Without even checking medical records, the admissions lady casually blurts this luxury nightly rate to a troubled family concerned about the placement of their retired male. She continues gabbing about the long list of amenties throughout the hallways of an old, burgundy geometric carpet that’s been downtrodden by heavy wheels and chairs, while grief-stricken family members follow quietly in their first nursing home tour. The smells of human excess, the drab beige of a not-so-new medical building, and the many contorted faces sitting covered in blankets in the halls. Loud beeps and whizzes of respirators create a false excitement in the aisles, but the faces are ambivalent. A shy glance into a wide doorway reveals 3 residents on twin-size beds separated each by a thin cloth hung from the ceiling curtain matching the blue triangle-speckled hospital gowns. This is the last 20 years of your life in America’s healthcare, but how do most people get here?
LITTLE TO NO FAMILY SUPPORT FOR MEDICAL NEEDS
Either your medication list outnumbers your toes and fingers twofold, or you’re unable to eat/poo/pee on your own due to your condition. The rate above was quoted to cover bedside care 24/7, physical therapy, occupational therapy, medication assistance, all food/meals and some hospital transport. As most nursing homes are near capacity from hospital discharges, most families need a week or two head-start to scope potential places to rest their loved one and reserve a bed in advance. Aging in place by home health aides or home care are nearly impossible to afford through Medicare, especially when most octogenarians require 24-hour care. For an aide paid at $19/hour, most siblings work too far to care for mom or dad at home, nor can most families afford this weekly expense usually reserved for the higher earning families or those with flexible schedules. Shopping for a nursing home can be a lot like shopping for a home, where the highest bidder wins.
HEALTH & MEDICAL INSURANCE ISN’T WHAT YOU THINK
Nursing home care requires a high level of care which comes with a fixed rate of reimbursement by insurance carriers. Kaiser Permanente, one of the nation’s most respected and wide-reaching health plans, only has 4 skilled nursing facilities listed as in-network in Orange County, California, where there are a 74 total nursing homes registered with the State. This patient mentioned above was only approved for the 1 of the 4 facility pictured below based on the level of care, meaning the family had 1 choice of the 74 facilities that could accept them. So, while you’re paying your health insurance premiums every paycheck, remember that most large health plans do not include long-term care coverage. If your health deduction was $500 per month, you’ll need to add $549 per month just for skilled nursing care alone.
(NO) SAVINGS OR CASH
Most people (or 38% of Americans these days), even at a healthy retirement age of 65, have less than $50k total saved for more than a decade of retirement. Let’s do the math, shall we?
At $549 per night…
x 30 days = $16,470 cost per month
x 365 days = $200,385 cost per year
x 835 days, average length stay : $458,415
This means for most of Americans their entire retirement savings will not cover nearly 80% of over 2 years in a nursing home. So then, how does this 6-figure expense get paid?
SOCIAL WORKERS – YOUR SENIOR CARE BAILOUT SPECIALISTS
Consider these paper-laden, compassionate administratives your saviors from an unkind situation. Medi-Cal, Medicaid, Medicare and other social welfare programs are easily made available to the majority of Americans who cannot afford the overwhelming expenses of their seniorhood. Armed with the prowess of an uncertified financial planner, the tenacity to help unidentified emergency room patients in midnight hours, and the patience of a tortoise to withstand the seasonal timings of the CMS billing systems, these individuals can provide a road map for families to navigate the complexity of medical orders combined with the subsidized amounts offered by government. Social workers know both hospital and various payor networks, as well as the reimbursement rates for assigned treatment plans. Their relationship with admissions staff at different locations, whether by favor of donuts or contracted as an employer, is likely the primary driver of how any family ends up choosing a facility. If one finds themselves at the mercy of a government payment program, be sure to ask about policies like estate recovery for Medi-Cal if you’re forced to sell real estate or deal with probate court upon death.
Prevent sticker shock and do the homework decades before you are a few cents short for a life-threatening decision. If you’re lucky to have all expenses taken care of by your own private pay, you’re tiers above your peers. You can also find a trustworthy life insurance representative who can help you navigate to a financially secure portfolio to greatly alter the outcome of your longest days of care. Check out Genworth’s Cost Calculator here if you’re curious about different kinds of senior care, or want to learn some interesting baby boomer statistics for some perspective.
Whether it’s your first time or a recent experience with a nursing home yourself, let us know how you first dealt with this healthcare setting and funded your high costs. Or, if you’re currently searching for a skilled nursing facility in Orange County, message us in the Contact form and we’ll refer you to several county and community resources.