As you age, you probably hope to be healthy and mobile enough to live in your home for the remainder of your life without assistance from live-in caregivers. However, that vision for your golden years often doesn’t work out for many older adults.
Many people won’t be able to age in place due to issues ranging from a debilitating stroke, mobility challenges, chronic illness or cognitive impairment from Alzheimer’s disease or another form of dementia.
In fact, around 70% of people age 65 and older will at some point need long-term care such as assistance with activities of daily living like getting dressed, preparing meals and driving to appointments, says the U.S. Administration for Community Living (ACL).
When that happens, many people move to an assisted living senior community. If their health worsens, however, they may need 24-hour skilled nursing and medical care at a nursing home.
If you’re assuming that Medicare will pick up the cost of long-term care in a nursing home for yourself or a loved one, that could turn out to be a costly mistake down the road.
The following are important things to know about nursing homes so you can effectively plan for the future and make the best choices for yourself or loved ones.
How much nursing homes cost
The national monthly median cost for 24-hour skilled nursing care in a nursing home is about $8,390 (or $100,679 annually) for a semi-private room and $9,584 (or $115,007 annually) for a private room, according to 2023 estimates from the Genworth Cost of Care Survey.
However, nursing home costs vary greatly, depending on the city and state. For example, costs for a nursing home in Los Angeles, California, rise to more than $9,600 per month (or $116,000 annually) for a semi-private room and nearly $12,000 (or $143,000 annually) for a private room, according to the same source.
Costs are much lower in Dallas, Texas, where the monthly cost for a nursing home semi-private room is about $6,000 ($72,000 annually) and around $9,000 ($108,000 annually) for a private room.
Check the Genworth Cost of Care Survey to find nursing home costs near you or any city, state or ZIP code.
Who covers the cost of nursing home care
Medicare Part A (hospital insurance) doesn’t generally cover long-term nursing home costs. Medicare covers only short-term nursing home costs “under certain conditions” for up to 100 days in a benefit period, according to Medicare.gov. After that, you must pay the cost yourself unless you have long-term care insurance, which helps pay nursing home costs.
Medicare Advantage and Medigap supplemental plans also generally don’t cover the cost of nursing home care. Medicare recommends contacting your Medicare Advantage or other private health insurance carrier to check whether your health insurance policy covers any long-term nursing home costs.
How to find and compare nursing home ratings
Choosing a nursing home can be daunting, especially if the move must take place just after a sudden major health setback and hospital stay.
Fortunately, you can compare nursing homes in your area and view their ratings by typing in your ZIP code on Medicare.gov. Other nursing home rating sources include U.S. News and J.D. Power.
How to select a nursing home
The National Institute on Aging recommends asking family and friends for nursing home recommendations. Consider what your or your loved one’s needs are, such as memory care, physical therapy or maybe a religious connection. Location and proximity to family and friends may also be important.
After narrowing down a list of potential nursing homes, contact each one and ask questions about the number of residents, costs, waiting lists and any other concerns you may have. Then visit each nursing home, asking about Medicare and Medicaid certification and handicap access. Pay close attention to whether residents look like they’re well-cared for and if staff and residents interact warmly with them.
For guidance and taking notes, bring along this Medicare Nursing Home Checklist on your visit.
While nursing home ratings are a good place to start, don’t go by rankings and ratings alone. Visit and tour nursing homes, ask about staff-to-patient ratio and look up online reviews (outside of the nursing home’s website) before choosing a facility.
Alternatives to nursing homes
Depending on your health care needs, you might be able to stay in your home with the help of home health nurses and aides or part-time, full-time or live-in paid caregivers.
If you or your loved one require around-the-clock care but not to the extent a nursing home provides, you may want to find an assisted living community. Many offer different levels of care to meet your needs.
A board and care home — also known as residential care facilities or group homes — may be another alternative to nursing home care. However, board and care homes usually don’t provide on-site nursing and medical care.
Another option is a continuing care retirement community (CCRC), also known as a life care community. CCRCs typically offer independent living in a house or apartment as well as assisted living and a nursing home. These are all in the same place, allowing for a fluid transition as your needs change.
A CCRC generally requires a contract and what’s known as an entrance fee, which can run from $40,000 to more than $2 million, according to AARP.
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