State Laws and Resident Contracts Govern Discharges
Unlike federally-regulated nursing homes, assisted living facilities (ALFs) are governed by state-level standards. This means that the rules regarding discharge for non-payment vary significantly depending on where the facility is located. Most ALFs are businesses and include provisions in their resident contracts that outline eviction procedures for non-payment. It is crucial for families to review these contracts carefully before signing.
The Critical Role of Proactive Financial Planning
Planning for long-term care costs well in advance is the most effective way to prevent a financial crisis. Experts in elder law and financial planning recommend discussing payment options and potential future needs long before they become urgent. Proper planning can help protect assets and secure a path forward if private funds are depleted.
Discharge Procedures and Resident Rights
Even in cases of non-payment, facilities must follow proper legal procedures. They cannot evict a resident without appropriate notice. Most states require a minimum of 30 days' written notice before a discharge can occur. This notice must typically include:
- The reason for the discharge (non-payment).
- The effective date of the discharge.
- Information on how to appeal the decision.
- Contact information for the local Long-Term Care Ombudsman.
Residents also have the right to a dignified and respectful transfer. The facility must provide a discharge plan, including recommendations for where the senior might live after leaving. Appeals can be filed with the state's licensing agency, and in some states, residents may have additional protections under landlord-tenant law.
Exploring Financial Assistance Options
When private funds are running low, several options can help residents and their families find alternative payment sources:
- Medicaid Waivers: Many states offer Home and Community-Based Services (HCBS) waivers that can help cover some costs of assisted living, particularly services related to personal care. However, these waivers typically do not cover room and board, and eligibility requirements vary by state. It is important to remember that not all facilities accept these waivers, and some may only have a limited number of beds available for Medicaid residents.
- Veterans' Benefits: The U.S. Department of Veterans Affairs offers the Aid and Attendance benefit, a pension increase for qualifying veterans and surviving spouses who require assistance with daily living activities. This benefit can provide significant financial support for long-term care expenses.
- Supplemental Security Income (SSI): Low-income seniors who qualify for SSI may receive additional income. Some states also offer an Optional State Supplement (OSS) that can help cover the cost of room and board in assisted living.
- Long-Term Care Insurance: For those who planned ahead and purchased a policy, long-term care insurance can cover a portion of assisted living costs, subject to policy terms and coverage limits.
How Assisted Living Differs from Nursing Homes
It is vital to understand the distinction between assisted living facilities and skilled nursing homes. While federal law and Medicare strictly regulate nursing homes, assisted living facilities do not have the same federal protections against discharge. This is why non-payment in assisted living can lead to eviction, whereas in a nursing home, a resident who qualifies for Medicaid generally cannot be discharged.
Taking Action When Funds are Low
If a resident's funds are dwindling, taking immediate action is crucial. Do not wait for the eviction notice. Begin by contacting the facility's administration to discuss the situation. They may be willing to work with you on a payment plan or provide information on local resources. Simultaneously, start investigating eligibility for state-specific programs like Medicaid waivers or supplemental income. Consulting an elder law attorney can also provide valuable guidance and ensure resident rights are protected.
Comparison of Paying for Long-Term Care
| Funding Source | Covers Room & Board? | Covers Medical/Care Services? | Key Considerations |
|---|---|---|---|
| Private Pay | Yes | Yes | Fastest and most flexible, but assets will be depleted. |
| Medicaid | No (typically, waivers only) | Yes (for eligible services) | Eligibility based on low income and limited assets; state-specific rules and waiver availability vary. |
| Medicaid (Nursing Home) | Yes | Yes | For nursing home level of care only; federal protections prevent discharge during application. |
| VA Aid & Attendance | Can help cover | Can help cover | For qualifying veterans/spouses; provides a monthly pension increase. |
| Long-Term Care Insurance | Yes (depending on policy) | Yes (depending on policy) | Requires pre-planning; policy terms dictate coverage amount and duration. |
| SSI & State Supplement | Yes (state supplement) | No | Provides basic income; state supplement specifically for room and board may be available. |
Conclusion: Planning is the Best Protection
Running out of money in an assisted living facility is a serious and stressful situation, but it does not automatically mean immediate eviction. While facilities can discharge residents for non-payment, they must follow legally mandated processes. The key to ensuring a smooth transition or avoiding displacement is proactive financial planning and a thorough understanding of state laws and available assistance programs. Resources like the local Area Agency on Aging or an elder law attorney are invaluable allies in navigating this complex process.
For more information and state-specific guidance on senior financial planning and resident rights, the National Consumer Voice for Long-Term Care is an excellent resource, offering advocacy and education for residents and families. You can learn more at theconsumervoice.org.
