Back to Basics: A Guide to Paying for Senior Care

A major concern for many families when it comes to finding care for their loved one is how they will pay for the best care. Below is a quick guide to help you to understand the options available, and make the best decision for your family and your loved one.

As our loved ones age, the thought of paying for senior care can be a major contributor to stress on top of all the other changes happening in their lives. Regardless of the type of care your senior requires, it often will come with some level of expense. Thankfully, there are a few options that may work well for you and your family. Below, we’ve outlined a few of these choices. Keep in mind, every senior’s situation is different and there is no “one size fits all” solution; find what works best for you, your family, and your senior! 

Laura Shorb, Director of Clinical Services, has this to say about PLC communities:

“One of the most rewarding things about working for Priority Life Care is we are always looking for ways to help people get the assistance that they need, even if we have to do the extra work. I have seen people spend down their savings to afford a private-pay assisted living community. But what happens when they run out of money before they qualify for another program? Our communities work with the resident and family to help seniors find the financial programs that are available.” 

Where To Start Looking for Funding 

RESOURCES

Ombudsman

An ombudsman is an equal party that knows all programs and regulations, helping guide you in the right direction and get you the best result. Check your state website for the contact and location of the local ombudsman office. While you may not qualify for medicaid or medicare, the ombudsman may be able to help connect you to the right resources. 

Department of Aging

Anyone over the age of 55 can reach out with what they’re looking for and can get advice on where to start. This is a great place for your family to start gathering information on programs and services available. 

Senior Centers

There are many social workers that work in this type of setting that can guide you toward who to reach out to or provide financial resources. Senior centers may even plan nights where medicaid case managers come in and give advice. Be on the lookout for this sort of opportunity near you. 

Elder Law Attorney

Elder law attorneys are advocates for the elderly and their loved ones. Most elder law attorneys handle a wide range of legal matters affecting an older or disabled person, including issues related to health care, long term care planning, guardianship, retirement, Social Security, Medicare/Medicaid, and other important matters.

PRIVATE PAY

Out of Pocket 

Paying out of pocket is a great option for many seniors. These funds often come from personal savings, a retirement fund or pension, or even income from selling the home. A downside to paying for senior care out of pocket is that, for many, the cost of care increases as senior’s age. It will be important to keep this in mind when paying for care using personal funds.

Long Term Care Insurance

When it comes to covering the cost of care through insurance, each person’s coverage will vary based on their policy. You’ll want to look for “custodial care” when checking the policy, which includes the cost of assisted living communities. 

GOVERNMENT FUNDED

Medicare 

Medicare is for people who are 65 and older as well as people who have end-stage renal disease. There are 3 parts to medicare:

Medicare Part A (Hospital Insurance)

Part A covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care.

Medicare Part B (Medical Insurance)
Part B covers certain doctors’ services, outpatient care, medical supplies, and preventive services.

Medicare Part D (prescription drug coverage)
Helps cover the cost of prescription drugs (including many recommended shots or vaccines).

Medicaid

Medicaid provides medical care, such as physician visits, and non-medical support services, such as in-home personal care assistance. Nursing home care is also provided via the state plan. If a senior is financially and medically qualified, Medicaid will pay nearly all of his or her long-term care costs. 

Medicaid Waivers – Also called Home and Community Based Services (HCBS) Waivers, 1915(c) Waivers, & 1115 Demonstration Waivers, these are state-specific programs that provide long term care and support to individuals outside of nursing homes, like in an assisted living facility. 

​​Many Medicaid programs link eligibility to the number of ADLs (activities of daily living) with which an individual requires assistance. This can include dressing, bathing, eating, cooking, etc. Most states require a “nursing home level of care“, but each state defines that level of care differently.

PLC aids seniors in understanding the resources that may be available to them to help pay for senior living.  Reach out to your local Priority Life Care community to see what may be available in your area.

To learn more about Medicaid, call 1-877-267-2323, TTY: 1-866-226-1819, or visit the Medicaid website. Or, contact your State health department. For a State-by-State list, visit Medicaid’s State Overviews page.

Program of the All-Inclusive Care for the Elderly (PACE)

The Programs of All-Inclusive Care for the Elderly (PACE) provides comprehensive medical and social services to certain frail, community-dwelling elderly individuals, most of whom are dually eligible for Medicare and Medicaid benefits. For most participants, the comprehensive service package enables them to remain in the community rather than receive care in a nursing home. Individuals can join PACE if they are age 55 or older, live in the service area of a PACE organization, eligible for nursing home care, can live safely in the community.

To find out more about PACE, call 1-877-267-2323, or visit the PACE website or Medicare’s PACE page.

VA Aid and Attendance

VA Aid and Attendance provides monthly payments added to the amount of a monthly VA pension for qualified Veterans and survivors. Veterans who served on active duty for at least 90 consecutive days, including at least one day during wartime, may be eligible for Aid and Attendance if they also qualify for the basic Veterans Pension and meet the A&A clinical and financial requirements.

To learn more about VA healthcare benefits, call 1-877-222-8387, or visit the Veterans Health Administration or the Veterans Affairs Caregiver Support page.