Long Term Care

Making the choice to enter a long term care facility for yourself or loved one can be challenging and overwhelming.  Briefly described below are the various levels of senior housing, services and financial responsibility offered by some of the most common care facilities. 

Long Term Care Facility Options

Some important things to think about when visiting care facilities:

  • quality of care
  • the number of staff and responsiveness of staff
  • the cleanliness of the facility
  • level of family involvement

Assisted Living - Appropriate for seniors who may need help with bathing, dressing, medication, etc. Senior assisted housing combines lodging and various personal support services, such as meals, housekeeping, laundry, and shopping. Assisted living benefits seniors who need regular help with daily activities but do not need nursing home care.
Continuing Care - Appropriate for seniors who want to provide for health needs as they age without having to relocate. Continuing care communities, also referred to as "life care communities," provide services specified by contract, usually for the remainder of the resident's life. The types of services provided range from housekeeping services to skilled nursing care.
Nursing Care - Appropriate for seniors with deteriorating mental or physical abilities or having great difficulty with daily activities. Nursing care communities provide residential medical care for the aged who need continual attention.
Alzheimer’s Care - An Alzheimer's Unit is secured within a care facility for individuals with Alzheimer's and other forms of dementia. Their goal is to maintain quality of life for residents as their needs change, through the course of their disease.
Rehabilitation Care - Rehabilitation centers offer many different services, including physical, speech and occupational therapy. Many who attend a rehab program have disabilities or ongoing medical problems, while others are recovering from an accident or a medical incident such as a stroke. Rehabilitation centers are often affiliated with another health care organization, such as a hospital or nursing home, although they can be separate, free-standing facilities.

Paying for Long-Term Care and Insurance

The most important thing to remember is that Medicare will NOT pay for most long term nursing facility care, because  most nursing facility stays are considered “custodial care” (meaning no active treatment is being made with a goal of curing a disease or condition).  That means that families typically have to pay out of pocket for nursing services. It will cover costs if your loved one is sent to the hospital, and for short term rehabilitation following a hospitalization (usually 21 days or less).  Low income seniors may qualify for Medicaid or a welfare program (See resource below.) This leaves two options.

Admission Agreements/Contracts to Pay Privately for Care:

The resident and/or family members will be required to sign an admission agreement that includes both an upfront deposit (at least a minimum of one month’s stay) plus a requirement that someone be the responsible party (i.e. they are responsible for paying the bill and can be sued for breach of contract if they do not pay.) Most facilities will not allow your loved one who is now the resident in the home to be the only responsible part; however, family members may NOT be held financially responsible for their loved one and do not have to sign paper work stating that they are. (This also is a time when it is important for someone, be it family or friend, to be appointed the Durable Power of Attorney for the loved one.  That way they can access the loved ones funds and use them to cover the cost of care.)
Long Term Care Insurance Policies

These policies can provide a means to cover some of the costs of care.  Remember that all long term care insurance plans are not the same.  Keep a copy of the policy in a safe place and review it to understand exactly what it does (and does not cover.) Some older plans require a hospitalization of three days or more before your loved one is covered in a nursing facility.  The amount paid per day can vary widely depending on the plan.  Most plans will not cover the complete cost of care.  Many plans have a limit on either the number of days covered or the amount that can be paid out for nursing facility care. Either way, long term care insurance can be a great help in covering the cost of care.


The two most frequent questions asked by family members who are arranging long term care for their loved one are:

What do we do when she/he runs out of money?  

In this case, your loved one may be eligible for Medicaid. Unlike Medicare, Medicaid will pay all expenses for skilled nursing home care indefinitely for qualified persons (through their monthly income, less for personal items, must be paid to the nursing home; Medicaid pays the difference between the person’s income and the total bill each month.) The loved one must be in a Medicaid certified Vendor bed.  The Medicaid Program is administered by the Missouri State Family Support Division (FSD).
Where do I go to apply for Medicaid?

As soon as your loved one is residing in a Medicaid Certified Vendor Bed (either going directly there from the hospital or their home, or having moved from a private pay bed to a Medicaid bed, you need to apply in person at the Family Support Division office in the county where the nursing home is located (not where your loved one’s home is.)

Missouri Department of Social Services

St. Louis County

Franklin County

Jefferson County

St. Charles County