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I Need to Receive Additional Care in a Nursing-Home, But the Medical-Insurance Said, “It’s Not Covered.”

Ailments requiring long-term care strike approximately 70% of the US population. Nursing-homes, the predominant venues of long-term-care, cost an average of $205 per day according to the US Department of Health and Human Services, for a semi-private room. While the majority of people believe nursing homes only provide care for the elderly, these facilities provide care to individuals of all ages. Some nursing-home residents need care for stroke or accident rehabilitation or the exacerbation of diseases-e.g. pneumonia, AIDS, influenza, or cancer. These types of illnesses can take weeks, if not months, to heal. The stresses of staying in a nursing-home include loss of income, living in a foreign environment, and healing time. Often, people forget to assess the financial costs of providing nursing-home care for family members or themselves. Unfortunately, medical insurance, usually, doesn’t provide the benefit of covering long-term-care costs. 

Nursing-home-insurance offers a security net for individuals wary of long-term-care costs. Policies covering inpatient nursing-home-stays give people the opportunity to heal without concern over paying for their care. Insurance underwriters have the option of creating these policies with specific limitations to the maximum amount of payment for consecutive days, the maximum daily benefit, or the requirements of the facility. Similar to medical insurance, nursing-home-insurance covers the cost of staying in a nursing home. 

Why Would I Pay More Than The Daily Charge? In addition to the base daily cost, the nursing home charges additional for medical supplies, procedures, or therapies completed during the stay.


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Rehabilitation Therapies

A. Ventilator/Tracheostomy Care- Millions of people find themselves in need of rehabilitation following an injury or illness. A person suffering from pneumonia may need an advanced care setting within the nursing home. For patients on a ventilator, the nursing home charges more for the increased acuity of care. Patients on a breathing-apparatus for an extended amount of time receive a tracheostomy. While on the ventilator, patients are unable to speak. A tracheostomy involves inserting a tube into the trachea through the front of the neck. This procedure is usually done in the hospital setting prior to transfer to a nursing-home. When respiratory therapists successfully wean the patient back to breathing on his own, the person may need speech therapy. Sadly, patients, who have a tracheostomy for longer periods, experience difficulties when trying to produce speech. Speech therapists work with these patients to learn to speak again. 

B. Speech- and Physical-Therapy- In a similar fashion, speech therapy may be required for people suffering from a brain injury. Brain injuries can result from accidents or strokes. Strokes occur when a blood clot occludes the flow of blood to an area of the brain. In certain stroke patients, the affected area of the brain may be the portion controlling the production of speech. Furthermore, producing speech requires the use of the muscles in the tongue and face. Physical therapists provide physical rehabilitation to patients. The amount of physical therapy can vary depending on the severity of the injury of illness. In the stroke example, a patient loses partial or total control of one side of the body. Physical therapists can prescribe and aide in exercises designed to help an individual regain control of the damaged parts of their body. 

C. Occupational-Therapy- Dependent upon the type of illness, some individuals may need occupational therapy. This type of therapy works to give patients skills needed for daily activities. Occupational therapists assist patients learn the fine motor movements needed to write and hold utensils. They work in conjunction with physical therapists to help people regain the ability to bathe or walk with prosthetic or assistive devices. 

Additional Supplies- The base cost of the nursing-home only covers the housing cost, food, and assistance with living. Unfortunately, unique wound dressings, comfort measures, and other medical devices aren’t covered in the daily cost of staying in a nursing-home. With the money saved by nursing-home-insurance, people can use their money for some of these needs. 

Procedures- Many people in nursing facilities suffer from infections and wounds in their bodies. One of the most notorious of these wounds remains stasis or pressure ulcers, commonly called bedsores. In these circumstances, wound-debridement—cutting away the necrotic tissue—may be necessary to stop the spread of bacterial infection. These possible procedures constitute another cost not included in the base daily cost of a nursing-home stay. 

Nursing-home-insurance can help pay for the additional costs of these types of therapies. It’s important for people to fully assess the amount of insurance needed prior to purchase. It provides a means to cover the cost of caring for a loved one while continuing to work and live. For the elderly and permanently disabled, who need permanent or temporary nursing-home-care, Medicare only provides a portion of the cost of living in a nursing-home. Any remaining costs become the responsibility of the individual in the nursing-home. This burden usually falls to a family member, who doesn’t have the financial resources necessary to pay for these expenses. 

It’s easy to see how the amount of financial cost can rise when someone needs long-term-care in a nursing-home. While no one plans for accidents or illnesses, the cost of being unprepared supersedes any costs in preventative measures. By choosing to purchase nursing-home-insurance, people have the opportunity to prepare for the future.