Covering Nursing Home Costs in North Carolina

Q: What is the average Nursing Home Bill in North Carolina?

A: There are many levels of care in nursing facilities and retirement communities. There is independent living where no care is rendered, assisted living where limited care is provided and rehabilitative and skilled care where substantial care is needed. Independent living is the least expensive option running several thousand to five thousand dollars a month depending on where you go. Assisted is several thousand dollars more, again depending on where you are living and rehabilitative and skilled nursing home care on average in North Carolina runs $7300 a month. I’ve seen some skilled care facilities which charge over $10,000 a month.

Q: How does it work and what will it cost if I stay home and pay for care?

A: Staying home is an option that appeals to many families. People often think that care at home is substantially less expensive than care in a facility. Sometimes that’s true if you need limited help, but some individuals need 24-hour care and often such care is just as expensive as a facility, if not more. There are also degrees of caretakers, from people who are sitters with limited or no training, to Certified Nursing Assistants to Registered Nurses. You may opt to hire and supervise the caretakers, but my preference is to use an Agency to make sure that you are covered if your caretaker gets sick or quits. Agencies run criminal background checks, monitor their workers, schedule their workers and provide you with a means of voicing concerns.

Q: What is the difference between Medicare and Medicaid? 

A: Medicare is the federal health insurance program which provides health insurance to individuals who are 65 and older. People often believe that this insurance will cover all the costs of their care, even skilled nursing home care, but this isn’t the case. Medicare will provide limited full payment for the first 20 days if you are approved for care, and partial payment of your medically authorized rehabilitative nursing facility up to 80 additional days. Provided that such care is preceded by a hospitalization of at least three days. However, there is no guarantee that you will be approved for any care, much less 100 days of care. To receive Medicare, your doctor must sign a federal form which states that you will rehabilitate.  So the illness you have must be an illness you will likely get better and be able to return home. Medicaid is a needs based program funded by the federal and state government which provides individuals who qualify with the money necessary to receive special assistance or skilled care. Medicaid qualification is very complicated with a multitude of rules and restrictions. Legal guidance is often necessary to achieve the best results.

Q: How will I pay for nursing home costs when the time comes?

A: When the time comes there are several options to pay for care.

  • Out of Pocket You can pay from your savings and contributions from your friends and family until your assets are used up.
  • Long Term Care Insurance You can access long term care insurance that you bought when you were well to assist with some or all of your care depending on the policy you bought. This strategy often preserves family assets.
  • Medicare If you meet stringent requirements and you’re likely to rehabilitate, then Medicare will assist with up to 100 days of care, but this is often difficult to get.
  • Medicaid With guidance you may be able to qualify for assistance that is paid for by the Federal Government and the State.

Q: What happens if my money runs out? 

A: If your money runs out and you haven’t taken any steps which would violate Medicaid Rules and you qualify medically and financially for Special Assistance or Skilled Care, then you will be eligible to receive Medicaid.

Q: What if I don’t qualify for Medicaid?

A: If you don’t qualify for Medicaid, then you will need to rely, in most instances, on your family and friends. If that doesn’t work, you will need to look to other Federal or State programs for help. Otherwise, the outcome will likely be very grim.

Q: Will I lose my home and land if I run out of money and need Medicaid?

A: All assets are subject to Medicaid Recovery. Without guidance people lose everything!

Q: I’ve heard that I can give away up to $14,000 per person each year. If that’s true can I give away my money in $14,000 increments until it’s all gone and qualify for help? 

A: There are income tax rules which allow you to give up to $14,000 a year to anyone you want, but such gifts are not allowed when seeking Medicaid if they were made within five years of needing care.

Q: Is my spouse responsible for my bills? 

A: When applying for Medicaid, the assets of both spouses are considered. Also, in North Carolina there is a further duty of spousal support. So yes, your spouse is responsible for many of your needs.

Q: Is there a way to give my children all of the money and qualify for Medicaid? Money or assets given to children within five years of needed

A: Money or assets given to children within five years of needed care, violates the rules. Such gifts will be penalized and this will result in time which you are not allowed to receive Medicaid.   This amount of time is calculated based on the amount of the gift or gifts, so more gifts result in a greater time period when you will ineligible.

Q: What’s the five-year look back all about?

A: In order to make sure that families to don’t give everything away and in order to qualify for Medicaid, rules have been constructed which penalize gifts of assets within five years of needing care.

Q: Is there a way to protect my home? 

A: In North Carolina, real estate held in a certain legal form may be excluded.

Q: Is there a way to protect my money?

A: With the help of a skilled Elder Law Attorney working within the confines of the laws and regulations currently in existence, some assets may be protected, thus qualifying individuals for Medicaid.

Q: How much will I be able to protect?

A: There are numerous variables in calculating how much of an estate may be protected. Depending on the time available before skilled care is needed, and the amount of money in the estate, we are able to calculate the amount of money which may be protected, but it is different for each individual.

Q: When is it too late to try to protect some of my estate?

A: It’s too late to protect your estate when all of your money is gone. Seek help sooner rather than later. The saddest cases I receive are those where every penny has been spent before my help was sought.  We’ve helped people at all stages, both prior to receiving care and even in the nursing home. So, here’s my advice: since you will likely know when you or a family member need help, set up an appointment to visit with us and discuss your options. We can help!

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