Residential Care
- Types of residential care
Rather than staying in your own home, you may prefer to move to residential care. There are different types of residential care facilities you can live in, based on the type of help you need:
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- Assisted Living Facility: helps with daily activities like meals, cleaning, and personal care, but not medical care
- Nursing Home: helps with daily activities like meals, cleaning, and personal care as well as medical care like nursing support and physical therapy
- Residential Care Facility: helps with daily activities like meals, cleaning, and personal care, but not medical care. Similar to an assisted living facility, but are usually much smaller in size.
- Continuing Care Retirement Community: offer different living arrangements (e.g., assisted living and a nursing home) in one location, so you can move as your needs change.
Choosing the right location for you depends on what you need, and that might change over time. The cost of these facilities and the amenities that they offer vary.
- Paying for residential care: Medicare and Medicaid
Medicare does not pay for long-term residential care. However, Medicare may cover medical care when in a facility like a nursing home, depending on your situation:
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- Original Medicare (Parts A and B): Only covers limited skilled nursing care in a skilled nursing facility when it is medically necessary. There is no co-payment for the first 20 days of care in each benefit period, but you will pay $200 per day for days 21-100. After day 100, Medicare will not cover the costs. For more information on Original Medicare paying for care in a skilled nursing facility, visit www.medicare.gov/coverage/skilled-nursing-facility-snf-care
- Medicare Advantage Plan (Part C): Coverage for nursing home care depends on your specific plan. Check your policy to see what is covered.
- Medicare Drug Coverage (Part D): You can still get your covered medications from a pharmacy that your plan approves if you are in a long-term care facility. If you switch nursing homes, you may be able to change your Medicare drug plan to match. For more information on Medicare drug coverage in a nursing home: www.medicare.gov/what-medicare-covers/what-part-a-covers/health-care-prescriptions-in-a-nursing-home
For information on Medicare’s coverage of long-term care: www.medicare.gov/coverage/long-term-care.
Medicaid can help cover nursing home care, both medical and non-medical services, for those who qualify.
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- Whether you are eligible for Medicaid long-term care and what services you can have covered depends on your state’s Medicaid program. Find your state Medicaid agency at TriageCancer.org/StateResources.
- Generally, you must meet certain functional requirements. A medical specialist, like a nurse or a social worker, will check if you need help with daily activities such as bathing, dressing, eating, using the toilet, caring for incontinence, and moving to or from a bed or chair.
- If you do not meet these requirements, Medicaid will not cover long-term care. Learn more about Medicaid: TriageCancer.org/Quick-Guides/Medicaid.
When thinking about applying for Medicaid long-term care benefits, it is important to be aware about the possible risks of Medicaid Estate Recovery. Estate recovery happens when Medicaid seeks repayment for certain benefits from the Medicaid beneficiary’s estate after they pass away. For individuals age 55+, states must recover payments for nursing facilities, home-based services, and related care. For details about Medicaid Estate Recovery: TriageCancer.org/Cancer-Finances-Long-Term-Care.
For details on Medicaid’s coverage of nursing home care, visit www.medicaid.gov/medicaid/long-term-services-supports/institutional-long-term-care/nursing-facilities/index.html. For more information on Medicare, visit TriageCancer.org/Medicare.
- Paying for residential care: U.S. Department of Veterans Affairs (VA)
Veterans may be eligible to receive long-term care in various services like at home, nursing homes, or assisted living facilities. To be eligible:
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- You must be enrolled in VA Health Care;
- The VA must determine your need for specific services to help with your ongoing treatment and personal care; and
- The services or space in a care setting must be available near you.
Other factors, such as your service-connected disability status or insurance coverage, may also be considered by the VA. To access long-term care services, contact your VA social worker or call 877-222-8387.
For more information: VA.gov/health-care/about-va-health-benefits/long-term-care.
- Paying for residential care: private long-term care insurance
Most private health insurance plans will not cover the costs of long-term care facilities. Long-term care insurance is specifically designed to cover the cost of long-term care at home or in a residential care setting. For more information on long-term care insurance, read our Quick Guide to Long-Term Care Insurance and visit our Cancer Finances module on Paying for Long-Term Care.
