When it comes to insurance policies, there tend to be guidelines when it comes to whether or not someone will qualify to have coverage for residing within an assisted living facility. This is true of most types of senior care in general.
As a general rule, in order to qualify for care, assistance with the activities of daily living is needed. This includes the everyday things that we typically take for granted, such as moving from one room to another, using the bathroom, bathing and grooming oneself, and eating. When needs of this sort are present and they cannot be accomplished alone without risk of harm or injury, that individual typically will qualify for senior care.
Please note that these qualifying factors often vary from state to state. What applies in California doesn’t always qualify in other parts of the country. If you have questions about coverage under your insurance, it is important to speak with a professional that is knowledgeable of your coverage and your situation.
When it comes to self-pay assisted living, the rules are not quite as strict. Yes, there are guidelines in place that can help a family to better determine whether or not this is the right service for you. But when it comes to qualification, they are much less strict because of the payment methods. Medicare and Medicare have qualifiers for their services in order to determine whether or not they will pay the fees associated with care. They must do this in order to prevent paying for unnecessary services so that as many people as possible can have access to this kind of care.
Assistance with the activities of daily living is typically needed to qualify for assisted living.
With that in mind, some care facilities do have restrictions in place, even for those that pay for their own care out of pocket. This happens for the exact same reasons–there is often such a demand for care compared to the availability of it that some businesses do find it necessary to limit their services. Now, this potential for a care shortage is an ongoing issue, but one that most communities are very much aware of. Resolving a care shortage is something that each community needs to address in a manner that works for them. It’s an issue that needs to be addressed on both the macro and the micro level.
Regardless of what you might be looking for when it comes to care, odds are you’re going to start by looking at what’s available nearby. The sooner you start the search, the likelier you are to be successful.
Additionally, you probably have questions about care and how it might help your family. Assisted living is a wonderful service, but it’s not the only type of care out there. If you have questions about care, your family’s unique set of circumstances, or any of the nuances that come along with care, please feel free to reach out to us. We offer a free consultation session that is designed to help answer all of these questions.
We’re here for you. Please feel free to reach out to us today to talk more.
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