Nursing Homes

Why do people want to qualify for Medicaid in the first place? Because, even though this knowledge may come as a shocking surprise, neither Medicare nor any supplemental insurance coverage policies pay for long term care. Long term care includes home care services and nursing home services. When paid for privately, the cost of long term care runs to approximately $150K-$200K in New York.

But can one qualify for Medicaid without being poor? In New York, the answer is surprisingly yes. When determining one's eligibility, for a person over 65 years of age, Medicaid evaluates both assets and income.

According to recent research by the AARP, about 90 percent of seniors would like to stay in their own home as they age, even if they require day-to-day assistance with activities of daily living. With a rapidly increasing senior population, demand for quality in-home care is beginning to skyrocket.

In the past, in-home care was usually delivered by home care agencies, who would provide a home care aide, and take care of the back-end reporting and financial requirements. However, the cost structure is beginning to shift.

First, cases involving cognitive decline, such as Alzheimer’s disease, usually require round the clock care.
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One in three people who turn 65 end up in a nursing home. No one ever wants to go there, yet most of the time the family has no choice about this issue (it becomes dangerous to keep the person at home, the daily care required is too much for a home care aide, etc). 

In New York and in New Jersey nursing home now costs $15-$20K a month! The vast majority of people cannot pay this bill on their own, especially after years of retirement spending. Even if the person wants to stay at home, an average home care bill is $10-$12K a month, which, for most people is also unaffordable based on Social Security pensions and retirement savings.

Currently, Medicaid pays for home care and nursing home care.
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A nursing home is prohibited from requiring a third party to guarantee payment from his own funds to the facility as a condition of admission or continued stay of another party. Any attempt by the nursing home to do so is a blatant violation of the law, and may be reported to the local District Attorney’s office.

On the other hand, a nursing home may require an individual who has legal access to the resident’s income or resources to sign a contract to provide payment from the resident’s income or resources for such care. An individual can have access to resident’s income and resources through a Power of Attorney, a joint bank account or through an appointment as Guardian.

If an individual signed a contract to provide payment to nursing home from the resident’s income or resources, and then that individual breaches this contract, then a nursing home may institute a cause of action. The individual may become personally liable for the cost of care if the resident’s funds were misspent and were not turned over to nursing home, as required.

 Nonetheless, very often certain nursing home facilities are in high demand and there is a waiting list. The chances of an individual’s acceptance into a particular nursing home may be greatly enhanced by some private pay in advance.

Disclaimer: This article only offers general information.  Each situation is unique. It is always helpful to talk to a specialized attorney, to figure out your various options and ramifications of actions.  As every case has subtle differences, please do not use this article for legal advice. Only a signed engagement letter will create an attorney-client relationship. ATTORNEY ADVERTISING.