If My Senior Family Member Has to Go to the Nursing Home, Will Medicare Pay the Bill?
Many times when a senior falls, the result is a broken hip. After surgery, the senior will most likely be released from the hospital to a skilled nursing facility for help in regaining their strength and balance before ultimately returning home.
If the senior was in the hospital for at least 3 nights, then in a majority of cases, Medicare can be used to help pay for at least a portion of the rehabilitation stay in the skilled nursing facility. This assistance from Medicare for the rehab stay can sometimes lead the senior, as well as their family, to believe that Medicare will pay for any stay in the nursing home. This is not the case.
There is a difference between a rehabilitation stay in the skilled nursing facility and moving to the skilled nursing facility because it is no longer safe for the senior to live at home. Many times, when it is no longer safe for the senior to live at home it is because they need assistance with the activities of daily living. The activities of daily living include activities such as eating, dressing, bathing, using the restroom and getting into or out of bed.
Medicare is health insurance. Medicare is available when as a result of a health event (the broken hip), the senior needs rehab to improve their strength and balance so they can safely return home. However, when it is just the general state of the senior’s health that creates the need for assistance that is not a Medicare nursing home rehab stay. A need for that type of assistance is instead a nursing home custodial care stay.
Medicare does not pay for a custodial care stay in the nursing home. In a custodial care situation, the senior has to pay the $6,000 – $10,000 per month Florida nursing home bill using either 1) their retirement savings, 2) long-term care insurance and/or 3) Medicaid benefits.