Frequently Asked Questions
What is the difference between Medicare and Medi-Cal?
- Medicare is the Federal Government’s Medical Insurance Program for people age 65 and older (and for people who are disabled.)
- Medi-Cal is the state-run medical assistance program for people in financial need.
Will Medicare pay for all or part of my stay at Mission View Health Center?
- Your Medicare benefits are “activated” by a 3-night stay in a hospital within the last 30 days.
- Your physician must certify that you need skilled nursing care. (For example: skilled nursing may be determined by a need for Physical Therapy after your 3-night qualifying stay in a hospital due to weakness/strengthening after a surgery.)
Once these guidelines have been met, Medicare will pay for days 1-20 at 100% if you require skilled nursing care throughout that period. After day 20, if you still require skilled care, there is a co-insurance daily rate charge that many secondary insurances (AARP, Blue Cross) will cover. To find out if your secondary insurance pays for this co-insurance rate, call the number listed on the back of your secondary insurance card for more information.
How do I qualify for Medi-Cal?
- Your income must be less than state limits.
- Your assets must be less than state limits.
- A physician must certify that you need nursing home care.
For more information, please visit the Department of Social Services and obtain an application for Medi-Cal eligibility.
For further information about Medicare, Medi-Cal, and other insurances, call Mission View Health Center directly or HICAP (Health Insurance Counseling & Assistance to Senior Citizens) at 1-800-434-0222.
Living in a Nursing Facility: Myths and Realities
Provided by the American Health Care Association
Reality: Because many people mistakenly believe that Medicare or health insurance will cover their long term care costs, they are forced to spend down their savings to cover the cost of care.
Consumers should be aware that the government provides little financial assistance for nursing facility care unless a person is impoverished and qualifies for Medicaid. Nursing facility coverage falls under Part A of Medicare and is very limited. If certain stringent conditions are met, Medicare pays for 100 percent of the first 20 days of care in a skilled nursing facility (SNF) if that many days are needed. For the 21st through the 100th days, the patient must share the cost of care by paying a daily co-insurance rate that changes yearly. In 2006, the co-insurance payment was just over $119 per day. Medicare Part B may help pay for covered services received from a doctor in a SNF, if the person has chosen to participate in the Part B medical insurance program. If they have used up their Part A coverage for a spell of illness, Part B also covers a portion of services received in a SNF, such as physical and occupational therapy.
Under the Part B program, they must pay an annual premium and a deductible for all Part B services including physician services, after which Medicare pays 80 percent of the reasonable charges for covered services.
Long term care insurance offers a viable solution to accessing the facility or setting of your choice, paying for it while preserving personal assets. However, due to lack of public awareness about long term care and who pays for it, long term care insurance is used by only five percent of the
Financing nursing facility care should be approached with as much thought and preparation as any major expense. Obtain in writing what the basic charge will be and understand clearly all financial arrangements before signing a contract.
Reality: At first glance, nursing facility costs may appear high. The average daily cost is in the range of $176 with geographic variations. This daily cost covers a complete set of services, including room, board, medical and personal care, health professionals on staff or on call, and a full range of activity programming. Once the range of services is taken into consideration, it becomes clear that the daily charge is reasonable.
It is also important to note that the primary goal of nursing facilities is to maintain the individual’s quality of life while providing needed care, rehabilitation, and a safe environment. Staff members encourage patients toward self-reliance as much as possible so that they can maintain or achieve the highest level of independence possible.
Reality: In some cases, this is true even though the facility staff does everything possible to encourage visitation. Staff members often become surrogate family members and friends to patients. However, as hard as they try, the staff cannot fully offer the same social and psychological support as friends and family. Staff members recognize this and try to encourage visits and to make visitors feel welcome. Many facilities encourage and facilitate communication via email, the Web or telephone.
Reality: This is simply not true. Many couples enter nursing facilities together and may share a room if they so choose. Some couples have even met at the nursing facility and decided to marry. Staff members respect the privacy of couples living in nursing facilities.
Reality: Family members are encouraged to participate in care planning meetings with the staff and patient. By being involved in care decisions, the information you can provide will help ensure quality and satisfaction of care. Keep in mind that nursing facilities are expected to meet government-quality standards, and they are inspected to ensure that they do. When a problem is found, a plan for correcting it is put into place promptly. In addition, most areas have an active, government-supervised, Ombudsman program that provides advocates for patients. Family and friends also serve as an important safety net by being regular visitors. If you feel that proper attention or care is not being given to a specific situation, bring it to the attention of the appropriate staff person, for example, the director of nursing, social worker or administrator. If you are not satisfied with their responses, you may wish to contact the facility’s Ombudsman or other authorities.
Reality: Nursing facility staffs strive to maximize independence and honor patient preferences. It is a patient’s legal right to make choices about activities, schedules, health care and other aspects of their life. Yet it is important to recognize that the facility must ensure an environment where people can live together safely and harmoniously. Whatever an individual’s physical condition, the over-riding objective for the facility is respecting an individual’s rights and wishes and providing a supportive environment and quality care.
Resident councils, which are self-governing bodies in nursing facilities, provide an opportunity for patients to become actively involved in addressing their concerns to staff and to one another.
When it comes to treatment decisions, some patients choose to shift decision-making responsibilities to their adult children or others. Patients, if they have not already done so, are encouraged to prepare an advance directive. An advance directive is a legal document designed to express an individual’s wishes for treatment should he/she be unable to communicate his/her preferences.
Reality: A primary goal of the nursing facility staff is to rehabilitate patients so that they can return home or to an assisted living setting. Those
who cannot return home permanently may be able to make short visits, health permitting. In most states, Medicaid-certified nursing facilities
will hold beds for patients while they make a short visit home. Check on how your state government regulates a home visit by asking the admissions person at the nursing facility that you are considering.
Reality: Nursing facilities must strike a balance between providing security and adequate supervision while respecting a person’s privacy. Common areas in nursing facilities tend to be open, while patient rooms are considered private. Staff members respect patient privacy by being courteous and by knocking before entering the room.
Reality: Most people slow down physically as they age and perhaps get easily tired. Some may slow down mentally as well. In fact, many people enter a nursing facility, in part, because poor memory makes caring for themselves difficult or impossible. However, with adequate nutrition, exercise, social stimulation, and properly controlled medication memory problems often can be improved. It is important to take into consideration that a nursing facility has professional caregivers that are extraordinarily capable of interacting with the elderly or persons with a disability in a variety of situations. It is true that a large number of nursing facility residents have Alzheimer’s, an irreversible disorder that causes progressive mental difficulties. In many cases, Alzheimer’s patients live in distinct units where they can be among people having the same limitations and receive the specialized care they require in a secure setting.
Reality: A nursing facility is not a hospital. Many people enter a nursing facility after a hospital stay and tend to think of the nursing facility as an extension of hospital care. However, a nursing facility is much different. Medical, rehabilitative and nursing care is provided as needed by health care professionals and dedicated caregivers. Yet at the same time, nursing facilities try to be homes – where people can feel comfortable, find familiar faces, and continue life’s activities appropriate to their age and capabilities.
Nursing facilities do not have restrictive visiting hours like hospitals. Family members and friends are encouraged to visit. Whenever possible, patients eat in dining rooms rather than in their rooms. Various activities and outings are offered each day to stimulate and entertain patients mentally, physically and socially.