Understanding Skilled Nursing Facility vs. Assisted Living Facility in Florida
A Radio Interview of Attorney John R. Frazier by Attorney Joseph Pippen
A complete transcript of the program begins below:
Attorney Pippen:
Let’s go to Attorney John Frazier. Good morning, John.
Attorney Frazier:
Hey Joe, how are you doing today?
Attorney Pippen:
Good. John is our Medicaid planning and VA Attorney. He calls in early on Sunday morning, to give us the Medicaid tip of the week. What are we talking about today, John?
Attorney Frazier:
Today I’m going to talk about the differences between a skilled nursing facility and an assisted living facility here in Florida (skilled nursing facility vs. assisted living facility). There are very many significant differences, and I think many of our clients are not aware of those differences. And I think some clients might even think that they’re actually the same thing. As a general principle, a nursing- yeah, sure.
Attorney Pippen:
John, first of all, why does that make a difference to somebody listening?
Attorney Frazier:
I’ve got about five to seven reasons why it makes a big difference. I was going to talk about all of those. I think the first distinction is that an assisted living facility is going to be more of an apartment-like setting. A nursing facility is going to be more of a hospital-like setting. And, some of the reasons for the confusion; I think one reason is that there may be different terminology in other states and we have many, many people here in Florida who have retired here from Northern states and other parts of the United States. And, I think that there’s different terminology in other states and different, possibly different classifications for these two different types of facilities. Another reason for the confusion is, for example, sometimes an assisted living facility is called Memory Care, and I’ve had a number of clients hear that term “memory care” and think it means nursing facility.
Here in Florida, Memory Care means assisted living facility, not nursing facility. Another term that you’ll sometimes hear is something called a “lockdown unit”. We see that only in nursing facilities. They may have an Alzheimer’s wing where there the doors are always locked. So, we have a “lockdown unit” which is another terminology issue that we see. There’s also different licensing requirements for the two different types of facilities. The licensing for hospitals, nursing facilities, assisted living facilities, clinical laboratories, hospice, residential treatment centers; that is all done by the Florida Agency for Healthcare Administration, also known as AHCA. And, nursing facilities and assisted living facilities actually have different types of licenses. It’s kind of like the difference between a doctor and a nurse; they’re both medical providers, but they have different training and different license, and they can only do certain things with those licenses.
Also, we have very significant cost differentials; a nursing facility on average here in Florida costs about $9,485 per month. I see between $7,500 a month and up to $17,000 a month. On the other hand with assisted living facilities, I generally see costs ranging from a low of maybe $1,500 a month to a high of about $7,000 a month, so that’s another major difference. Also, there are very, very significant Medicaid differences. One difference is that virtually all nursing facilities in Florida accept Medicaid. That is not the case for assisted living facilities. Only a percentage of assisted living facilities accept Medicaid. So, some people wrongly assume that their assisted living facility automatically accepts Medicaid, and that is not correct. You have to verify that with the facility.
Another very, very significant difference is that here in Florida; we have a waiting list for assisted living and community Medicaid type programs. And, if a person is either in an assisted living facility or going to an assisted living facility, there is a process that must be followed first, which involves the Area Agency on Aging. There are a number of these organizations throughout the state of Florida. And the person must, or the representative; it’s usually the power of attorney or the spouse, must complete a form with an interview with the area agency on aging, and the name of that form is the 701S Form. In order to bypass the waiting list, you have to get a score of a five on that form. If you get a score of a five, the waiting list is usually just 30 to 60 days for, even if the person is financially eligible, there’s going to be a waiting list for an assisted living resident.
On the other hand, if the person is financially eligible in a nursing facility, there is no waiting list. One of the similarities is that the financial criteria for qualification, for an assisted living and a nursing facility are exactly the same.
Another difference, for example, in a nursing facility is the amount of reimbursement from the governments. So Medicaid is a federal and state program, and there is a cost sharing between the federal and state government. So, if you have an unmarried person in a nursing facility, their entire monthly income will cover the entire cost of their care. And what they’re required to pay is called the Medicaid patient responsibility, which is their gross monthly income minus $130, minus anything that they pay for their health insurance premium. On the other hand, the Florida assisted living Medicaid program only pays between a $1,000 and generally up to $1,400 a month. So there’s a very, very significant difference there.
Another difference is the interplay between VA benefits and whether or not the person is in an assisted facility or a nursing facility. The, the primary difference involves non-service connected pension, which I’ve spoken about in a recent radio show. This VA pension for a veteran is $1,936 per month. For a surviving spouse of a veteran it’s up to $1,244 a month. So the person can have both Medicaid and this VA pension, and those extra dollar amounts are very, very significant, if the person is in an assisted living facility. However, if the person is in a nursing facility, those numbers don’t apply. If you have an unmarried veteran or surviving spouse on Medicaid, in a nursing facility, the maximum amount they can receive for that VA pension is only $90 a month.
And then, I think the final difference has to do with service-connected disability benefits for a veteran. If a person is disabled 60% or higher, they then are eligible for free care in a nursing facility, as long as the nursing facility has a VA contract. So that’s the basic summary of the differences between assisted living and nursing facility here in (Florida Skilled Nursing Facility vs. Assisted Living Facility).
Attorney Pippen:
John does the nursing home… How do they accept clients? They have to be recommended by a doc, to a doctor to enter into a nursing home for some major reason?
Attorney Frazier:
Oh, yes. There’s a form. It’s a medical form that is required to be signed by the doctor. It’s called a 3008 medical form. And that is required, so a person can’t just check into a nursing facility. It’s like going to a hospital; you have to be admitted by a physician.
Attorney Pippen:
And would, would a doctor recommend a nursing home that had a lockdown feature? Sometimes if the person just had memory care-
Attorney Frazier:
I normally just see that when someone has advanced Alzheimer’s or because unfortunately, some individuals with Dementia and Alzheimer’s have a tendency to wander. And you even hear about the stories in the news. Sometimes you’ll have an individual with Dementia or Alzheimer’s still living in the community and they’ll wander off and you find them on the other side of the county. Sometimes we have tragic situations where they end up walking into a pond or something like that and drowning. So it’s very, very important for some of those clients to have locked doors, and that’s called a lockdown unit in a nursing facility.
Attorney Pippen:
So I’m just wondering if a spouse went to a doctor and said, “look, I’m trying to get my husband on Medicaid and I would prefer he’d be in a nursing home because of memory issues. And, would you sign a form to allow my husband to go to a nursing home that has locked down features.” What would a doctor do in that case?
Attorney Frazier:
That’s very much a medical judgment. I think so. And it’s going to be on a case by case basis. I think Dementia and Alzheimer’s are really a continuum. Usually, at the beginning of the disease, the problems are not that significant and then, sometimes, those symptoms progress very slowly. Sometimes, they progress rapidly. So I think that, that would really be entirely up to the physician to make that determination (skilled nursing facility vs. assisted living facility), even regardless of what the spouse might want, it ultimately as a medical decision.
Attorney Pippen:
All right, John, how does someone contact you if they have Medicaid planning or VA questions? You give a free consult for a few minutes about issues like that. So how can they contact you?
Attorney Frazier:
The office number is (727) 586-3306, extension 104. My cell phone is area code (727) 748-5374. And my email address is John, john@attypip.com.
Attorney Pippen:
All right John, thanks for calling. I hope you have a great Sunday.
Attorney Frazier:
Okay. You too. Thank you very much.
Attorney Pippen:
All right, Thank you.
If you plan on hiring an attorney take a look at why you might want to hire Attorney Frazier.
Before you go check out our free Elder Law eBooks.