Navigating the complexities of long-term care for elderly loved ones often brings families to the critical question: how to afford nursing home care? As the cost of nursing homes continues to rise, understanding the available Programs To Help Pay For Nursing Home Care becomes essential. This guide provides an in-depth look at various financial assistance options, designed to alleviate the burden of nursing home expenses and explore alternatives that can prevent or delay the need for such intensive care.
Helpful Resources
Before we delve into specific programs, it’s important to acknowledge the emotional and financial challenges families face. Numerous resources are available to help you navigate this process. These resources can range from government agencies to non-profit organizations, all dedicated to providing guidance and support.
Understanding the Cost of Nursing Home Care
To effectively explore financial assistance, it’s crucial to first grasp the significant expenses associated with nursing home care. In 2024, the national average daily cost for a semi-private room in a nursing home is approximately $285. However, these costs can fluctuate dramatically depending on geographic location.
The Southeastern, South Central, and Midwestern regions of the United States generally offer more affordable rates, ranging from $207 to $252 per day. Conversely, the Northeastern and New England states, excluding Alaska and Hawaii, represent the most expensive areas, with daily costs averaging between $377 and $495. It’s worth noting that specialized Alzheimer’s care within skilled nursing facilities typically adheres to the standard nursing home fee structure, unlike assisted living facilities which often impose additional charges for dementia care.
The table below illustrates the considerable variation in nursing home costs across all 50 states, providing a clearer picture of what you might expect to pay based on location.
| 2024 Nursing Home Care Costs by State (semi-private room) |
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| State |
| United States |
| Alabama |
| Alaska |
| Arizona |
| Arkansas |
| California |
| Colorado |
| Connecticut |
| Delaware |
| District of Columbia |
| Florida |
| Georgia |
| Hawaii |
| Idaho |
| Illinois |
| Indiana |
| Iowa |
| Kansas |
| Kentucky |
| Louisiana |
| Maine |
| Maryland |
| Massachusetts |
| Michigan |
| Minnesota |
| Mississippi |
| Missouri |
| Montana |
| Nebraska |
| Nevada |
| New Hampshire |
| New Jersey |
| New Mexico |
| New York |
| North Carolina |
| North Dakota |
| Ohio |
| Oklahoma |
| Oregon |
| Pennsylvania |
| Rhode Island |
| South Carolina |
| South Dakota |
| Tennessee |
| Texas |
| Utah |
| Virginia |
| Vermont |
| Washington |
| Wisconsin |
| West Virginia |
| Wyoming |
Financial Assistance Programs for Nursing Home Care
Given these substantial costs, understanding the programs to help pay for nursing home care is vital. Several avenues of financial assistance exist, each with its own eligibility criteria and coverage parameters.
Medicare’s Role in Nursing Home Coverage
Medicare, or Original Medicare, offers limited benefits for nursing home care and is not designed for long-term custodial care. Medicare primarily covers skilled nursing care needed for a short period following a hospital stay. This short-term care is often referred to as convalescent care.
Medicare fully covers the first 20 days of skilled nursing facility care. For days 21 through 100, a daily co-payment is required, which in 2024 is $204. Individuals with Medicare Supplemental Insurance plans may have this co-payment covered by their supplemental policy. However, neither Medicare nor supplemental insurance extends coverage beyond 100 days in a skilled nursing facility. A rare exception applies when a nursing home is also a psychiatric hospital and the patient is receiving care for a psychiatric condition.
Eligibility for Medicare nursing home benefits is further restricted by the requirement of a minimum 3-day hospital stay prior to nursing home admission, and the need for skilled nursing care must be related to the same condition that necessitated hospitalization and begin within 30 days of hospital discharge. Furthermore, Medicare coverage is intended for recovery from an illness or injury, not for chronic, long-term conditions like Alzheimer’s disease. A partial exception exists for individuals in states with Medicare PACE programs, which offer more comprehensive care options. More information about Medicare PACE programs can be found here.
Medicaid: A Major Payer for Long-Term Nursing Home Care
Medicaid, administered by individual states, stands as the largest single source of funding for nursing home care in the United States. Estimates suggest Medicaid covers between 45% and 65% of total nursing home expenses nationwide. However, Medicaid is a means-tested program, meaning strict income and asset limits apply to qualify. Applicants must meet these financial criteria to be eligible, but once qualified, Medicaid typically covers 100% of nursing home costs at Medicaid-approved facilities.
Medicaid eligibility criteria vary based on age, marital status, and state of residence, and these requirements are updated annually. Certain assets, such as a primary home (up to specific equity limits), may be exempt from asset calculations, and provisions exist to protect assets for a non-applicant spouse. Similarly, spousal impoverishment rules allow for income transfer from the applicant spouse to the non-applicant spouse, ensuring the community spouse has sufficient financial resources. These rules, including the Community Spouse Resource Allowance and Monthly Maintenance Needs Allowance, aim to prevent spousal impoverishment while effectively reducing the applicant spouse’s countable assets and income for Medicaid eligibility purposes.
For detailed information, explore Medicaid eligibility requirements or seek assistance with Medicaid planning.
Veterans Benefits for Nursing Home Care
Veterans and surviving spouses have access to specific programs to help pay for nursing home care through the Department of Veterans Affairs (VA). Two primary options are available:
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Aid and Attendance Benefit (Improved Pension): This program provides financial aid to wartime veterans and their survivors who require assistance with daily living activities. The Aid and Attendance benefit is intended for those with limited financial means, although the financial restrictions are less stringent than Medicaid. Both income and assets are considered during the application process. This benefit can be used towards nursing home or assisted living costs. Learn more about income calculation for Aid and Attendance and program eligibility requirements.
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State VA Nursing Homes: State-run VA nursing homes offer an alternative to the Aid and Attendance benefit, and are not limited to wartime veterans. However, individuals cannot receive both benefits concurrently. Eligibility and application processes for state VA nursing homes vary by state and facility. A general guideline is that the veteran or spouse must have at least a 70% disability rating. Each state operates its own VA nursing homes with unique eligibility criteria and limited space, often resulting in waiting lists. A directory of VA nursing homes is available online.
Other Financial Options for Nursing Home Costs
Beyond government programs, several other financial tools can help families manage nursing home expenses:
Reverse Mortgages: In specific situations, reverse mortgages can provide funds to help cover nursing home costs. A reverse mortgage is a loan against a homeowner’s property equity, available as monthly installments. However, reverse mortgages have age restrictions (typically 62+) and require the borrower to reside in the home. This limits their direct use for nursing home residents. However, if a spouse remains in the home, they can utilize the monthly payments to contribute to nursing home expenses. Explore the pros and cons of reverse mortgages for long-term care funding.
Long-Term Care Insurance: Long-term care insurance is specifically designed to cover long-term care services, including nursing homes. While beneficial, many who need nursing home care lack this insurance, often due to cost. Long-term care insurance currently covers about 5% of the nation’s nursing home expenditures. Policies typically require a “triggering event” based on care needs to initiate payouts, which can then be used for nursing home fees or other care services. Premiums increase with age and health decline; individuals over 65 with pre-existing conditions may face very high premiums or be denied coverage.
Nursing Home Tax Deductions: Nursing home expenses, including medical procedures and room and board costs, are tax-deductible. These costs are frequently claimed through the Medical and Dental Expense Tax Credit. Further details are available about this tax credit.
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Programs to Prevent Nursing Home Placement
Often, nursing home placement is considered due to perceived financial constraints of in-home care. While 24/7 home care can be expensive, nursing home care is also a significant cost, frequently subsidized by state and federal governments. Recognizing this, numerous programs are designed to support individuals requiring nursing home-level care to remain at home or in community settings. These programs to help pay for nursing home care at home provide various forms of assistance, including care services, financial aid, and in-home support, to enable home-based care, at least for a period.
Most states offer multiple programs aimed at supporting families in providing nursing home-level care for their loved ones at home.
Medicaid Waivers: Home and Community-Based Services (HCBS)
Medicaid waivers, also known as HCBS Waivers or 1915(c) Waivers, allow Medicaid-eligible individuals who clinically qualify for nursing home care to receive those services outside of a nursing home, while living in their homes or communities. Waivers exist for in-home care, assisted living, and other community-based settings, provided the recipient does not reside in a nursing home.
Medicaid waiver eligibility typically mirrors institutional Medicaid requirements. States often stipulate that the cost of home-based care under a waiver cannot exceed the cost of nursing home care (or a percentage thereof). Waivers often have enrollment caps, leading to waiting lists for services due to limited available “slots.”
This website maintains a comprehensive list of Medicaid waivers relevant to seniors, organized by state, with detailed information on eligibility and benefits for each.
State Plan Medicaid: Personal Care Assistance
Standard state Medicaid programs, often termed Aged, Blind, and Disabled Medicaid for seniors, may offer personal care assistance, also known as attendant care. This benefit is for individuals needing help with daily living activities. Unlike Medicaid waivers and institutional Medicaid, state plan benefits are an entitlement, meaning guaranteed assistance for all eligible individuals, without waiting lists. Income and asset limits still apply. A state-by-state directory of state plan personal care Medicaid programs is available here.
Medicare Advantage Plans: Expanding Home-Based Support
Since 2019, some Medicare Advantage (MA) plans have begun incorporating home and community-based services and supports (HCBS) to delay or prevent nursing home needs. Medicare Advantage plans (Medicare Part C) are private insurance alternatives to Original Medicare (Parts A and B), often including prescription drug coverage (Part D) and additional benefits not covered by Original Medicare, such as dental and vision. The availability of HCBS varies by MA plan and state. Examples of potential covered services include adult day care, respite care, personal care assistance, medical and non-medical transportation, home modifications, and meal delivery. These expanded benefits are exclusive to Medicare Advantage plans and are not offered under Original Medicare.
Nursing Home Diversion Programs: State-Funded Alternatives
Many states operate non-Medicaid funded programs to help pay for nursing home care prevention. These “nursing home diversion programs” offer services and supports to individuals who require nursing home-level care but may not qualify for Medicaid. Similar to waivers, these programs aim to prevent nursing home placement by providing services in homes or communities, recognizing the higher cost of nursing home care compared to in-home support. These programs often support family caregivers by offering respite care, transportation, and home-delivered meals, acknowledging the significant burden family members often bear.
“Nursing home diversion program” is a broad category, and specific program names vary by state. Some states offer multiple programs targeting different senior populations, while others may have no such programs. Services typically focus on enabling individuals to remain at home, and commonly include home care, respite care, transportation assistance, and chore services, among others. A state-by-state list of these programs is available here.
Money Follows the Person (MFP) Program: Transitioning from Nursing Homes
The Money Follows the Person (MFP) program provides federal funding to states to facilitate the transition of individuals living in nursing homes back to community settings. While not directly providing individual financial assistance, MFP expands options for nursing home residents seeking to return to community living. The MFP program is currently active in 38 states, the District of Columbia, and American Samoa. Learn more about the MFP Program here.
Assisted Living as a Potentially Lower-Cost Alternative
It’s crucial to recognize that not all nursing home residents require the intensity of care provided in a skilled nursing facility. Many assisted living communities now offer advanced care services that approach the level of care found in nursing homes. Considering assisted living can be a cost-effective alternative to nursing home care in some situations. Explore the key differences between assisted living and nursing home care to determine the most appropriate care setting for your loved one’s needs and budget.
By understanding the range of programs to help pay for nursing home care and exploring preventative options, families can make informed decisions to ensure their loved ones receive the necessary care in the most appropriate and affordable setting.
