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.
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
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
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.
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
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
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
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.
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 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,
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
Information on applying for SSI is available through your
local Social Security office, or through the Social Security
web site at www.ssa.gov
Rent for senior housing complexes varies widely based upon
the accommodations offered. Senior housing may be government
subsidized, requiring that applicants meet certain income
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.