Saving Something for the (Better) Nursing Facility
Saving Something for the (Better) Nursing Facility
November 5, 2010
As most are aware, Medi-Cal benefits are not available for assisted living facility expenses or even board and care facility expenses - but only for nursing home (convalescent hospital) care.
This can create something of a nightmare as families watch remaining funds dwindle, spent on an incapactiated loved one's care at, for instance, a board and care facility. Though care at a board and care facility is preferable to care at a nursing facility, the question becomes how long and to what extent should those available funds be spent on board and care expenses before the move to a nursing facility is made? Do you spend the funds down to the last penny, or gift extra funds away, and then move your loved one to a nursing facility at that time - i.e. at the last minute when no cash is remaining? ... and then apply for Medi-Cal coverage?
In making this decision (i.e. in spending the remaining money, or converting it to "exempt" assets. or gifting it away - and, please, get some professional elder law guidance before you do any gifting!) you must remember that there exists a "spectrum" of nursing facilities - which starts with the "good ones" and extends downward toward and to the "less-than-good ones" - and you'll obviously want to get your loved one into as good a facility as possible.
In all cases accomplishing this will typically mean saving some your loved one's funds for purposes of "buying-in" to a better facility.
To get a better idea of the issue here, let's take a look at this "spectrum" of nursing facilities.
At the "really good facility" side of the spectrum, you have the purely "private-pay" facilities (they accept no Medi-Cal patients). These are the places which charge anywhere from $10,000 to $15,000 (and up) per month for the care they provide, and these places are great: private rooms, large TV sets, colorful prints of Renoir, Degas, and Monet on the walls, and food which is better than anything I think I have ever cooked for myself. But these places are exactly like hotels - when you run out of money, out you go.
At the opposite end of the spectrum are what I refer to as the "pure Medi-Cal" facilities. These are the facilities which accept almost all Medi-Cal patients who apply for residency. However, because their budget typically consists of the $5,500 - $6,800 per month which the State Medi-Cal system pays for Medi-Cal patients, these facilities will exhibit a lesser overall quality of care reflective of that budget: this will be seen in the generally lesser cleanliness of the facility, a lesser quality of food, a less than responsive attitude of the caregiving staff, etc. This makes perfect sense - with less money to spend there will be less quality afforded the residents.
In the middle of this spectrum are what I refer to as the "hybrid facilities". These are the facilities which accept both private-pay money and Medi-Cal money for the care of their residents. The average monthly private-pay rate for these facilities (in my county, Contra Costa) is about $8,600 per month. These facilities are the ones to target - if your loved one is to be an eventual Medi-Cal beneficiary (because their combined private-pay and Medi-Cal budget affords a better quality care and environment). But here's the "rub": even though it is true that one who is already a resident of one of these facilities cannot be "kicked-out" once he or she converts to Medi-Cal, the facility can play "economic politics" with you at the front door - asking you about your loved one's remaining assets - and thereby determining whether your loved one has the capability to pay at the private-pay rate for awhile... or for as many months as may then seem necessary to the admissions director. And if your loved one's assets don't pass muster, he or she will be denied admission.
In my 20+ years of elder law practice I have had two nursing home adminsitrators from local private-pay nursing homes in my office (who were seeking to obtain accelerated Medi-Cal benefits for their mothers), and during our conference I asked them how many months of private pay money each would want to see before admitting a patient they knew eventually would become Medi-Cal eligible. One replied 2 months, the other 4 months. More in-depth conversation revealed that it was usually a function of their budgets (duh!) , but more specifically, and with respect to Medi-Cal residents, they wanted to make sure that they would be receiving private pay money during the time it would typically take a Medi-Cal application to be approved and benefits cleared for payment (that used to be about 2-3 months, now sometimes it can take up to 6 months).
As you can probably see, if you have spent all of your loved one's money on another type of care, or if you have gifted it all away, or have converted the remaining cash to "exempt" assets, and then, with nothing left, you approach one of these hybrid facilities requesting admission, you are more likely to receive more "No"'s, or "Sorry we have a waiting list", or "There are no rooms available just now" (though you're sure you passed at least 6 empty rooms on the way to the administrator's office) .... and all of these rejections are going to have the effect of pushing your loved one further and further toward the other and less favorable facilities in the spectrum I have been describing.
So with respect to your loved one's remaining funds - before you spend it all, or gift it all away, or convert it all to exempt assets, keep in mind that by doing so you are likely limiting your loved one's access to the better facilities. Instead, be sure you save something for the better facility.
Of course, there are always exceptions to the general concept described here, even for those who find themselves with absolutely no cash, and the need to find a better nursing facility. A qualifed elder law attorney can help you through such a situation.
In the meantime, don't make your loved one too poor too fast. It may not be the best choice you can make.
Posted by F. Michael Hanson at 11-04-2010 11:06 PM 
Categories: Medi-Cal Eligibility, Medi-Cal Planning, Elder Law
Tags: nursing home issues Medi-Cal eligibility
Categories: Medi-Cal Eligibility, Medi-Cal Planning, Elder Law
Tags: nursing home issues Medi-Cal eligibility
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