As you get older, you probably hope to be healthy and active enough to live at home for the rest of your life without the help of a live-in caregiver. However, that vision for your golden years often doesn’t work out for many older adults.
Many people will not be able to age in place due to problems from debilitating strokes, mobility challenges, chronic illness or cognitive impairment from Alzheimer’s disease or other forms of dementia.
In fact, about 70% of people aged 65 and over require some form of long-term care such as assistance with daily activities like dressing, preparing meals, and driving to appointments sometime in our lives, says the US Administration for Community Living (ACL).
When that happens, many people move into assisted senior citizens’ communities. However, if their health deteriorates, they may need skilled 24-hour medical care and treatment in a nursing home.
If you assume that Medicare will cover long-term care in a nursing home for yourself or a loved one, it could be a costly mistake down the road.
Here are important things to know about nursing homes, so you can plan for the future effectively and make the best choices for yourself or your loved ones.
How much does a nursing home cost
The national average monthly cost for 24-hour skilled care in nursing homes is about $7,900 (or $95,000 annually) for a semi-private room and about $9,000 (or $108,000 annually) for a private room, according to the 2022 Genworth Cost of Care Survey.
However, nursing home fees vary widely, depending on city and state. For example, nursing home costs in Los Angeles, California, rose to more than $9,100 per month (or $109,000 per year) for semi-private rooms and nearly $11,300 (or $135,000 per year) for private rooms, according to the same source. .
Costs are much lower in Dallas, Texas, where monthly costs for semi-private nursing home space are over $5,600 ($68,000 annually) and about $8,400 ($102,000 annually) for private rooms.
Check out the 2022 Genworth Care Cost Survey to find nursing home costs near you or any city, state, or zip code.
Who pays for nursing home care?
Medicare Part A (hospital insurance) generally does not cover long-term nursing home costs. Medicare only covers short-term nursing home expenses “under certain conditions” for up to 100 days in the benefit period, according to Medicare.gov. After that, you’ll have to pay the costs out of pocket unless you have long-term care insurance, which helps pay for nursing home expenses.
Medicare Advantage and Medigap supplementary plans also generally do not cover the cost of nursing home care. Medicare recommends contacting your Medicare Advantage or other private health insurance provider to check if your health insurance policy covers long-term nursing home costs.
How to find and compare nursing home ratings
Choosing a nursing home can be daunting, especially if moving into a nursing home has to be done right after a severe deterioration in health and a hospital stay.
Luckily, you can compare nursing homes in your area and see their ratings by typing in your ZIP code at Medicare.gov. Other sources of nursing home ratings include US News and JD Power.
How to choose 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 might be, such as memory care, physical therapy, or perhaps a religious relationship. Location and proximity to family and friends may also be important.
After narrowing down the list of potential nursing homes, call each one and ask questions about the number of occupants, fees, waiting lists, and any other concerns you may have. Then visit each nursing home, asking about Medicare and Medicaid certification and disability access. Pay close attention to whether residents appear to be well cared for and whether staff and residents interact warmly with them.
For guidance and to take notes, bring this Medicare Nursing Home Checklist with you to your visit.
While ranking nursing homes is a good place to start, don’t just go by ratings and ratings. Visit and browse nursing homes, inquire about staff-to-patient ratios and look for reviews online (beyond nursing home websites) before choosing a nursing home.
Alternative to nursing homes
Depending on your health care needs, you may be able to live in your home with the help of a part-time, full-time, or live-at-home nurse and home health aide or paid caregiver.
If you or a loved one needs round-the-clock care but not to the extent that a nursing home can provide, you may want to find an assisted community. Many offer different levels of treatment to meet your needs.
Boarding and nursing homes – also known as residential care facilities or group homes – can be another alternative to nursing home care. However, boarding and nursing homes usually do not provide on-site medical care and treatment.
Another option is a continuing care retirement community (CCRC), also known as a life care community. CRC usually offers independent living in a house or apartment, and assisted living, and has a nursing home. These are all in the same place, allowing for smooth transitions as your needs change.
The CCRC generally requires a contract and what’s known as an entry fee, which can range from $40,000 to more than $2 million, according to the AARP.