Alternate Care Facilities (Part 2)

In last week’s post I discussed lesser known facilities that provide some level of long term care. One is a residential health care facility and another is a dementia care facility. They are categorized differently by the State of New Jersey for licensing purposes. But paying for them can also be very different than covering the cost of a nursing home or assisted living facility.

One way, however, does remain the same. Private paying – using your own savings – always works as long as you don’t run out of money. If you have a long term care policy it can be a little more tricky. A residential health care facility such as the Society House which I talked about last week probably would not be covered under a long term care insurance policy for one of two reasons.

Policies that cover the cost of a nursing home or assisted living facility will define those facilities within the insurance contract. Boarding homes, individual residences and independent living units won’t qualify for coverage. Whether a residential health care facility will be covered will also depend on what services it provides to residences and the frequency.

A second reason the insurance may not cover the cost is because residents may not meet the requirement of needing assistance with at least 2 of the activities of daily living. ADLs are defined as bathing, dressing, toileting, transferring, eating and continence. A residential health care facility catering to the needs of a healthier senior is likely to be covered.

Turning on a long term care insurance policy is less of an issue with a dementia care facility. That’s because the focus there is on caring for residents already in more advanced stages of dementia. These residents are more likely to fall within the definition of an assisted living facility or nursing home. Additionally, the resident will be able to more easily meet the test of needing assistance with the activities of daily living.

The answer, however, is not necessarily the same when it comes to Medicaid. Many dementia care facilities do not participate in the Medicaid program so choosing this type of facility is like choosing a nursing home that does not take Medicaid.

There are many choices and options when it comes to long term care facilities. To the untrained eye they may appear to be the same. A closer look, however, reveals important differences that play a meaningful role in coming to the right decision for your loved one.

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