Area Agency on Aging of North Idaho
Dedicated to protection, independence and dignity of individuals through advocacy and service

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Medicare and Long Term Care

Medicare covers only a limited amount of nursing home care under very specific circumstances (does not cover assisted living). The Medicare home health benefit and sometimes the hospice benefit can be important sources of long-term care coverage for some beneficiaries.

The eligibility requirements to receive Medicare coverage in a Skilled Nursing Facility (SNF) are:

bulletA physician must certify that you need SNF care.
bulletYou must generally be admitted to the SNF within 30 days of a three-day qualifying hospital stay.
bulletYou must require daily skilled nursing or rehabilitation.
bulletThe SNF must be a Medicare-certified provider, meaning that Medicare authorizes that facility to provide care to people with Medicare.

After a 3-day qualifying hospital stay, Medicare pays for the first 20 days of a skilled nursing facility stay each benefit period. Days 21 through 100 the coinsurance (resident responsibility) is $128 per day for a skilled nursing facility stay each benefit period.

All costs for each day for a skilled nursing facility stay after day 100 in the benefit period are the coinsurance (resident) responsibility.

For more information on Medicare, visit www.medicare.gov on the web, or call 1-800-MEDICARE (1-800-633-4227).

Long Term Care Options

What are options for long term care?
bulletHome Care
bulletAdult Foster Care
bulletCertified Family Homes
bulletAdult Day Care
bulletAssisted Living
bulletSkilled Nursing

Finding a Good Nursing Home or Assisted Living Facility

bulletIs there cheerful, respectful, pleasant and warm interaction among staff and residents?
bulletDoes the administrator seem to know the residents and enjoy being with them?
bulletDo the rooms of the residents appear to reflect the individuality of their occupants.
bulletAre the rooms, hallways and meal tables clean?
bulletDo residents look clean, well groomed, well fed and free from bruises?
bulletDo many residents seem alert, happy and peaceful?
bulletIs the home free from unpleasant smells?
bulletAre residents calling out? If so, do they get an appropriate response from staff?
bulletDo the meals look appetizing? Are residents eating most of their food? Are staff members patiently feeding residents who need it?
bulletAre residents in physical restraints (formal or informal devices that tie residents to beds, chairs, and wheelchairs)? Why?
bulletAre residents engaged in meaningful and pleasant activities by themselves or with others?
 

 

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   For More Information Contact:

Area Agency on Aging of North Idaho

2120 Lakewood Drive, Suite B
Coeur d'Alene, ID 83814 USA
email us at infoassist@aaani.org

208-667-3179 / 800-786-5536
FAX: 208-667-5938