Frequently Asked Questions

This FAQ page has common questions about choosing senior care and paying for senior care.

FAQ About Choosing Senior Care

Q. How do I know it’s the right time to begin looking for long term care services?
A. This can depend on a variety of factors. Your loved one may be unable to manage routine tasks and may be at great risk when they try. For personal reasons, you may not be able to provide a high level of care for this individual. If you feel overly stressed or physically unable to keep up with the demands for caregiving, you may want to seek advice from a doctor or other health professionals in your community.

The Senior Care Assessment Tool found on this web site is a valuable resource for people struggling with issues of caring for an elderly loved one. We know that this may be a difficult, confusing, and emotional time for any family. We hope that our assessment tool can provide you with some guidance. After you answer the 11 questions on the web tool, you will be provided with a list of options that may best suit the kind of care that your loved one may need.

Sometimes just opening a dialogue with your loved one can be helpful. Now is the best time to begin gathering information and preparing for the future – sometimes the person you care for can help you sort out these critical issues.

This may also be the perfect time to look into the status of the individual’s health care proxy, will and power of attorney.

Q. What options do I have if my loved one is in the hospital and needs extra care after the hospital stay?
A. Many families don’t realize that they have the right to choose a senior care facility for a loved one in a hospital who needs to be transferred within days. Often the physician and discharge planner will suggest a specific care setting that has availability. But if you have a preference – such as a facility close to you or one that a family member or friend has recommended – you should contact that facility immediately and ask about availability.  In addition to this option, you could choose to bring your loved one home with homecare. Ask the hospital discharge planner for recommendations on home care providers. This process can also be used in identifying a senior care facility.

Q. What questions should I ask?
A. The questions contained in the Senior Care Assessment Tool on this site provide an excellent starting point to assess a challenging caregiving situation. When enlisting the services of a senior care provider, you will need to ask questions about cost; the services that the provider will offer on a regular basis; the expectations for how their services will help you and your family; and steps you can take to make sure the delivery of care remains consistent.

FAQ About Paying for Senior Care

Knowledge is a valuable asset when you try to plan for the future, especially in light of the fact that costs associated with all forms of health care are on the rise. Individuals and families must educate themselves on the financial realities of senior care services and anticipate the needs of aging.

Use the following information to gain a basic understanding of the financial options available to pay for senior care. To find out more, utilize the resources on this web site or consult with your financial advisor or attorney.

Private Pay

The senior or his/her family pays for services from personal income, including savings, pensions and other resources. Personal assets are the first consideration when determining ability to pay for senior care services.

Long Term Care Insurance

Long term care insurance offers a way for individuals to maintain control of their assets and to retain the choice in where they receive services. This insurance covers hospice care and various levels of services in nursing facilities and adult care facilities. In addition, some policies will cover home health care services, respite care and adult day care services.

Several insurers in New York State offer long term care insurance policies, and New York has a special program called the NYS Partnership. Partnership policies allow individuals to purchase three years of coverage with the expectation that they will be eligible for Medicaid once their insurance coverage is exhausted.

Premiums for long term care insurance vary widely based upon the age and medical condition of the applicant and the deductibles that the applicant is willing to pay. Experts recommend that the cost of long term care insurance not exceed 7 percent of one's income. Because long term care insurance policies are medically underwritten, individuals with pre-existing health conditions may not qualify for this insurance, although some companies have more stringent requirements than others.

Unlike Medigap policies, long term care insurance is not a supplement for Medicare. It is designed to cover what Medicare does not.

Long term care insurance is an essential part of any financial plan. There are some federal and state tax incentives for individuals who purchase these policies. Individuals should contact their financial planner or attorney for assistance in determining if they should consider long term care insurance and, if so, what type of policy is right for them.

For more information on long term care insurance, individuals may contact the New York State Health Insurance Information, Counseling and Assistance Program (HIICAP) through their local county department of senior services (office for the aging), or visit the web site at www.hiicap.state.ny.us.

Medicare

Many people mistakenly assume that Medicare will pay for all their senior care. Medicare is a federal health insurance program that provides limited coverage for services provided in nursing facilities and in home care settings. Assisted living is not covered by Medicare. Medicare will cover the first 20 days in a nursing facility that are determined to be medically necessary. The next 80 days require a co-payment. Coverage can end at any time during the stay if the resident does not meet Medicare's strict medical criteria. Medicare does not pay for assisted living and will only pay for extended home health care services if a stringent set of conditions is met. Hospice care services in both a nursing facility and home care setting are covered.

Medigap policies and private supplemental insurance will generally pay part or all of the Medicare co-payments. These policies will not pay for extended nursing facility stays. Medigap coverage always ends when Medicare coverage ends. For information on Medicare coverage of long term care services, contact your local Medicare agency or visit the Medicare web site at www.medicare.gov.

Medicaid

Medicaid is a federal, state and locally financed program that pays health care expenses for those who qualify financially and medically. It is very common for residents in nursing facilities and those receiving home health care services to turn to Medicaid because they have spent down, or exhausted, their assets.

Medicaid also covers some home health care services, but does not cover most housing programs with the exception of the New York state-administered Assisted Living Program.
Medicaid eligibility is determined by both need for service and the applicant's financial resources. Income and resource eligibility guidelines vary based on marital status and other variables. Medicaid will review the income and resources of the applicant and spouse for 60 months to determine if they have made any asset transfers.

Hospice services, in both a nursing facility and home care setting, are covered as long as Medicaid is the only insurance.

Individuals may contact their county department of social services for more information on eligibility for Medicaid, or call the social work department at any facility listed on this web site.

Supplemental Security Income (SSI)

Administered through the Social Security Administration, this program supplements pay-ments for adult care facilities and housing for individuals with low incomes. Like Medicaid, financial qualification is necessary for this program. Individuals can be dually eligible for Supplemental Security Income (SSI) and Medicaid (for health care needs), as well as other government assistance programs.
Information on applying for SSI is available through your local Social Security office, or through the Social Security web site at www.ssa.gov

Housing Subsidies

Rent for senior housing complexes varies widely based upon the accommodations offered. Senior housing may be government subsidized, requiring that applicants meet certain income specifications.
Subsidized housing programs for low to moderate income seniors include: rental units in public and assisted housing complexes (HUD Housing); the Section 8 Housing Choice Voucher Program; and Section 202 housing, which provides housing to low income seniors and generally includes some supportive services.