Most residents of Homestead Village (and most other retirement communities) pay for their services with their own funds. Other non-charitable sources of payment are long-term care insurance and Medicare. Medicare has many forms and primarily pays for the first 30-100 days of care in a nursing home as well as for medications, therapy, physician services and other ancillary services. Long-term care insurance pays in most licensed areas of care, including nursing care, personal care and home care when a recipient meets the medical requirements of the plan.
For most of us, if we live long enough, we might outlast our assets. It doesn't help that as we get older, we require additional assistance which costs more money. The end result for many people is the inability to pay their full bill. When this occurs, we ask the resident to write a letter detailing the situation and provide a full accounting of their financial situation, including all assets, income, expenses and debts. Homestead Village's CFO, Brent Messner, then makes a determination as to the amount of charitable financial assistance necessary to meet the full bill. The resident continues to pay as much as they can afford. That is how charitable care is provided in residential living and personal care.
In the nursing home, charitable care is governed by the Medicaid program. Medicaid requires in most cases, a recipient to spend down most of their assets. Exceptions are made for the spouse in the community and residents can often keep their homes; but the Department of Human Services is likely to put a lean on the home to recoup Medicaid payments. Residents applying for Medicaid must provide their financial information to the county assistance office, which makes the determination as to how much of the nursing home bill will be paid by the Commonwealth and how much will be the responsibility of the resident.
There are a number of challenging scenarios related to planning for health care later in life. One of the first is Long Term Care Insurance. Long Term Care Insurance is a complicated purchase and it is difficult to know when to purchase it and how much coverage to buy. A financial planner can help determine the specific policy and values to purchase, depending on your age and physical condition when you apply. The second difficult decision is whether to listen to the many schemes about shielding assets. The temptation is great but there are two problems. One is the five year look back that the Department of Human Services employs and second is the ethical question. Any money that is transferred within five years of application for Medicaid will be disqualified and that money will be required to be spent toward care prior to approval for Medicaid. The ethical issue is simple. Why should the rest of society, and in the case of the Apostles Center, the rest of Homestead Village pay for your care if you have the financial resources to pay for it yourself. The Federal Government is nearly $19 trillion dollars in debt. Every state is struggling to balance its budget and Homestead Village loses money on each resident on Medicaid. Thus all other residents have to pay more money each time a resident qualifies for Medicaid. Lawyers offer many other schemes to shield money and help individuals with means qualify for Medicaid sooner. While these schemes are usually legal, each elicits many ethical issues.