What Does A Nursing Home Cost in Philadelphia, Pennsylvania?

10 Nov What Does A Nursing Home Cost in Philadelphia, Pennsylvania?

Understand what factors into the cost of a nursing home in Philadelphia, Pennsylvania. Learn how you can prepare for costs and pay for care needs.

For seniors and individuals with disabilities, there are many considerations when it comes to evaluating care when you or a loved one needs extra help. From assisted living, home care, or around the clock nursing home care plus other options among them, care recipients and their loved ones can find a wide range of price points and available services to fit their needs. Some solutions may even combine or be a hybrid of different services delivered in tandem. 

Understandably, the cost of care is a huge consideration when weighing care options. Nursing homes are a common option for seniors, especially if they need intensive care. Home care is another choice for many elders. It can be a stepping stone between being at home and having regular care as a nursing home resident. Naturally, the ability to age in place at home and remain independent for as long as possible is ideal.

Home care can offer lower costs plus built-in flexibility as compared to a nursing home. However, you will have to see what option is right for you and your family, as there is no one size fits all for potential care recipients. For some scenarios, only the regular hands-on help of a nursing home will do. In this guide, we will review what the services of a nursing home cost in Philadelphia, Pennsylvania. Plus, we will look at how nursing home care can be paid for and what health insurance will and won’t cover. Finally, we will evaluate alternatives such as assisted living, home care, continuing care retirement communities (CCRC), and adult day care. Plus, we will look at what the future of nursing home costs may be. 

Nursing homes explained

When looking at nursing home costs, it is important to know what a nursing home is and what it is not. The term “nursing home” is often used broadly and in the context of other terms. It can mistakenly be used in reference to comparable but distinct services of their own, like assisted living facilities, residential facilities, senior living, or continuing care retirement facilities (CCRC). 

A nursing home is a residential facility for individuals that don’t need to be in a hospital but are unable to be cared for at home. Generally, many nursing homes have skilled nurses and nurse aides available to assist 24 hours a day. Some nursing homes look and feel differently from each other. Some are set up and designed like a hospital. Staff provides medical and health care. They also offer physical, speech, and occupational therapy services. They could have a nurses’ station on each floor as well, for example. Different nursing homes try to create more of a home-like vibe and setting for their residents. They attempt to recreate a neighborhood feel. Usually, there is no fixed daily schedule. Plus, kitchens may be open to residents. Due to the live-in and intimate setting of the facility, staff members  often develop relationships with the residents.

Specialized care

A team of nurses assist a senior in a long term care facility.

Additionally, some nursing homes are equipped with special care units. One common care unit is designed for individuals with serious memory problems like dementia or Alzheimer’s disease. Others allow couples to reside together. One common myth is that nursing homes are only for seniors and older adults over the age of 65. However, nursing homes serve a variety of individuals. They serve anyone that may need 24-hour care, like those that have physical disabilities.

Read more of our senior care resources:

• Get Paid to Care For A Loved One in Pennsylvania: A Guide
• How Much Does Home Care Cost in Philadelphia, Pennsylvania?
• 5 Technologies to Combat Senior Loneliness

Cost overview

When evaluating nursing home costs, we will specifically focus on both private rooms and semi-private rooms in which an individual may reside. 

Private room

A private room is a room that has complete privacy from others. In other words, the resident lives in that room alone and does not share the space with anyone else. The bathroom, though, may be an enclosed bathroom inside of the room. It could also be a shared bathroom space with one or more individuals. Inquire into potential facilities for more information. 

Semi-private room

A semi-private room will be a shared living space with others. It may only have one roommate residing in the room. In other cases, there could be even more roommates. As you might imagine, a semi-private room tends to be lower cost due to the trade off in privacy. 

In Pennsylvania the average cost of a nursing home is $9977 per month in a semi-private space, and $10,463 in a fully private space, according to Genworth’s cost of care study. Pennsylvania does have significantly higher rates than the average US cost or nursing home care ($7513 for a semi-private, $8517 for a private).. 

It is important to know that specialty units, such as memory or dementia care units, will almost certainly have higher costs. 

Costs will continue to rise

The rate of nursing home care costs have risen considerably over the past few years and are projected to continue rising greater than the rate of inflation going forward. According to the Centers for Medicare & Medicaid Services, the total increase in nursing home care expenditures during the next ten years is expected to be around 5.1% per year. That is higher than the expected rate of inflation, which tends to be around 1.5 to 2% per year. 

There are varying factors that have created upward pricing pressures on the nursing home industry. Most notably, labor issues are front and center. A lack of supply of providers of care, including nurses and aides is one. Increasing minimum wage around the country along with more competitive wages from the likes of employers such as Amazon and Walmart are causing nursing homes to increase wages to sufficiently staff their organizations. This impacts nursing homes because a majority of the working are nursing aides, which is an entry level role. Plus, registered nurses are also in short supply. Finally, increases in the costs of land, rent, and food supplies is another. 

Paying for care

Nursing homes have been badly hit during the COVID-19 pandemic. However, in general, nursing homes are generally very safe and have taken tough measures to keep their residents safe. Plus, there will always be a need for high-quality nursing home care. Below, we discuss the options for people paying for nursing home care. 

Private pay: Many individual clients pay for nursing home needs from their own savings or assets, or those of their families. Sometimes family members will pool resources in order to contribute to care needs. Often, seniors or their family members may also sell certain assets that are no longer used or which may be needed to properly finance ones care needs. Finally, accessing home equity is another common option through a reverse mortgage or a home loan. 

Private Insurance: Insurance will cover nursing homes, generally speaking, under long term care (LTC) insurance. However, for those in need of benefits and care immediately, they will most likely be unable to purchase care insurance and be denied coverage. If it is possible, it will most likely be cost prohibitive. LTC can be an excellent option, but only if doing long term planning. 

Medicare and Medicare Advantage: Original Medicare will pay for nursing home care, but only under certain conditions.

Both Medicare and Medicare Advantage will cover care, including custodial care received in the skilled nursing home for a limited time period. The following conditions must be met:

• The care is directed to recovery from an injury or illness, and not for a chronic condition 
• It must be preceded by a hospital stay of at least three days.

Medicare provides limited coverage of nursing home costs in Philadelphia.

For the initial 20 day period, Medicare will cover 100 percent of the cost. Over the following 80 days, Medicare pays for 80 percent of the cost. Any nursing home care beyond 100 days will not be covered.

Those that have a Medicare Advantage plan will have the same coverage as mentioned above. Some plans go above and beyond that, and may cover additional services or care needs. For those with Medicare supplemental health plans, they may be able to get additional assistance towards covering the costs associated with nursing home care. Some plans available will pay for 100 percent of the coinsurance payment required by Medicare. If this is the case, then 100 percent of the cost of the nursing home care for 100 days will be covered. 

Medicaid: Medicaid is an insurance program for low income individuals. Medicaid coverage is determined at the state level, so Pennsylvania manages Medicaid coverage and support for nursing homes. Many individuals rely on nursing home care support through the state Medicaid program. However, the nursing home stay must be deemed medically necessary by a doctor. That means that the doctor will need to certify that you have a condition that requires more care than just room and board.

Keep in mind that there are strict eligibility requirements, and that there is generally a long waiting period for benefits to be active. That being said, the Medicaid waiver program is an excellent option for those that qualify. It will help to provide nursing home care and a long list of services for those who qualify. An alternative program is known as the Medicaid waiver program. This does not pay for nursing homes, but it can pay for care provided at home.  Check out our comprehensive guide on medicaid waiver benefits in Pennsylvania. 

Veterans programs: There are several forms of assistance and benefits from the Department of Veterans Affairs (VA). Three different pension benefits are available and you can view them in more detail here. 

Nursing home costs compared to alternative options

Evaluating Nursing home costs compared to alternative options can be tricky. For starters, services offered and what one values can vary. Also, nursing home care may mean that supplemental services are rendered at the same time compared to other options. Naturally, cost is a critical factor when evaluating options. Regardless of the extent of services received, care and support for you or your loved ones will almost certainly be a major expense. 

Nursing home versus at-home care:If you compare the cost of a nursing home to home care services, it will depend almost entirely on the amount of hours needed for home care. That is because nursing homes cover round the clock care, while home care can vary from a few hours a week to 24 hour care.  So, if one needs care at 20 hours per week, you can estimate local Philadelphia home care costs by multiplying 20 by the average cost of care ($24 per hour), and then multiply that by the number of weeks in a year (52). In this example, $24,960 would be the yearly cost of care. A comparable nursing home using our cost calculations above might run from $100,000 a year to $120,000 a year in many cases. Of course, the level of services received varies dramatically between them. 

Nursing home versus assisted living: Just like a nursing home, there exists various levels of assisted living options, so costs will naturally vary based on scope, location, and care needs. As an example, a private room at an assisted living facility will average $4000 a month, which is much lower of a cost than a nursing home. However, an assisted living helps with just activities of daily living, while nursing home care is more skilled and involves more high-complex cases. 

The benefit of receiving at-home care as compared to a nursing home is the flexibility in the coverage of one’s needs via their hours received. Accordingly, this will impact one’s costs. So while you can’t receive nursing home care part time, you can receive care in your home part time. Additionally, hours can be adjusted on short notice in most cases, which adds additional flexibility. These are important considerations to keep in mind when comparing costs. However, it must be mentioned that this is only a good option if the family member also has another level of support at home when a home care attendant is not available. This is because most nursing home candidates are in high need, so just having part time home care is usually not feasible if no other support exists. Depending on one’s situation, home care may not always be the most feasible or safest options. For example, in an assisted living situation, it is likely that one may only receive a few hours of direct care per day, but help and assistance will always be close by. 

Conclusion

In summary, cost considerations are understandably a major component of the care a senior received, whether it be from an institutional care center like a nursing home or an in-home care provider. While receiving care can be a major expense, the high level of care and complexity of an individual’s need might make a nursing home the safest and best option. Additionally, it is important to remember that paying more for quality nursing home care can pay dividends in the long term by providing both better quality of life and improved health outcomes, which can make a more satisfying and dignified life in one’s golden years.

Follow our insights for senior resources and tips to improve the quality of your loved one’s life, plus important tools and support for family caregivers.  Chosen Family home care is a Philadelphia based home care agency that will work within your care needs and budget to find the best option for you or your loved one. We provide caregivers for individuals in need but also work with a variety of nursing home facilities. Reach out to us today at info@chosenfamilyhomecare.com or call us at 267-457-4122 for a free care consultation and assessment. We will evaluate what your needs are and consider what the best options may be while determining what your coverage and care options are available.