4. What is the average cost of nursing home care?
Nursing home cost in Georgia average from approximately $70 to $150 per day. This fee generally includes room, board, routine nursing care, general toiletries such as soap, shampoo, tissue, etc., and flat laundry (linens). There may be additional charges for other items such as some medications, and some incontinent supplies.
Depending upon the resident’s source of payment, and / or the facility policy, the average cost may vary. Additional charges should be specified in the written admission agreement.

5. What kinds of financial assistance are available for persons needing nursing home care or alternative home care?
1) Medicare and Medicaid will pay for both nursing home and in-home care under certain circumstances. An individual’s eligibility for payment by these programs depends on the person’s financial situation and on non-financial criteria, such as health care needs and age. (Refer also to questions #14 and #16).
2) The Veterans Administration (VA), under certain very specific circumstances, may pay for nursing home care, personal care, or other services, or in-home care for a veteran. Please contact your Area Agency on Aging – Aging Connection for the phone number to your local VA office or click here to find the information online.
3) Long-term care insurance may pay a portion of these costs.

6. Will Medicare pay for nursing home care?
Yes. Medicare A can help pay for certain in-patient care in a Medicare- participating skilled nursing facility if all the following requirements are met:
1) the individual is a patient in a hospital for at least three days (not counting the day he / she leaves) before being transferred to the nursing home;
2) the patient is transferred to the nursing home because he or she requires care for a condition that was treated in the hospital;
3) the individual is admitted to the nursing home within a short period of time, generally 30 days, after leaving the hospital;
4) a doctor certifies that the patient needs and that he or she actually receives a skilled nursing or skilled rehabilitation services on a daily basis; and
5) the part A intermediary or the nursing home’s utilization review committee approves the patient’s stay.
If an individual is eligible, Part A will help cover services for up to 100 days per benefit period. A benefit period begins the day the patient is hospitalized and ends the day after he / she has been out of the hospital or skilled nursing facility for 60 consecutive days. If the patient is hospitalized after 60 days, a new benefit period begins. There is no limit to the number of benefit periods a person may have.
Medicare pays all covered expenses for the first 20 days and, if additional days are approved, Medicare pays all but a $99 per day coinsurance amount (in 2002) from the 21st day to the 100th day. Beginning with the 101st day of skilled nursing facility care in any benefit period, the resident and / or responsible party is responsible for all charges.

7. Will Medicaid pay for nursing home care?
Yes, if a doctor certifies that the person is in need of nursing home care, and if he / she meets Medicaid’s financial eligibility guidelines. (See questions #10 and #14).

8. What is the difference between Medicare and Medicaid?
Medicare is a Federal health insurance program for people 65 years of age or older and certain younger disabled people. For information about Medicare and health insurance call the HICARE (Health Insurance Counseling Assistance and Referral for the Elderly) program. To apply for Medicare, contact your local Social Security Administration office.
Medicaid is a medical assistance program jointly financed by the State and Federal governments for eligible low-income individuals. Medicaid coverage and eligibility vary among states, and eligibility depends on both financial and non-financial criteria. (See question #10 for information on who to contact).

9. How do I become eligible for Medicaid?
An individual may apply for Medicaid at the Department of Family and Children’s Services (DFCS) in the county where the nursing home is located.
Medicaid eligibility in Georgia includes both financial and non-financial criteria. To meet the non-financial criteria for Medicaid in a nursing home an individual must:
- be age 65 or older, totally disabled, or blind;
- reside in a Medicaid approved nursing home;
- be a citizen of the U.S. or lawfully admitted alien;
- be a resident of Georgia;
- agree to assign all health insurance benefits to the Department of Medical Assistance; and
- apply for and accept any other benefits which might help pay medical expenses.
To meet the financial criteria for Medicaid, an individual’s
- income must be less than the cost of the nursing home; and
- countable assets must not exceed $2000. (see question #17 re: transfer of assets to spouse living in the community).

10. Do I have to spend all of my money to become eligible for nursing home Medicaid?
No. A nursing home resident is allowed to retain $2000 in countable assets. Countable assets do not include the nursing home resident’s home, automobile or personal property.
Countable assets do include any real property other than the resident’s home, saving and checking accounts, investments such as certificates of deposit, stocks, bonds, mortgages and promissory notes, life insurance, inherited property and jointly owned assets. Any life insurance policies with a face value of $5000 or less are not counted. An individual is also allowed to pre-pay funeral expenses and to have a separate burial account with up to $5000.
Any individual who gives away assets (except to a spouse) within 36 months of entering a nursing home in order to become eligible for Medicaid is subject to a penalty. (See questions #13). Call the local county Department of Family and Children’s Services for additional information.

11. Do I have to sell my home to qualify for Medicaid?
No. An applicant does not have to sell his or her home to qualify for Medicaid because the home is not a countable asset.
Effective October 1, 1993, states were mandated by the Federal Government to actively seek estate recoveries and to impose liens against properties owned by individuals who were Medicaid recipients residing in nursing homes at the time of death. The State of Georgia does not currently have an estate recovery program in place. Persons with further questions may call the local office of the Department of Family and Children’s Services in their county.

12. If a nursing home resident has applied for Medicaid, can the nursing home require that person to pay out of pocket until Medicaid is approved?
If it is apparent that the resident will be Medicaid-eligible, the nursing home may not require out-of-pocket payment while approval is pending. If it is not clear that the recipient will be eligible for Medicaid, the nursing home may charge out-of-pocket fees. However, should the resident then become Medicaid eligible, the nursing home will be required to reimburse the resident for fees collected since the date that the Medicaid application was made.

13. As a Medicaid nursing home resident, will transferring my assets to my children affect my Medicaid eligibility?
An applicant for nursing home Medicaid may not transfer assets to any family member other that the spouse within 36 months of entering the nursing home without incurring a penalty. The penalty will result in denial of all Medicaid payments to the nursing home during the penalty period.

14. What happens if I run out of money while in a nursing home? Where do I go for help? How do I pay until I get help?
If a private pay nursing home resident runs out of money in a Medicaid certified nursing home, the resident may apply to become Medicaid eligible. The nursing home social worker or admissions staff provides information about Medicaid eligibility requirements and assistance with applying for Medicaid benefits. (See question #10).
The Medicaid certified nursing home is prevented by regulation from discharging a resident while a Medicaid application is pending. If the resident qualifies for Medicaid benefits, Medicaid reimburses the nursing home for the resident’s care retroactive to the date of application for benefits.
If the nursing home in which the resident resides is not Medicaid certified, the resident can be discharged when the nursing home bills are no longer being paid. Nursing home staff are required to assist in finding appropriate placement for the resident being discharged.

15. How does a nursing home that is Medicaid certified determine its costs for private pay patients?
The private pay rate in any nursing home is determined by the facility and is generally higher than the Medicaid reimbursement rate. By regulation private pay rate cannot be lower than the Medicaid rate.

16. What happens if I do not qualify for Medicaid or Medicare to pay for nursing home care? Medicaid and Medicare are the only public programs that help pay for nursing home care. If an individual needs nursing home care according to Medicaid guidelines, but is ineligible because of assets greater than the allowed limit, it may be possible to qualify for Medicaid by “spending down” countable assets. Call the local county Department of Family and Children’s services office for additional information.

17. Will my being in a nursing home affect my spouse’s income?
The income of the spouse or any other family member is not considered when determining the nursing home resident’s financial eligibility for Medicaid. The spouse living at home is allowed to keep enough of the nursing home spouse’s income to make the at-home spouse’s total monthly income $2,232 (for 2002).
The spouse’s assets must be counted when determining Medicaid eligibility. Total combined assets for the resident and spouse must not exceed $91,280 (for 2002).
The spouse’s financial situation is not considered when Medicare pays for nursing home care.

18. Will I need a primary physician to be admitted to a nursing home or to care for me after I become a resident?
A physician must determine whether an applicant requires nursing home care and complete a DMA-6 (see questions #23, 24 and 25). A resident needs to have a physician who is wiling to provide services in the nursing home setting. Even though residents frequently want to maintain relationships with their family doctor, not all doctors are willing to visit patients in nursing homes. The nursing home staff may be able to give you names of physicians who will provide medical care to residents.

19. What is the procedure for transferring a resident from an out-of-state home to a nursing home here in Georgia?
Some of the specifics will depend upon which other state is involved. If the individual receives Medicaid, the local office of the county’s Department of Family and Children’s Services (DFCS) will need to be contacted in Georgia as well as the corresponding agency in the other state. If the individual is a “private pay” he or she will simply need to check with the current nursing home and the Georgia nursing home regarding their requirements for transfer. Please note that eligibility for Medicaid may vary from one state to another. This factor may affect the potential transfer.

20. What is the procedure for transferring a resident from one local nursing home to another?
Check with each home regarding the facility’s requirements for transfer.

21. What are the best nursing homes and which nursing homes would you would you recommend? How do I find out if a nursing home has a poor reputation?
Staff of the Area Agencies on Aging and the Georgia Division of Aging Services may not endorse or recommend one nursing home over another. However these agencies can provide some information about facilities, which may be of some help as persons are seeking to evaluate nursing homes, including lists of facilities in their service area.
There are several sources of information regarding the quality of nursing homes. The Office of Regulatory Services (ORS), which is part of the Georgia Department of Human Resources (DHR), makes periodic unscheduled visits to all nursing homes to survey patient care and medical care. ORS will provide summary information to you about these surveys and specific types of complaints for various nursing homes / you can access this information at www.medicare.gov. Your local Long Term Care Ombudsman Program (LTCO) can also share information about the types of concerns expressed about nursing homes and advise consumers about what to look for in choosing a nursing home. Go to www.gacoco.org and check the menu for Ombudsman Listings.

22. Where can I find information about nursing home vacancies?
Currently no agency maintains a nursing home vacancy list, which is available to the public. Therefore, it is necessary to call facilities you are interested in to determine whether they do or do not have vacancies.

23. What is a DMA-6?
A DMA-6 is a Department of Medical Assistance form, which provides a physician’s verification of the individual’s need for nursing home care. All applicants to nursing homes that receive Medicaid funds must complete the DMA-6. The DMA-6 must be signed by the prospective resident’s physician and forwarded by the nursing home to the Georgia Medical Care Foundation for review and approval that the resident needs nursing home care before Medicaid payments can be made.

24. How do I obtain a DMA-6?
If your physician does not have this form, please check with the nursing home or the Georgia Medical Care Foundation.

25. Will the nursing home accept a DMA-6 that has been completed by a physician from out of state if the prospective patient is relocating to Georgia?
A physician licensed by the State of Georgia must complete the DMA-6.

26. What recourse do I have if the staff of a certified Medicaid nursing home states that the facility has no available Medicaid nursing home beds, but that it does have beds available for private pay or Medicare patients?
Nursing homes are prohibited from discriminating based on source of payment. However, it is very difficult to regulate this type of discrimination. Should such a circumstance occur, you should contact the local Long Term Care Ombudsman Program for assistance. In a Georgia Medicaid certified nursing home all beds are certified as Medicaid beds. However, the reality is that it is often difficult to find nursing home placement for an individual on Medicaid.

27. If I am a nursing home resident and my physician admits me to the hospital, how long is the nursing home required to hold my bed?
The nursing home is required to hold the bed for (7) days for Medicaid recipients and to provide the first available bed after that time should the hospital stay be longer. Private pay residents will be required to pay the nursing home for their beds if they wish to have the nursing home hold the beds for them.

28. What is Respite Care? Is it available in a nursing home?
Respite care provides time off for caregivers who provide care for a chronically impaired person. Respite care might be offered on a regular basis such as adult day care, or for longer periods intermittently. Some facilities provide short-term respite care if space is available.

Revised January 2002 by Northeast Georgia Area Agency on Aging to reflect current financial information and changes.

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