The Truth About Medicaid and Medi-Cal Paying for a Nursing Home

Are you a Senior Who is Afraid of Running Out of Money?

Do you worry about the cost of long term care if you or your spouse can not live at home any longer?

Nobody ever wants to be put in nursing home?  The reality is that many seniors end up having to go to a nursing home (sometimes called a skilled nursing facility, SNF or convalescent home).  Families are shocked when they find out that the cost of staying in a nursing home is $225-$300/day!

• Are there any government programs to help defray this cost?
• Does a family have to spend all of their money before they can become eligible for a program?
• Is there a way to preserve any of a seniors' money and still get government assistance? 
• Are adult children responsible to pay back the government from the inheritance if their parent receives Medicaid or Medi-Cal?

Sometimes a senior needs to be admitted into a nursing home for rehabilitation services, mom falls and breaks her hip or dad has a stroke.  Sometimes it is because a senior simply can no longer live at home alone safely due to their inability to take care of themselves.  As we age most of us will need assistance with what is called our daily living activities.  

With costs of staying in a San Diego California nursing home for only a few months costing tens of thousands of dollars, most families want to know if there is any help to pay for this.

There is help - but you do need to plan for it!

The good news is that Medicaid or what California calls Medi-Cal will help pay for care received in a nursing home if the person who goes into the nursing home meets strict income and asset limits.  Basically the government will look at how much money you bring into your family from ALL sources as well as how much money (property and savings) a family has.  If you fall below a certain amount then the government will help pay.  If you are over their set limits,  then you are on your own and have to pay on your own! 


Please note that a person can be charged with Elder Abuse if they transfer money from a senior - even their parents - unless they have the property authority to do so! 

There are things you can do even if you have too much money to qualify for Medicaid and Medi-Cal!


There are quite a few strategies that one can use to preserve their hard earned money and property.  The only kicker is that this needs to be done while you still are competent and know what you are doing.  In other words, your kids can not decide after you are unable to make you own decisions to take steps to save your money unless you have already given very specific instructions and the OK to do so in your estate planning documents.  

Most people I speak with want to save their money and property including their home for their husband or wife and then for their children rather than spend it all on a nursing home in the last few years of their life.

Each family is different and what works for one may not work for another

Since each family is different, a plan that works for one family may not be right for another family.  The only way to know what is right for your family is to meet with an experienced Elder Law Attorney who knows the rules and how to legally get you qualified for Medicaid - Medi-Cal and how to avoid having to pay the government back for the services received once you pass away!

Free Phone Consult with Elder Law Attorney Vincent M. Casiano, Esq.

I know how confusing this can be, so I do offer to speak with potential clients at no charge to talk to them about their family's situation to see if I am able to help.  I welcome calls from wives, husbands, and adult children that are concerned about their parents' health and safety.  Call me so we talk and we can decide if you want me to help your family - 619-800-6820.  

New Rating System for Nursing Homes

The Centers for Medicare and Medicaid Services (CMS) announced this week the implementation of a new rating system for nursing homes. Nursing homes will soon be rated on a 5-star scale, similar to the way hotels and restaurants are currently rated by critics, with one star being the lowest rating and five stars the highest possible rating. The new system is designed to assist families in determining the best facilities in their area. The new system will appear on Medicare’s “Nursing Home Compare” Web site, hopefully before the end of 2008.

Nursing Home Compare basic staffing information, general findings of inspection reports for the past three years, and a list of quality indicators. Quality indicators include the percentage of residents subject to some form of restraint; percentage of residents with pressure sores; and percentage of residents who have lost too much weight. Some have criticized the current Web site as being difficult to navigate.

The new system is designed to make it easier for consumers to evaluate a home and distinguish one facility’s performance from another. Proponents of the new system believe it will hold nursing homes accountable and force underperforming facilities to improve their standard of care.

CMS is currently holding a period of public comment to determine the best method of translating inspection reports and quality indicators into star ratings and to allow the public to suggest other information that should be included in the ratings. Many hope that the ratings will take into consideration resident satisfaction surveys, which most homes already conduct on an annual basis. Advocates of including these survey results in the ratings state that it is important to give the families of the residents some input in the facility’s rating. The first ratings are expected to be completed by December. Ratings will be updated quarterly.

Regardless of the new rating system, it is important to personally check out a nursing facility. A rating system should not be a substitute for your own observations and best judgment. If you have a comment, feel free to post it here, but keep in mind your posting will not be confidential. If you have a question or need assistance with a matter involving a nursing home or assisted living facility, call my office for immediate assistance. Thanks for reading my blog.

Medi-Cal Benefit Increase for Nursing Homes Fails to Improve Care

In 2004, California legislatures passed a law that provided California nursing homes with $590 million by raising Medi-Cal (California’s Medicaid program) payments. The purpose of this law was to give nursing homes more financial resources to help poor residents. From 2004 through 2006, a UC-San Francisco study found that nursing homes not only received the $590 million, but their total revenues rose by $1.1 billion.

The increase in funding and profits does not appear to have translated into better care. The same UCSF study reports the following statistics in 2006:

1. A 3.6% decrease in nursing home spending on direct patient care

2. A 6% increase in state and federal citations of nursing homes

3. A 38% increase in complaints of patient mistreatment

4. 16% of nursing homes still did not meet California’s minimum staffing levels

5. 88% of nursing homes did not comply with federal regulations

6. 22% of nursing homes had violations that harmed patients or jeopardized patient care

The study also found that nursing assistant wages increased an average of 71 cents per hour (or 6%), licensed nurses increased by 9% and administrators pay rose by 13%. Nursing homes also enjoyed a rise in net profits of 233% to $248,047.

Nursing Home Residents Bill of Rights
The California Health and Safety Code, Section 1771.7(b) provides that all residents in residential living units (such as nursing homes) shall have all of the following rights:

1. To live in an attractive, safe, and well maintained physical environment.

2. To live in an environment that enhances personal dignity, maintains independence, and encourages self-determination.

3. To participate in activities that meet individual physical, intellectual, social, and spiritual needs.

4. To expect effective channels of communication between residents and staff, and between residents and the administration or provider's governing body.

5. To receive a clear and complete written contract that establishes the mutual rights and obligations of the resident and the continuing care retirement community.

6. To maintain and establish ties to the local community.

7. To organize and participate freely in the operation of resident associations.

The increase in funding was meant to help California nursing homes comply with California statutes such as Section 1771.7(b). It appears from the UCSF study that nursing homes have not really improved; while administrator salaries benefitted from the influx of funds, patient care actually became worse. It is important to keep a watchful eye on your loved ones who reside in nursing homes. Be especially on the look-out if the nursing home has difficulty keeping staff. With nursing assistant wage increases not even keeping up with inflation, a high turn-over is likely, leading to poorly trained employees and a high likelihood of neglected patients. If any of the rights listed above has been violated, it is important that you consult an elder law attorney as soon as possible.

Thanks for reading our blog. If you have a question or comment, feel free to respond to this posting, but keep in mind that any response will not be confidential. If you or a loved one is a victim of elder abuse and have questions on how to protect your rights, contact us for a free, confidential consultation.

The Worst Nursing Homes

There are approximately 16,400 nursing homes nationwide, and each year American taxpayers spend about $72.5 billion annually to subsidize nursing home care. With the amount of resources devoted to nursing home care, one would hope that patients are receiving quality care. Unfortunately, not all nursing homes are safe. This month the Bush administration released the names of 131 nursing homes that rank among the worst in the nation. The list released by the Centers for Medicare and Medicaid Services (CMS) names facilities identified as a “special focus facility”, meaning the home has a poor inspection record meriting additional governmental oversight. These homes are subject to inspection every six months rather than once a year.

Typical offenses include overmedicating patients or unnecessary medications for elderly patients, and inadequate safeguards for patients with Alzheimer’s or dementia from everyday hazards in the nursing home. While most nursing homes have some deficiencies and may receive six or seven noted deficiencies per inspection, the homes on the list averaged twice as many deficiencies. In order to be placed on the list, the home must show a demonstrated pattern of serious problems for occurring over a prolonged period of time.

The director of the CMS encourages patients and their families to use the list to enhance their awareness of any deficiencies with a facility, but cautions that “there is no substitute for visiting the nursing home in person.” The CMS notes that publicity about a home’s problems often leads to improvements within the facility; out of 54 homes listed as poor performers in a November 2007 study, 21 showed improvement. However, about 16 percent do not improve and are eventually terminated from Medicare and Medicaid. The list will be updated every quarter, with the next list to be made public in April of 2008.

To view the February 2008 list of the worst nursing homes in the nation in pdf format, visit http://www.cms.hhs.gov/CertificationandComplianc/Downloads/SFFList.pdf.

Evaluating Nursing Homes

Welcome to my blog. I will be posting information related to elder law and estate planning. I hope you find my blog to be both interesting and informative.

In today’s Los Angeles Times, there is an article entitled “A Nursing Home Death, and a Shocking Phone Call.” Elmore Kittower was an 80 year-old resident of Silverado Senior Living in Calabasas who passed away suddenly last month. His 83 year-old widow, Rita, was told by a staff member of the facility that “He just stopped breathing.” The day after Elmore’s funeral, Rita received a telephone call from a woman claiming to be an employee of the nursing home. She informed Rita that her husband had been beaten and suffocated by another employee at the nursing facility. Days later, detectives from the Los Angeles County Sheriff’s Department requested Rita’s permission to exhume Elmore’s body. Sources close to the investigation confirmed that there was trauma to the body consistent with an assault.

Rita made the decision to find a nursing facility for Elmore after he suffered a massive stroke and became combative. She perused literature and visited dozens of nursing homes before selecting Silverado Senior Living. Rita admits the $75,000 a year expense for a semi-private room was a hardship, but states “But it was a beautiful place, like a five-star hotel.”

The decision to place a loved one in a nursing facility is never easy. How do you ensure that the facility you are entrusting with the care of your loved one will provide a safe and caring environment? Here are some resources you can consult:

• Medicare Website called "Nursing Home Compare"
• U.S. Department of Health, Center for Medicare and Medicaid Services
• California Nursing Home Ombudsman Information
• California Advocates for Nursing Home Reform
• AARP Website

Thanks for reading. Please contact me if you have specific questions, or feel free to leave a general comment in response to this posting.