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Ask The Experts

As we discussed earlier S.I.R. Management is comprised of a group of experts in the field of Long Term Care. Long Term Care is a governmental term for nursing home care. You may E-mail us with any questions regarding Long Term Care, or Senior Care. Our experts will certainly be able to answer your questions or refer you to someone who can and who may be able to direct you to where you can obtain additional information.

Below are some sample questions most often asked of our experts:

Q. "How do we make the decision to place our Mom in a nursing home?"
A. Generally people tell us they know when the time is right. The decision often comes with a host of emotions, guilt usually top of the list. What we usually tell care giving family members is to "go back to being a loved one - let us be the care giver now." Caring for another person, whether it is a husband, mother or grandmother is difficult. The decision to continue caring - but leaving the care giving to professionals is difficult. The decision is usually arrived based on what's best for everyone, not just the elder.
Q. "Who pays for Nursing Home Care?"
A. Well there is no quick, easy answer to this question! There are several payor sources for Nursing Home care.
  1. Medicare pays for nursing home care on specific cases and under specific conditions. Even if and when those conditions are met, Medicare only pays for 100 days of coverage (20 days at 100% and 80 days at 80%.)

  2. The Resident or Family Members pays. Most nursing facilities call this Private Pay status. The person is paying from his/her own funds or their family funds.

  3. Private Insurance is becoming more popular as people begin to plan for their retirement. There are policies of Insurance to cover Long Term Care and other policies that pay for your care and protect your financial assets.

    In addition to these policies, the Federal Government is privatizing the Medicare program (in some areas) by offering HMO groups the opportunity to enroll individuals in their program. This type of program is often called the "Managed Care Medicare program." Usually in the managed care type of insurance the Medicare rules of coverage are used.

  4. Medicaid or Public Aid pays for individuals in nursing facilities that have no financial assets or who have used all of their assets for qualified items. The individual may keep $2000 in cash and have a paid burial plan and still be eligible for Medicaid. All other assets including monthly Social Security payments (less $30.00 a month for personal incidental expenses) must be used to pay for the persons care to the nursing facility. This is a Medicaid requirement. Medicaid will make up the difference between the cost of care and the Social Security/Pension amount.
Note: Currently, Medicaid is requiring a three year asset discovery prior to approval for Medicaid.

There are different rules for financial assets with a spouse who will remain in the community.

Q. "We are planning to pay for Mom's care, how much will we need?"
A. Good idea to start planning ahead. A rough estimate of costs would be $2,500 to $3,500 per month for room and board which includes nursing care, meals, activities, laundry and some miscellaneous services. This does not cover Medications, medical supplies, rehabilitation programs or Physician services and some miscellaneous services. Medicare Part B will often pay for rehab programs and medical supplies. It usually pays for Physician services. Some miscellaneous services (such as laboratory, x-ray) will be covered by Medicare Part B.
Q. "Grandpa isn't quite ready for a nursing home, but we think we need some help and how can we get him (and us!) ready?"
A. Well there are several avenues to explore here.

First, let's look at the "we need some help" part. There are several options depending on the type of help you need. We can help families explore Home Care options. Having someone come into the home to provide some services can be helpful. There are several programs that offer a wide variety of these services. The services range from Homemaker services which offers housekeeping, shopping and laundry type of services to Registered Nurses, Therapists or Physicians providing their skills to patients within their own home.

The next thought our experts had was maybe an Adult Day Care program or Senior Center that offers some support and services to Senior Citizens. These programs usually offer recreational things, supervision and a meal. Some have a medication monitoring program within it and offer transportation.

As far as getting Grandpa and yourselves ready for a nursing home, here's our advice. Most nursing facilities have a Respite program available for shorter-term stays. This program in S.I.R. facilities is called VacationStay. It can be a vacation for the care giving family member who needs a much desired and needed rest or it can be a vacation for the Senior who could use some time away too. We advise using this program to "get Grandpa and yourselves ready." This allows both parties to slowly acclimate to the changing environment.

These are just a few of the hundreds of questions we answer regarding Long Term Care, nursing homes and Senior Care - including "What Managed Care means to Senior health care." Please feel free to

ASK OUR EXPERTS at:
info@sirmanagement.com
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