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Married or Single: If you have a spouse
or other family members who can provide care you are more likely to
be able to remain in your own home when you need care. If family members
are unable to provide care, and you cannot pay someone to take care
of you, then a nursing home may be the only available option. The condition
that causes you to need care, and the severity of that condition, may
determine whether you can be cared for at home or whether institutional
care is the only option. For instance, a severe stroke could be so disabling
that care at home is impossible, or an Alzheimer's patient may need
constant supervision.
Health factors: Certain health conditions,
like Alzheimer's or a stroke, can cause a need for long term care. If
you know that certain health conditions run in your family, you may
have a greater risk of needing long-term care than another person of
the same age and gender. Unfortunately, it may be that this known health
condition could also make you ineligible to buy this type of insurance.
How Much Does Long-Term Care Cost?
In 2002, the cost of nursing home care in California averages $141 a
day. Costs may be lower in rural areas and higher in suburban and urban
areas. A short 30-day stay could cost $4,230 or more; a 3 month stay,
$12,690 or more; and, a year stay, $50,000 or more. The cost of care
in the future will be much higher than it is today. California nursing
home rates increased at an average rate of over 5% per year during the
past twenty years¹ and are likely in the future to continue to
increase by at least 5% per year. A 5% annual increase means a year
of care that costs $50,000 today will cost twice that amount in 14
years, or $100,000 a year!
Who Usually Pays for Long-Term Care?
. Medicare may pay for skilled care in a nursing home for a very short
period of time - but no longer than 100 days - and only when the patient
meets all the Medicare requirements for daily skilled care. While people
do get personal care services at the same time, Medicare will not pay
unless there is also a need for daily skilled services that only a nurse
or therapist can provide. Medicare may pay
for some personal care services at home but again, only if you also
need skilled care on a daily basis that only a licensed person can provide.
For more details, see the Medicare benefits book available from your
Social Security office or by calling the Social Security Administration,
toll-free at800-772-1213.
. Medi-Cal (called Medicaid outside California) pays
for necessary health care that is not covered by Medicare, but only
if you meet federal and state poverty guidelines. In 2002, a single
person over 65 would qualify for Medi-Cal if he/she had $2,000 or less
in non-housing assets. A married spouse, living in the community, however,
can keep up to $89,280 in non-housing assets and $2,232 in joint monthly
income, when his or her spouse is in a nursing home and applies for
Medi-Cal. These guidelines and the amount of assets and income a person
may keep can change annually.
Note: Non-housing assets are mentioned
several times in this guide. In general, the value of a person's house
is not counted when applying for Medi-Cal. While the state does have
estate recovery rights after the death of a Medi-Cal beneficiary, there
are certain exemptions that apply, particularly for surviving spouses.
There are certain rules that the state must follow if it is to be successful
in recovering any amounts the program paid. You can get the most current
information about Medi-Cal from your local county Department of Social
Services, Legal Services Program, or an elder law attorney.
¹ Issuers Bulletin for 2002, California Partnership
for Long-Term Care, based on data from the California Office of Statewide
Health Planning and Development.
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