Nursing Home Care: Criteria for Medicare Benefits
Based on a study by the Centers for Medicare and Medicaid Services, majority of US senior citizens aged 65 and above will require some type of long-term care services, while more than 40 percent of those aged at least 55 will require some period of care in a nursing home facility.
Moving an older family member into a nursing home facility becomes necessary when a person reaches a certain age or following hospitalization, since the family members are hindered by work or other concerns from giving their loved one all the care and attention that he or she needs. In a nursing home, also known as a skilled nursing home care facility, people who need full time care (especially medical care) and assistance will be provided with significant support in all daily activities (including eating, bathing, dressing and toileting) and round-the-clock nursing care. To provide these needs, besides trained staff, nursing homes also have nurses on 24-hour duty, a licensed physician and other medical professionals, like a physical therapist.
A nursing home is designed to provide older adults the highest level of custodial care outside of a hospital. According to the Centers for Disease Control and Prevention (CDC), as of February of 2015, about 1.4 million older adults received this type of care in 15,700 various nursing homes all across the US. The national median cost of a semi-private room in a nursing home facility is about $222 per day, while the median rate for a private room is approximately $248 per day (geographic location is one of the factors that greatly affect nursing home cost).
If the length of care required by the adult is only on a short-term basis (100 days or less), then he or she may qualify for Medicare benefits, so long as he or she:
- Is at least 65 years old or has been diagnosed with renal failure
- Is currently receiving Medicare Part A benefits (Hospital insurance)
- Has been hospitalized for three or more consecutive days within the past 30 days
- Has been determined by a physician as needing skilled care and/or rehabilitation (in a Medicare-certified facility).
Qualified seniors can enjoy 100% coverage from Medicare for the first 20 days of stay; from the twenty-first day onwards, the patient will have to pay about $130 per day. Patient contribution may come from his or her own savings or from long-term care insurance, if the patient has one.