Once you turn 65, there is a 70% chance that you are going to need some kind of long-term care during the remainder of your lifetime, according to LongTermCare.gov.
Unfortunately, paying for this care can be very difficult: Genworth’s Cost of Care Survey shows the median cost of a semi-private room in a nursing home in the US was $111,325 per year in 2024.
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So what if this happens to you or your parent? Let’s say that your 80-year-old mother spent a month in the hospital and was sent to a skilled nursing facility because she’s unable to manage on her own.
However, her insurance doesn’t want to pay for the care and claims she doesn’t need it. So the nursing home wants to take all her Social Security and pension checks to pay the bills.
Can the nursing home take that money, even though your mother has bills to pay, debts she took on before getting sick and a home she wants to maintain after she gets out of the care facility?
Here’s what you need to know if a nursing home is threatening to take your mom’s benefits and pay in order to allow her to live there.
Can a nursing home or skilled nursing facility take your money?
The first thing to know is that Medicare is probably your mom’s insurer, as it covers most Americans who are 65 and over.
If your mom has chosen a Medicare Advantage Plan, it will be administered by a private insurer and it must cover all that Medicare does.
Medicare does not ever cover routine nursing care (called custodial care) for those who can’t do basic life tasks. Medicare does cover skilled nursing care for up to 100 days but only under limited circumstances such as when you’ve just left the hospital.
Since your mother did just leave the hospital, you may want to appeal the denial of the skilled nursing care. If her doctor or care provider believes your mother needs skilled care, you should see if they will support your efforts to file an appeal with Medicare.
Medicare has information on how you can appeal a denial to try to get covered.
If your appeal isn’t successful, your mother will be considered a private pay patient. While she will not have her benefits seized, she will be billed for nursing home care and expected to pay the bills. Nursing homes usually bill in advance, so she’ll have to cover her costs to keep her place.
If your mother cannot pay, the nursing home can ask her to leave with "reasonable and appropriate notice," if she’s not in the process of applying for Medicare or Medicaid.
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Medicaid does pay for nursing care, but she has to qualify — which means she can’t have countable property or resources above $2,000.
Once she is on Medicaid, she will be required to send her Social Security checks to the nursing home, minus a personal-needs allowance and minus other insurance premiums she may be paying.
In 1972, the PNA was set at a minimum of $25 per month, which was raised to $30 per month in 1987. That $30 amount remains the federal rule, but states can set higher PNAs up to $200 per month maximum. In 2024, PNAs averaged $70 nationwide, but ranged from $30 to $200.
So, unfortunately, based on the current rules, the nursing home can take almost all your mom’s money if she isn’t successful at appealing and getting Medicare to cover her skilled care, but she still needs to be in a home.
What can you do if this happens to you?
The best thing to do to avoid this happening is to be prepared for the chance of going into a nursing home by buying long-term care insurance.
The National Association of Insurance Commissioners has a guide to buying long-term care insurance that can help you find the right policy.
If your mom didn’t do that, you unfortunately don’t have a lot of options.
You can try to reach out to the mortgage company and other creditors to see if they will put payments into forbearance while she is in the nursing home. They may be willing to work with you if the situation is temporary. If you can swing it, you can also pay those costs yourself.
However, if you are trying to qualify for Medicaid to cover her nursing home and you want to keep the house, you may also need to create an intent to return home document.
You’ll need this to allow your mother to keep the property without being disqualified from Medicaid because of its value. You also need to be careful about giving her too much financial help that could put her above the $2,000 asset limit.
While your mother’s primary home doesn’t count as an asset that disqualifies her from Medicaid, the house wouldn’t be considered her primary home anymore if she was living in the nursing home instead.
And, even if the house is her primary home, there’s no exception to the Medicaid eligibility rules that allow her to keep extra money for property taxes, insurance and other homeownership costs.
So, as you can see, things get complicated — especially if you’re trying to bring Medicaid into the mix to cover the nursing home cost.
You can always choose to talk with an elder law attorney to help you appeal the Medicare denial or see what can be done to protect your mom’s assets, but nursing home planning usually needs to begin long before the time care is needed.
If your mother’s benefit checks are big enough to cover the nursing home, and if you can put payments on her other debt and on her mortgage into forbearance, that may be your best bet if the situation is really temporary and she hopes to return home.
If the nursing home costs too much and she can’t afford the fees, looking into a home health aide could be an option, too.
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This article provides information only and should not be construed as advice. It is provided without warranty of any kind.