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What if You Can’t Pay for a Nursing Home?

Posted May 19, 2015 | Uncategorized

As we’ve noted in previous blog posts, assisted living and nursing home care can be expensive. The Pennsylvania Health Care Association (PHCA) reports that the average annual cost of assisted living is nearly $40,000, while yearly expenditures for nursing home care are closer to $110,000. For most families and senior citizens, these sorts of expenses are simply not affordable.  If your parent or grandparent needs professional supervision, but you can’t afford to pay for elder care services, what should you do?  In this article, nursing home abuse attorney Brent Wieand will go over some of the financial options that may be available to help pay for the costs of senior care, and will explain seniors’ legal rights when it comes to how nursing homes can (and can’t) use resident funds.

Qualifying and Applying for Medicare and Medicaid

We have written extensively about Medicare and Medicaid coverage for nursing homes in the past. Essentially, while there are no laws mandating that each and every facility accept Medicare and/or Medicaid, the majority of facilities do accept one or both forms of payment.  (On an important side note, facilities which elect to accept Medicaid and/or Medicare payments must obey the provisions of the Federal Nursing Home Reform Act, or FNHRA.  The FNHRA outlines federal standards for quality of elder care, in plain language designed to be easily understood by any reader.)

In its analysis of Pennsylvania elder care costs, the PHCA found that just under 50% of residents paid via Medicaid, while another 23% paid via Medicare, meaning that together, they accounted for about 70% of patients.  However, that still leaves an additional 23% who paid out-of-pocket (in addition to another 7% who paid with either Veterans’ benefits, state benefits, or private health insurance).

If you cannot cover the cost of nursing home care on an out-of-pocket basis, it is worth examining whether your loved one could be eligible for Medicare or Medicaid.  Most senior citizens (aged 65 or older) automatically qualify for Medicare, provided they are legal U.S. residents and have worked in the past, while Medicaid is available to many low-income individuals.

You can apply for Medicaid online through COMPASS, a service offered through the Pennsylvania Department of Human Services.  You can also apply for Medicaid in person by visiting your local field office.  Field office locations include the following:

Berks County
Berks County Assistance Office
Reading State Office Building
625 Cherry St.
Reading, PA 19602
(866) 215-3912

Bucks County
Bucks County Assistance Office
1214 Veterans Hwy.
Bristol, PA 19007
(215) 781-3300

Delaware County
Delaware County Assistance Office Headquarters
701 Crosby St.
Suite A
Chester, PA 19013
(610) 447-5500

Philadelphia County
Philadelphia County Assistance Office Headquarters
801 Market St.
Philadelphia, PA 19107
(215) 560-7226

Montgomery County
Montgomery County Assistance Office
Norristown District
1931 New Hope St.
Norristown, PA 19401
(610) 270-3500

Please refer to the County Assistance Office for a full list of local office locations where you may apply.

brent wieand

Nursing Home Residents’ Financial Rights

Unfortunately, nursing homes can and will evict patients who stop paying for services rendered by the home, including the cost of admission.  However, like private landlords who hold residential properties, nursing homes must comply with various laws and regulations throughout each stage of eviction proceedings.  It is not unheard of for care facilities to deviate from state and federal laws in an attempt to minimize their own financial losses — to the extreme detriment of the resident and his or her family.

Sometimes, these cost-cutting measures are actually preemptive rather than reactionary. For example, it is common for homes to try and force residents to sign pre-dispute arbitration agreements upon admission which are almost always unfavorable to consumer.  These agreements are designed to block personal injury victims and their loved ones from initiating legal actions in the future. It is important to know that you are not required to sign an arbitration agreement as a prerequisite to admission at a nursing home.

Use and treatment of residents’ funds is addressed by 42 CFR §483.10, the section of the Code of Federal Regulations which deals with residents’ rights.  In accordance with 42 CFR §483.10(c)(8), which specifically addresses the protection of resident funds, “The facility may not impose a charge against the personal funds of a resident for any item or service for which payment is made under Medicaid or Medicare (except for applicable deductible and coinsurance amounts).”

In accordance with 42 CFR §483.10(c)(i), all of the following items and services are covered by Medicare and Medicaid:

  • Room and bed maintenance.
  • Nursing services.
  • Dietary services.
  • “Personal hygiene items and services” (e.g. toothbrushes, deodorant, towels).

In addition, 42 CFR §483.10(b)(i) provides that homes must “inform each resident who is entitled to Medicaid benefits, in writing, at the time of admission to the nursing facility.”  Moreover, 42 CFR §483.10(c)(1) and 42 CFR §483.10(c)(2) provide the following, respectively:

  • “The resident has the right to manage his or her financial affairs, and the facility may not require residents to deposit their personal funds with the facility.”
  • “Upon written authorization of a resident, the facility must hold, safeguard, manage, and account for the personal funds of the resident deposited with the facility.”

If you’re concerned that a nursing home resident’s legal rights are being violated, or if you’re worried your loved one may be a victim of financial exploitation, elder abuse, or caregiver neglect, nursing home injury lawyer Brent Wieand may be able to help.  If you’d like to talk about your situation in a free and completely confidential legal consultation, call Brent right away at (877) 654-3887.