Does a Live-In Caregiver Affect Your Assisted Living Reimbursement
Sep 11, 2024
Running a residential assisted living facility requires numerous considerations, including the reimbursement model. As a facility owner or manager, it is important to understand how different caregiving arrangements affect your finances. One common topic is whether having a live-in caregiver affects your reimbursement rates and overall financial plan. This blog will explore this topic, illuminating the financial implications of hiring live-in caregivers for your senior living home.
Live-in caregivers give continuous care, resulting in a more stable and consistent environment for residents. This approach benefits the residents and the facility by ensuring that care is always available, improving resident happiness and outcomes. However, it is critical to consider how this caregiving model affects your reimbursement from insurance companies, Medicaid, or other funding sources. Understanding these consequences might help you make more educated decisions about your staffing and care models.
Throughout this blog, we will explore the nuances of payment models, how live-in caregivers impact them, and what this implies for your assisted living facility. We'll review the potential benefits and drawbacks, allowing you to consider the pros and cons of hiring live-in caretakers.
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Understanding the Reimbursement Model
Before we get into the specifics, let's clarify the reimbursement model in assisted living. There are several ways you can get paid:
- Private Pay: In this payment method, residents or their families directly pay the assisted care facility for the services delivered.
- Medicaid: Residents who qualify for Medicaid can have their assisted living expenses reimbursed by daily rates billed to Medicaid or a third-party service provider. In addition, rent payments are collected based on the residents' Social Security numbers to repay any outstanding charges.
- Medicare: It should be noted that Medicare does not cover the price of assisted living services for residents.
- Long-Term Care Insurance: This payment mechanism is part of the private pay model and can compensate residents for long-term care insurance plans, which can help cover the expenses of assisted living services.
Impact of Live-In Caregivers on Reimbursement
Let's address the main question: Does having a live-in caregiver impact your reimbursement model?
Private Pay
When it comes to private-pay residents, there is typically no impact on your rates. However, the presence of a live-in caregiver may allow you to charge more. Many families value the security and individualized care a live-in caregiver may provide and are ready to pay more for these extra services.
Medicaid
Staffing models do not impact Medicaid reimbursement. Instead, Medicaid ensures that necessary care and coverage are delivered in line with regulations. As long as facilities follow Medicaid rules, their compensation will not be affected.
Long-Term Care Insurance
Again, there is no impact. When it comes to long-term care insurance reimbursement, the same considerations apply as they do for private pay. This means that having a live-in caregiver should not impact the reimbursement procedure. Essentially, the existence of a live-in caregiver has no bearing on how long-term care insurance reimbursement is calculated.
The Family Factor
However, there is an important exception about family members providing care. According to federal law, reimbursements cannot be paid for services provided by people who are legally obligated to care for the individual. This means that family members who are legally required to give care cannot be reimbursed for their time and effort.
While this may be irritating for people who require financial recompense for their caregiving responsibilities, it is critical to understand the requirements. However, there are provisions for special care payments if the amount of care required is beyond the regular scope of assisted living facilities. If you find yourself in this circumstance, it's critical to investigate your options and push for the help you need.
Getting Involved
If you are passionate about this topic, you should consider joining advocacy organizations that are actively fighting to change the legislation. Your active participation and support may help shape legislation that improves support for family caregivers and ensures they get the recognition, financial support, and resources they need.
Final Thoughts
When considering the impact of a live-in caregiver on your private pay, Medicaid, or long-term care insurance reimbursement model, remember that it does not usually have a direct influence. However, it is critical to be aware that family members who provide care may face reimbursement restrictions under federal law. Navigating these laws carefully is essential and looking into available possibilities for unusual care payments, if appropriate, can be a helpful step in ensuring that all parts of care are effectively covered.
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Show full transcript 👇
Transcript
00:00:00
hey friend it's Brandon Gustafson with Assisted Living investing excited to have you here on the channel our topic for today's video is does having a living caregiver impact your reimbursement model when you're running a residential assisted living facility if you're interested in learning about that make sure you stick around for today's [Music] video hey friend I'm Brandon guson I own and operate two assisted living facilities and I created this channel to help people just like you learn the in
00:00:30
an ounce of assisted living welcome to Assisted Living investing before I get started on the topic today which is does a living caregiver impact your reimbursement model I wanted to remind you to get over to the website Assisted Living investing. netcc we'll link that down below in the video description H we'll get you your free underwriting calculator to help you through your investment journey and help you get through all of this so that you can be successful and reach your investment
00:00:59
goals let's get into the topic of today's video again we're talking about does a living caregiver impact your reimbursement as you're operating your assisted living facility now to answer this question I want to make sure you have a good understanding of what the reimbursement model looks like in Assisted Living there's a few different ways that you can get paid here there uh there's private pay which is is something where you're you're working directly with the person to to get paid
00:01:26
from them directly there's Medicaid as well and I've done videos on this so make sure you go and watch that but Medicaid is somebody that uh qualifies for Medicaid and gets um gets on to Medicaid and then they you you get reimbursed from Medicaid um actually get reimbursed by a few different ways one is a daily rate that is buil to the Medicaid provider um service provider and that could be Medicaid itself or it could be a third party um and you also are collecting a rent amount based off
00:01:54
of social security from your resident so you get paid twice with Medicaid again make sure you go watch that video um and I go deep into that and then Medicare actually Medicare and I've talked about this before as well Medicare does not work with Assisted Living um it's actually not a covered service for Medicare so you want to be aware of that long-term care however is if somebody has long-term care insurance you can get re get reimbursed for that it kind of falls into that private pay method of of
00:02:22
doing things though so you just want to be aware that that's kind of what you're working with on that now let's get into the impact of how this is going to impact you if you are a living caregiver is going to have the impact on your reimbursement model let's first talk about private pay the answer is no there's no impact on your rates with private pay residents at all you're able to do this actually you might be able to charge a bit of a premium because people want to have you
00:02:49
in the facility with their loved one and having a living caregiver in their mind makes it feel like it's a little bit more secure and and then you're going to give them the love that they that they need so no impact at all uh for a private pay model now let's talk about Medicaid is there any kind of impact when you are doing this with a Medicaid resident no there's no impact here either um you're still going to be able to collect the the the money that you would otherwise even without a living
00:03:19
caregiver um really what Medicaid is looking for is are you providing the cares that are necessary providing the coverage that is needed um and required for an assisted living facility and are you kind of complying with the rules and regulations if you are they don't care if they're a living caregiver or you are bringing people in and kind of a different Staffing more traditional Staffing model it's not going to matter to them you're going to be able to to track all of the cares that you're
00:03:45
providing and make sure that you are um doing what you need to do as a caregiver but Medicaid is not going to it's not going to have any impact on them either same thing with long-term care again it's kind of a part of this the private pay uh world it's not going to impact any type of reimburse model there so there is absolutely no impact um in the states at least that I operate in you could probably double check this with the states that you're working in just to be on the safe side but there's no
00:04:11
impact on having a living caregiver on your reimbursement model in assisted living now if you are in a state where this does impact that make sure you comment that down below because I'd love to hear about it and do a little bit more research and I think other people would be get would love to hear that type of information as well you but now let's get into a part where there is a little bit of a hairy situation and this is working with families and have to be a little bit sensitive here because um I
00:04:42
think it's a bit touchy for for people to think about this when you think of your loved one you think about your family member who is uh going through this phase of life where they need assistance your first impression is I want to help them I want to provide them with the care that they need and this can be really difficult for you uh because it takes a lot of time to provide appropriate care for people I was actually as I was filming this video my grandpa who lives across the street from me um and he has Parkinson's um I
00:05:11
he called me because he needs some help um getting the brakes changed on his car now he's he's pretty mobile um but he's getting up there in age and and struggling with things and needs help so he he called me and so I'm going to have to um step away from work and step away from all the things that I have going on today and go do that and I don't mind it uh I I'm I'm happy to go and serve him and help him out um that's part of the reason why we live here across the
00:05:34
street from him but it's also something that it's timec consuming and if you're doing this on a regular basis um you just kind of have to be careful with that so can you do this when you are working with family there's actually a federal law around this and what it states is that reimbursements cannot be made for services performed by persons who are legally required to care for the IND individual and as a family member you fall under that you are legally obligated required to care for that
00:06:07
family member so you don't get reimbursed for it that that's kind of how that works which is can be frustrating for for some people that might need that cash you know you I am not in any way telling you to take advantage of a system here if you were able to get reimbursed that is not the purpose of this at all Full Stop period um what I'm trying to tell you is if if you are doing this and you're caring for loved ones you're not going to be able to to get paid for the amount of time
00:06:35
that you're putting into it despite how much time it might take you to care for them it's not not allowed it's a federal law however there can be extraordinary care payments that that come that can come through and that is in the event that uh you're having to do something that is beyond um a normal level of care uh the types of care that you would provide in an assisted living facility is what you would call a normal level of care if you're going above and beyond that then there's going to be a level of
00:07:03
reimbursement that can happen and you want to look into that if you're in that situation you need to know a little bit more about this and you're not getting reimbursed by the time for what you would think is extraordinary care U make sure you're talking with people and figuring out the process there I also know that there are a few different organizations that are trying to change the law here there's a bunch of different advocacy groups and so if you go online and search for um advocacy
00:07:27
around caring for family members um something along those lines you're going to find some of these groups and if this is something that you're passionate about I'd encourage you to go in and um kind of get involved in those those types of groups because there there's there's a level of care and a level of love that you have for your family member and uh and the level of care that you're going to provide is frankly probably going to be better than the level of care that they might receive in
00:07:52
an assisted living facility because of the amount of love that you have for them and so uh you know you might might think you might um feel like you should get reimbursed for the amount of care that you're providing to them uh that's something up to you but I wanted to just kind of make you aware that while there is no impact on a living caregiver in a facility there is a bit of a hitch in that when you're dealing with family members so want to make sure that you are aware of that to recap today's video
00:08:20
we've been talking about does the reimbursement model get impacted in any way if you have a living caregiver at a facility the answer is no it doesn't matter if you're private pay uh Medicaid um if you're working with somebody with long-term care insurance that's not going to matter at all with the exception that if you're working with family members then they're you're not going to get the the reimbursement there um with that one so just want to kind of make you aware of that if you found this
00:08:44
helpful make sure you like this video subscribe and ring the bell so you get notified every time we put this content out here and also get over to the website Assisted Living investing. net and if you go to uh the link down below you'll get access to our free calculator which will help you out on your invest Journey does residential Assisted Living sound interesting to you but you don't know where to get started at Assisted Living investing we're here to help you through the process start to finish
00:09:07
thanks for watching and have a great [Music] day
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