What a nursing home really costs, and how families pay for it

Industry cost surveys in recent years have generally put private-pay nursing home care in the neighborhood of $9,000 to $12,000 per month, with large differences by state, room type and level of care. Treat any national figure as a starting point and get written rates from the facilities you are considering.

Only partly and only for short-term skilled care. Original Medicare Part A can cover up to 100 days per benefit period in a skilled nursing facility after a qualifying 3-day inpatient hospital stay, with a daily coinsurance from day 21. It does not pay for long-term custodial care.

Medicaid is the largest payer of long-term nursing home care, but you must meet strict income and asset rules, and the facility must accept Medicaid. Most of your monthly income goes toward the cost of care, and the state pays the rest.

When you apply for Medicaid long-term care, the state reviews transfers of assets made in the previous 60 months (five years) in most states. Gifts made during that window can cause a penalty period of ineligibility.

Use Medicare's Care Compare tool to see star ratings, staffing data and inspection results, then read the full state inspection reports and call your local long-term care ombudsman. Visit in person at different times of day.

Federal rules prohibit a facility that participates in Medicare or Medicaid from requiring a third party to personally guarantee payment as a condition of admission. You may be asked to sign as the resident's representative, so read the wording closely.

Facilities can pursue involuntary discharge in limited circumstances, including nonpayment, but they must give proper written notice and a safe discharge plan, and residents have the right to appeal. Contact the ombudsman right away if you receive a notice.

If significant assets, a home or a living spouse are involved, a certified elder law attorney can help you avoid errors that trigger penalties. Many offer a first consultation, and your local Area Agency on Aging can suggest resources.