Nursing Homes, Group Homes and Assisted Living – Nursing Homes Example

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"Nursing Homes, Group Homes and Assisted Living" is a perfect example of a paper on nursing homes. As age advances, many people find themselves in need of care services. With age comes the inability to perform daily living activities like cooking, using the bathroom at night, traveling, and even generally keeping the house tidy as the individuals would wish. This aspect is even urgent in people with disabilities regardless of age. With such inabilities, many people face the need for long-term care. The need to either be under the assisted living program, group home or in a nursing home thus grows regardless of age. According to Kaye, Harrington, and LaPlante (2010), there are about 10.9 million community residents and 1.8 million nursing home residents in need of long-term care in the United States.

Out of this number, 92% receive unpaid assistance while the rest gets paid for assistance. The unpaid care services are majorly provided by family caregivers. The paid services for community residents are majorly funded by Medicare or Medicaid while nursing home care services are partly funded by Medicaid and partly by the patient.

The shared cost is necessitated by the huge expenditure associated with these care services.   It is estimated that at least 1.6 million community residents who are basically in assisted living and group homes get long-term paid help per month (Kaye, Harrington, and LaPlante, 2010). Nursing homes are basically paid for by the patients from out of pocket payments and insurance policies. When the need for assistance is expressed by a patient, Medicare pays for nursing home expenses of up to three months. Together with insurance policies, Medicare clears the bills.

Insurance policies usually avoid paying for such services since their prolonged nature may pose high losses to the companies.   Only a few cases are considered by private insurance companies as worth paying. Assisted living homes are solely funded by Medicare. These homes take in persons in need of rehabilitation and restoration services that lead to hospitalization. Medicare pays for periods below six months till the person recovers to either go home or join group homes. Medicaid takes over after six months where Medicare cannot pay (Kaye, Harrington, and LaPlante, 2010).

Medicaid and out-of-pocket payments cover the bills in the nursing homes. However, Medicaid will consider paying for stays of over three years since by then out-of-pocket payments have decreased considerably.   Health care cost keeps changing with demand for medical care services. In 2010, healthcare cost was 17.9% of GDP which was different from 13.8% GDP in 2000 (CMS, 2014). The funding bodies thus spend different amounts each year. For example in 2007,   “ Medicare paid for 25%, Medicaid and other public funds paid for 42%, out – of- pocket funds paid for 22% and 11% was paid by private insurance and other sources in 2007” (Ng, Harrington, and Kitchener, 2010). To be eligible for any of these programs, one must show the need to be assisted.

Among the dire needs considered are for populations with no live-in family helpers. Such people could be in need of institutional care especially if they have more than one activity of daily living (ADLs) need like bathing and dressing on their own. Poverty is the other aspect that makes one be considered eligible for the program. Many people in need of long-term care have much lower personal incomes.

There are special cases of persons who had assets but due to prolonged need for care services, the assets got spent down. Such individuals are considered eligible since the chances of them getting finances to foot the bills get narrow by each asset spent. Besides these qualifications, Medicare will consider an individual as eligible if they show the need for short-term home health services and skilled care (Ng, Harrington, and Kitchener, 2010).

References

CMS. (2014). National health expenditure data. Centers for Medicare & Medicaid Services. http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/NationalHealthAccountsHistorical.html. Accessed 16 November 2014.

Kaye, H. S., Harrington, C., & LaPlante, M. P. (2010). Long-term care: who gets it, who provides it, who pays, and how much? Health Affairs, 29(1), 11-21.

Ng, T., Harrington, C., & Kitchener, M. (2010). Medicare and Medicaid in long-term care. Health Affairs, 29(1), 22-28.

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