Nursing Home Cost

Nursing home cost is highly dependent upon the circumstances of an admission, particularly whether care is needed on a short-term or long-term basis. While short-term care is almost always covered by Medicare for those who are eligible to receive benefits, long-term care requires alternative payment methods and the costs can be very expensive. Other factors influencing nursing home costs include the geographic location of the facility and whether a patient has a private or semi-private room.

Short-Term Care & Medicare

Skilled care, provided by nursing homes (or skilled nursing facilities), is often needed on a short-term basis by seniors who have been hospitalized due to illness or injury. Medicare provides coverage for skilled care on a short-term basis when the following criteria are met:

• A senior is currently receiving Medicare Part A (Hospital insurance) benefits and is therefore 65 years or older or has been formally diagnosed with renal failure.
• A hospital stay of three or more consecutive days (three midnights) has occurred within the past 30 days.
• A physician has determined that skilled care and/or rehabilitation is medically necessary due to a current health condition.
• The skilled services required are provided in a facility that has been certified by Medicare.

If all of these conditions are met, Medicare will contribute to the nursing home cost required on a short-term basis (for up to 100 days). Specifically, Medicare will provide 100% coverage for skilled nursing costs for the first 20 days of a nursing home stay. From day 21 through day 100 of the benefit period, the patient is responsible for paying approximately $130 per day.

Long-Term Care & Alternative Payment Methods

A benefit period ends when skilled care or rehabilitation has not been provided by the nursing home for 60 days. In such cases, Medicare no longer covers nursing home costs unless a patient experiences another qualifying hospital stay. Nursing home care provided from this point on is typically considered long-term care and patients must rely on other types of insurance coverage or pay privately. Other payment types include long-term care insurance (which does not cover pre-existing conditions), Medigap policies and/or Veteran’s Administration benefits. Those who pay privately will commonly spend down their assets to qualify for Medicaid, a state-administered program for low-income individuals or families.

Other Factors Influencing Nursing Home Costs

Nursing home costs vary depending on the geographic location and whether a patient receives care in a private or semi-private room. According to the 2008 MetLife Market Survey, the nationwide average daily rate for care provided in a private room was $212 and, in a semi-private room, $191. Geographically, the highest nursing home costs were found in Alaska, where average daily rates for private and semi-private rooms respectively were $577 and $566. Alternatively, the lowest costs were as follows: private rooms in rural areas of Louisiana had average daily rates of $127 and semi-private rooms in rural Minnesota and Oklahoma had average daily rates of $121. Additional costs incurred during a nursing home stay may include supplies such as incontinence products, transportation to medical appointments and nutritional supplements if requested by the patient or family members.

Written by gerontologist Sara Shelton.