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What Nobody Tells You About Paying for Assisted Living

What Nobody Tells You About Paying for Assisted Living

Author: Lauren O’Desky, CSA

When it is time to consider assisted living, we may not have any choice in what our physical or cognitive limitations are, but with knowledge and planning, we can have choices in how we live and where we live. This seems pretty obvious, but what you don’t know about paying for in-home care or assisted living now, could affect you down the road.

No two assisted living communities are alike. Each has its own feel, culture, specialties, design and care philosophies, as well as specific requirements on how to pay for the care provided.

Costs of assisted living in Wisconsin can range anywhere from $3,500 per month to over $10,000 a month. Many people choose to use their income, in combination with savings and assets or long-term care insurance, to cover this vast expense.

Most seniors will spend more money than they have in income or assets when in assisted living because of the high cost of care. Once one has “spent down” their assets to a certain amount, they are eligible for Family Care, Wisconsin’s Medicaid long-term care program for frail elders, and adults with physical, developmental, or intellectual disabilities.

The financial window of opportunity - a required private pay funding period before Medicaid Family Care spend-down - is the key to going to the assisted living community of your choice.

What most assisted living communities don’t tell you is that even though they may accept Family Care, they prefer not to. Family Care pays a smaller percentage of the actual cost of care for a resident. Assisted living communities can only sustain a certain amount of Family Care spots and still make a profit or break even.

The majority of assisted living communities will accept Family Care, but only after about two or three years of private pay first. Some do not contract with Family Care at all, and some accept it from the first day a senior moves in.

For a senior to have the most choice in which assisted living community they’d like to live in, that senior must be able to show he or she can afford the amount of private pay that the assisted living community requires before their spend down to Family Care eligibility.

This poses a huge problem for a number of reasons. Assisted living communities contract with the state to have a certain number of Family Care spots in a given year. This means that a community with sixty apartments may have only ten or fifteen apartments reserved for people on Family Care at a given time.

So, if a senior moves into an assisted living community today, pays the required years of payment privately and then runs out of assets, there is no way to know if the assisted living community will have a Family Care spot available at the time when it’s needed. What we need is crystal a ball.

Don’t panic.

There are two distinct types of policies amongst assisted living communities. There are those that will try to find a Family Care spot for their resident when the time arises - these communities truly want to do everything they can to find a spot, but they do not guarantee a spot – and there are those communities that will never ask you to leave provided you have followed through on your private pay requirement.

At the end of the day, everyone does their best to keep their residents in the place they call home, but money is money and policies are policies. It’s as simple as that.

How can you protect against an undesired move happening to you or your loved one? There is no surefire way, but asking that community what happens when you run out of money is the first step.

Some people choose to stay at home and to receive in-home care until they spend down to Family Care. When they start to look at assisted living communities, they realize that they don’t have the private pay funds required by some communities, and thus their options are limited. While paying for in-home care, a senior can save for the next step of care if they desire.

It’s important to point out that people can enter assisted living communities when they are already on Family Care, but their choices are very limited.

Consulting a Certified Senior Advisor or an elder law attorney early in planning may not only be beneficial in facilitating and planning for the Medicaid Family Care “spend down,” but will help preserve the greatest number of options for whatever the future holds.

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