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How much will medicare cover for someone to stay in a assisted living facility or nursing home?

My mom has a mental illness and it's getting to the point where she may not be able to live at home for much longer. The problem is we don't know where to place her because of the cost. Some places say they accept medicare (which she has) but how much do they normally cover?

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  • 9 years ago
    Favourite answer

    I am not sure how old your mother is, but if all of her problems are due to mental illness versus medical conditions or physical debility, there may be some options for you other than a nursing home. You may want to consider calling your state Dept of Mental Health to see if they could provide any services for your mother to remain in the home. If she doesn't have any medical diagnoses, and just a mental illness some states will not allow her to be admittedinto a nursing home. Federal regulations require what is called the PASRR (pre-admission screening).

    The Pre-Admission Screening Resident Review (PASRR) determines whether or not an individual who has an active diagnosis of mental illness or mental retardation meets the criteria for admission to a nursing facility and may require specialized services.

    Medicare part A only covers skilled services, such as occupational therapy, speech therapy, speech therapy, nursing services (i.e. IV antibiotics). And typically individuals have at least a 3 day hospital stay prior to Medicare covering these services.

    National Institute of Mental Health: http://www.nimh.nih.gov/index.shtml

    Medicaid will also pay for nursing homes for individuals who do not have any assets. There are specific requirements for Medicaid eligibility for long-term care. Nursing homes are very expensive, so Medicaid requires certain things.

    Long Term Care Planning: http://www.longtermcarelink.net/eldercare/medicaid...

    Source(s): long term care experience
  • Zarnev
    Lv 7
    9 years ago

    Medicare does not cover anything in an assisted living facility or in a nursing home. They will cover up to 100 days in a skilled nursing facility in some cases but only after a 3 day hospital stay.

    Medicaid will cover based on income and assets. Before she would qualify she'd need to spend down her assets, such as any retirement savings and cash in any cash value life insurance. She can keep one car, a pre-paid burial plot, her current house and some furnishings, and a wedding ring. Everything else would need to be sold off and those funds used first. Then, when Medicaid starts paying, the state will take her entire social security check with the exception of about $40 per month (varies by state) for personal needs. They will also put a lien on her home when she passes.

    This is the reason everyone needs a long term care plan.

    Source(s): Independent Ägent Certified Senior Advisor®
  • Kini
    Lv 7
    9 years ago

    Medicare pays for nursing care only following a hospital stay or for rehabilitation. It pays partially up to 120 days including the hospital stay. Beyond that, the person must pay from their own pocket or be eligible for Medicaid, and not every nursing home accepts Medicaid. You pay the amounts below for each benefit period following at least a 3-day covered hospital stay:

    Days 1 - 20: $0 for each day.

    Days 21 - 100: $141.50 for each day.

    Days over 101: You pay 100%.

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