We understand how overwhelming this all can be...

There are several options when it comes to residential care:

Independent Living:   Often this is a planned community that offers maintenance-free housing, dining services, scheduled transportation, and social activities designed for active older adults.

Assisted Living:   Housing with 24/7 assistance, support for activities of daily living, and support services like medication management, transportation to appointments, in-house provider appointments, activities and more.  While a Director of Nursing often oversees care in these communities, this is not 'Skilled Nursing.'

Skilled Nursing:  Some residents have needs that require skilled nursing (wound care, ventilator care, fragile diabetics, etc).  Sometimes this is short term and when the skilled care is no longer needed, residents can return home or to Assisted Living.

Rehab & Post Acute:  After an illness or injury, a patient may be discharged from the hospital, but not ready to go home.  Maybe they need therapies to help them regain strength or increase independence - Rehab and Post Acute facilities are short term and help patients reach goals and plan for next steps.

Long Term Care:  This is a bit of a cross between Assisted Living and Skilled Nursing where nurses are available 24/7 and is, as its name implies, a long-term placement.

Home Health:  Maybe someone isn't quite able to live independently but doesn't need full-time care a residential placement would offer.  With adequate supports (medication management, meal prep, help with bathing, etc), some people are able to continue to live safely at home.  

None-medical home "care:"   These are non-skilled individuals that provide support and/or companionship.  Shopping, housekeeping, errands and transportation are among services provided.

Medical Insurance:  (Medicare, Medicaid, private insurances; Blue Cross/Blue Shield, Aetna, Cigna, etc.).   Plans vary, some have high deductibles, some have co-pays*, some have co-insurance*, some are HMO's, etc. but WHAT they do and do not cover is basically the same.  They cover (again, with copays, coinsurance, deductibles, out of pockets, etc.) hospital stays, provider visits, limited rehabilitation days, limited skilled nursing days.  They do NOT cover Assisted Living.  Unless you have a Assisted Living policy (purchased separately, most people don't because they are very expensive), medical insurance doesn't cover Assisted Living. 

Medicaid:  Medicaid (In Arizona, this is also known as AHCCCS - Arizona Healthcare Cost Containment System) covers doctor visits, hospital stays, ER visits, etc.  It is medical insurance for people that qualify financially (lower income).  

ALTCS:  (Arizona Long Term Care System) falls under Medicaid.  Individuals must qualify financially AND qualify medically.  ALTCS pays a large portion of Assisted Living costs.  This can be very helpful for individuals who are going to need Assisted Living long term.   If the patient has another source of income, their ALTCS case manager will consider how much income they receive (for example, social security benefits) and let them know what their shared cost for an assisted living stay will be.  Example:  Someone earns $2000 a month in Social Security, they qualify for ALTCS.  ALTCS will pay towards the Assisted Living monthly rate, and the resident will pay about $1850 a month towards the rate.  This varies of course based on income.

RBHA:  (Regional Behavioral Health Authority) - individuals with an SMI (Serious Mental Illness) diagnosis may qualify for RBHA under Medicaid.  This can help to pay for residential supports, and more.  Someone cannot have ALTCS and RBHA at the same time.

DD:  Developmentally Delayed funding - also through Medicaid.  Someone cannot have both DD and ALTCS funding.  DD can pay for supported housing as well.

*co-pay / co-insurance:

Copay:  a designated amount the insured owes for things like prescriptions, doctor visits, hospital stays.  It is a set dollar amount, for example:  $40 for a doctor visit.  Co-insurance is a percentage, often 20% under most plans.  Instead of having a $40 copay, you would owe 20% of the physician bill after you meet your out-of-pocket costs.

The information provided is for informational purposes only and not intended to be used as advice.  There is a lot to consider when choosing a community for a loved one and there are a lot of insurance options as well.

Everlasting services cares about our community and those searching for answers.  If we can help, we will do our best to do so.

For articles that have more information about resources, funding, etc. click here:

 BRAIN INJURY ASSISTED LIVING Videos and Articles 

If you are considering Assisted Living and want to learn more or apply for ALTCS, please feel free to utilize the link below.

ALTCS application:  

 DE101andDE202.pdf