect as they or someone in their family face a stay in a skilled nursing facility. One of the biggest hurdles people face when skilled nursing care is required is figuring out how they will pay for that care.
Licensed practical nurses (LPNs) are on duty around the clock in all certified skilled nursing facilities. Additionally, at least one registered nurse (RN) is on duty for eight hours of every day. On average, there will be forty nursing assistants, thirteen LPNs and seven RNs on staff for every one hundred beds. The staff is highly trained to provide the medically necessary care required by the residents.
This means that skilled nursing costs can run higher than other types of senior care such as assisted living. Costs can vary greatly from state to state and even from location to location in the same city.
Depending upon the state in which you reside, in 2017, the daily costs associated with skilled nursing care swung widely between $140 and $771 per day for a semi-private room and $165 and $771 per day for a private room. The overall average cost was $235 per day for a semi-private room and $267 for a private room.
Multiplying that out, in 2017, the monthly cost associated with skilled nursing care ran anywhere between $4,258 and $23,451 per month for a semi-private room and between $5,019 and $23,451 per month, with the average being closer to $7,148 each month for a semi-private room and $8,121 each month for a private room. If you omit the exorbitant costs of the state of Alaska, the high end average monthly costs appear a bit more reasonable running at $12,167 (rather than $23,451) for a semi-private room and $13,231 (rather than $23,451) for a private room.
Again, multiplying the costs out, the yearly cost of skilled nursing care ran between $51,096 and $281,412 per year for a semi-private room and $60,288 and $281,412 per year for a private room. The overall average cost was $85,776 per year for a semi-private room and $97,452 per year for a private room. However, you can expect costs to consistently rise each year.
Skilled nursing care costs vary widely from state to state. For instance, Texas runs at the low end with the average cost of a semi-private room being $4,258; and, Alaska spans to the upper end charging an average of $23,451 for a semi-private room. Even within a given state, prices swing widely. Take California, for instance, with the minimum cost of a semi-private room being $2,829 and the maximum for the same room running $27,770. Costs can even vary considerably between facilities in the same city. Check the following chart to determine the average cost of skilled nursing care in each state for both a semi-private room and a private room. (Please understand that the numbers provided can only be used as estimates since rates change regularly.)
Median Monthly Cost of Semi-Private Room
Median Monthly Cost of Private Room
Want to know more? The Genworth cost of care survey has been the basis of long-term care planning strategies since 2004 and assists families as they plan for the expenses related to long-term care. Genworth provides a cost of care calculator which outlines the costs of various types of care in each state. The calculator allows you to see daily, monthly and yearly costs as well as projecting the levels at which costs are expected to rise through 2047.
Fortunately, because care provided in a skilled nursing facility is medically necessary, you have options you can use to pay for that care other than your personal savings. However, if you choose to be in the skilled nursing facility for some other reason, one that does not require medical care, such as wanting to be with one’s spouse, then the cost of care would have to come from private funds.
Although almost ten percent of residents who are between the ages of 75 and 85 stay in a nursing home for at least five years, nearly thirty percent of them stay less than 100 days. This is good news for that thirty percent since Medicare will cover only a total of one hundred days of care in a skilled nursing community provided that all criteria are met.
Requirements that must be met include that you must have recently stayed in the hospital for at least three days receiving medically necessary care, your doctor must prescribe and verify that you require daily skilled nursing care or therapy and the facility to which you are admitted is a Medicare-certified skilled nursing facility. Other criteria may apply.
It should be noted, for each episode of illness, Medicare will pay all covered costs for the first twenty days, but for the remainder of the one hundred covered days, you will be responsible for paying a daily copayment and then Medicare pays for the rest of the covered expenses. Medicare does not cover the costs of convenience items such as televisions and telephones, private room charges when not medically necessary or private duty nurses.
According to the American Association for Long-Term Care Insurance, 40% of older adults with long-term care needs are poor or near poor, having income levels below 150% of the federal poverty level. For those individuals, and for those who have exhausted their assets after a spend down, they may be eligible for assistance from Medicaid.
If you will need to do a spend down to qualify for Medicaid, be sure to contact an elder law attorney or financial advisor. There are rules one must follow when going through a spend down. There are also actions that can disqualify a person from receiving benefits such as making large financial gifts to your children or grandchildren for five years prior to applying for Medicaid. An elder law attorney or financial advisor can guide you as you go through a spend down. Contact your local bar association to help you locate a qualified attorney and ask which of their attorneys are teaching seminars to other attorneys about Medicaid planning. Since Medicaid laws vary from state to state, be sure to contact an attorney who is licensed in the same state as the person who will be receiving the Medicaid assistance.
Also note, that although a family home may be exempt from the spend down, if the owner dies while receiving benefits, the government can take the home. Therefore, families who want to keep a treasured family home might want to forgo Medicaid if the applicant’s life expectancy is short and there are other means of paying for skilled nursing care costs.
According to the Internal Revenue Service, if you, your spouse or someone who is your dependent is in a nursing home (or skilled nursing facility) to receive primarily medical care, then the entire cost of the care, including meals and lodging, is tax deductible as a medical expense. However, if you are in the nursing home (or skilled nursing facility) for any other reason, then you may deduct only the cost of the actual medical care as a medical expense. You may not deduct the cost of meals and lodging in this instance. If you have any questions, it’s always advisable to get advice from someone who is familiar with the tax laws and eldercare in your area such as an elder law attorney or financial advisor.
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