Nursing Home Costs: What to Expect
A nursing home is usually the most expensive kind of senior care, and it's also the one families price last, because they get there in a hurry after a hospital stay. The pricing isn't complicated once you see how it is built. Here is how the bill is put together and who pays which part of it.
What you are actually paying for
A nursing home charges a daily rate, not a monthly rent. The rate covers the room, meals, and skilled nursing care around the clock, which is the part that makes it cost more than assisted living. Rates are quoted per day and billed monthly, so a short month and a long month don't cost the same.
Why two rooms in the same building have different rates
- A semi-private room, shared with one other resident, is the lower rate and the one most people start with
- A private room costs more, sometimes a lot more, for the same care
- Some buildings run a separate rate for a secured dementia unit
- Short-term rehab beds are often priced differently from long-stay beds in the same building
What is on top of the daily rate
Ask for the list in writing, because it differs by state and by operator. Common extras are a pharmacy charge, therapy that falls outside a covered rehab stay, incontinence supplies, salon visits, cable and phone, and a personal needs account the resident spends themselves. None of these are large on their own. Together they're a real number each month.
Medicare, and the part people get wrong
Medicare pays for a limited skilled nursing stay after a qualifying hospital admission, and only while skilled care is still needed and progress is being made. It's rehab coverage, not long-term care coverage. The early days are usually covered in full, a daily copay starts partway through, and coverage stops entirely after a set number of days. Once it stops, the bill becomes private pay or Medicaid.
Medicaid, which pays for most long stays
- Medicaid is the main payer for long-term nursing home care in the United States
- Eligibility is based on income and assets, and the rules are set state by state
- Most of the resident's income goes to the home, with a small personal needs allowance kept back
- There are protections for a spouse who stays in the house, and they are worth asking about early
- A look-back period applies to money or property given away before applying
Questions to ask before you sign
- What is the daily rate for a semi-private room, and for a private one?
- Which charges sit outside that rate?
- How often has the rate gone up in the last three years?
- Does the home accept Medicaid, and will it keep a resident who starts private pay and later qualifies?
- What is the notice period if the home decides it can no longer meet the care needs?
- What happens to the bill during a hospital stay, and is the bed held?
The bed-hold question, in plain words
If a resident goes into hospital, the home may charge to keep the room empty and waiting. Some state Medicaid programs pay for a set number of bed-hold days and some do not. Ask what the policy is before it happens. The answer decides whether a two-week hospital stay also costs you a room.
Where the money usually comes from
Savings and income first, then long-term care insurance if there is a policy, then Medicaid once assets reach the state limit. Some veterans and surviving spouses qualify for a VA benefit that helps. Your local Area Agency on Aging can explain what applies in your state at no cost, and so can a HavenLine advisor.
Next step
If you are comparing nursing homes, or trying to work out whether assisted living would be enough, a HavenLine advisor can talk it through. HavenLine is a referral service, not a care provider, and there is no obligation.
Questions
Does Medicare pay for long-term nursing home care?
No.
Is a nursing home more expensive than assisted living?
Usually yes, because the rate includes skilled nursing cover around the clock rather than help with daily tasks.
Can a resident be moved out if the money runs out?
A home that accepts Medicaid generally can't discharge someone purely for switching to it. A home that takes no Medicaid can, and that is exactly why the question belongs in the admission conversation rather than two years later. Ask it in writing, and ask what notice would be given.
General information only, not financial, legal or insurance advice. Rules, prices and benefits vary by state and by policy. A licensed professional can explain what applies to you.