Does Your Loved One Meet Level of Care?

What is level of care and what does that mean with regard to the care for which your senior loved one qualifies?

Some caregivers of senior adults will hear this sentence in the future if you have not already heard it.  If your senior loved one had a recent hospitalization followed by a short stay in a rehabilitation facility in order to regain strength back before returning home, you may have heard this.

Unfortunately, sometimes following a medical event requiring a hospital stay seniors get stuck in the crack where they are doing too well to stay in the rehab facility or nursing home but are not doing so well that they can go back to their prior living situation, either alone or without supervision around the clock.

Unless the senior is a private-pay (paying own way) patient, a level of care assessment is required by the government to be completed by a person not affilited with the facility so that impartiality is assured.  This assessment is used to determine whether or not the senior qualifies for Medicaid paid care.  This certification helps to verify the need for program admission and the level and types of services needed.

The assessment identifies long-term care needs, establishes the appropriate level of care (medical eligibility for nursing facility care) and recommends the least restrictive, most appropriate placement.  Medicare pays for services for seniors that are provided by a professional and referred to as skilled services such as therapy or wound care.  Custodial services are those needed that don’t require a professional to provide them such as housecleaning or grooming/bathing.  Medicare or Medicaid does not pay for custodial care.

Some of the criteria for determining if a senior will qualify for Medicaid services in a facility.

  • how they ambulate (get around)
  • how they care for themselves
  • behaviors
  • medications needed
  • whether tube feeding is needed
  • the patient’s prognosis
  • other areas as appropriate for specific evaluations

These answers are reviewed and a decision is made.

The ability to remain in a nursing facility, an assisted living facility or the community is dependent upon this assessment when requesting that Medicaid benefits cover the cost of care.

We all want our senior loved ones to get the care they need to maintain their health and well being but all too often, who will pay for this care is the biggest question of all!

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