What families need to know about levels of care


If you're a baby boomer with parents well into their 80's, it's important to know the different levels of care available, Medicare's role in the process and specifically how a skilled nursing facility can factor into the overall care provided.

When people move into a Continuing Care Retirement Community (CCRC), they live independently in apartment-type housing (some offer cottages, homes, duplexes, etc.) Most CCRCs have dedicated housing for assisted living and a separate skilled nursing facility, all on one campus. This allows residents to receive appropriate care and stay close to their spouse or friends.

Once an independent resident cannot perform the basic activities of daily living, or his or her mental acuity is compromised, he or she might need to transition to assisted living, where assistance is available for personal care and meal preparation, with access to a lively activity program.

When a resident is no longer capable of independently performing the five activities of daily living - bathing, feeding, toileting, dressing and transferring (moving from a chair to a bed, etc.) - or if a certain medical condition exists that requires special skilled treatment such as intravenous therapy or wound care, etc., the resident must move from assisted living to the skilled nursing facility.

Let's say, for example, your mother falls and breaks her shoulder, or your father comes down with pneumonia and requires hospitalization. Once they spend (at least) three (3) nights in the hospital, Medicare will pay up to 100 days of rehabilitation in a skilled nursing facility based on their progress during their stay. When their care becomes custodial, Medicare will no longer pay for their care.

When a resident is not eligible for Medicare in a skilled nursing facility, he or she is considered "private pay" and will be billed the "daily rate fee for service." If the resident has long-term care insurance, a certain daily amount is paid by the insurance company (some policies will cover the entire cost), with the balance paid by the patient.

In the event residents exhaust all ability to pay, they can apply for Medicaid assistance, which is offered by three different skilled nursing facilities in Beaufort County.

Finding the right facility or community can be a daunting task, but resources are available. Research the facilities online by using Nursing Home Compare at www.Medicare.gov.

Browse facility websites and ask your physician or hospital discharge planner for recommendations.

Finally, visit the facility, take a tour and be sure to ask the questions most important to you.

Joe Agee is the marketing and sales director for The Seabrook of Hilton Head. www.TheSeabrook.com

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