Reviewed by Carol Bradley BursackCarol Bradley Bursack spent two decades as a primary caregiver to seven elders. She’s the author of Minding Our Elders: Caregivers Share Their Personal Stories and a contributor to several other titles. Carol is a newspaper columnist, blogger, and writer. Learn more about her at mindingourelders.com.

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For low-income seniors with health issues who can no longer live alone, finding affordable care can be a challenge. Nursing homes are staffed by medical professionals and can offer long- and short-term round-the-clock care for seniors living with an illness or chronic condition. However, the cost of a nursing home can stretch to over $100,000 per year, according to Genworth’s most recent Cost of Care Survey. While prices for this type of care may push beyond the reach of many families, there are several financial assistance programs and options to help cut the costs of care for seniors with limited resources.

Key Takeaways

Nursing homes support the needs of individuals who require 24-hour medical care and supervision. They are staffed by trained medical personnel.
Medicaid covers nursing home care for low-income seniors. To qualify for coverage, seniors must meet functional and financial requirements.
The VA offers several care support options including nursing homes. Several programs provide financial assistance for care and access to VA nursing homes that can accommodate veterans’ medical needs.
Medicare will only pay for temporary skilled nursing care. A patient must get a doctor's order for this care and receive it in a Medicare-certified facility.

What is a nursing home?

Often, the term “nursing home” is used to describe any senior living community, but they differ greatly from assisted living and independent living facilities. Nursing homes are medical facilities designed to support the needs of individuals who require 24-hour medical supervision. These facilities are often staffed by medical personnel such as registered nurses (RNs), licensed practical nurses (LPNs), and occupational therapists (OTs) who provide medical care and oversee personal care services.

While some older adults only require a temporary nursing home stay to recover from an injury or illness, some may require long-term care. You may consider a nursing home if your parent exhibits signs of needing a higher level of care.

These can include:

Frequent falls or mobility issues
Cognitive issues like those related to dementia
Increased challenges with activities of daily living like bathing or dressing
Worsening symptoms due to a complex or progressive condition

Who pays for a nursing home if you have no money?

Families with senior loved ones who are low income have several options to help them pay for nursing home care, such as government-sponsored health insurance and veterans benefits. It can also help to consider ways to deduct some expenses on taxes. Depending on where your loved one lives, the type and amount of coverage may vary, but combining the following resources can help you create an affordable care solution.

The most common ways low-income seniors can receive assistance paying for nursing home care include:

Medicaid
Veterans benefits

Many families with a loved one currently in a nursing home may not have the financial resources to pay for care indefinitely. Those who anticipate running out of money to pay for care, should consider the following options to help them plan for the future.

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Medicaid

Medicaid provides health coverage to low-income and disabled seniors. The program pays for nursing home costs in a Medicaid-certified facility for qualifying individuals.^[01] Administered by individual states, Medicaid is a need-based program, which means an applicant’s income and assets cannot exceed limits set by their state. Additionally, an applicant must meet a level of care requirement specific to the state where they live.

Qualifying for Medicaid nursing home care

It’s important to remember that Medicaid varies from state to state and so will eligibility requirements. However, the following universal requirements apply regardless of the state your loved one lives in.^[02]

Applicants must:

Be a U.S. citizen (or qualified noncitizen)
Be a resident of the state in which they are applying

In addition, applicants must meet at least one of the following criteria:

Be 65+
Have a permanent disability defined by the Social Security Administration
Be blind

Additionally, applicants must meet medical, functional, and financial requirements.

Medical and functional requirements

Medical and functional requirements refer to an applicant’s need for care. States often require that a qualified senior need a nursing home level of care, and some states require a medical professional, such as a doctor, nurse practitioner, or registered nurse, to certify this need.

Individual state guidelines define what is considered a nursing home level of care, but usually a senior must require medical supervision and/or frequent skilled services performed by a medical professional. Examples include:

Injections
Wound care
Catheter care
Mobility assistance

While each state determines its own eligibility requirements, these guidelines usually include seniors who have a medical or cognitive condition that inhibits them from safely caring for their daily needs such as eating, bathing, and dressing.

Financial requirements

Because Medicaid is designed to help individuals with low income and limited assets, seniors must meet strict financial requirements to qualify. For example, numerous states have determined that a senior’s income must be below $2,742 per month with assets that equal less than $2,000 to qualify.^[03]

Medicaid clearly defines what can and cannot be counted as an asset.

Exempt assets include:

Primary residence
Personal belongings
One vehicle
Specific trusts

For seniors who meet the functional and medical requirements but fail to meet financial requirements, they will typically have to pay for care out of pocket. They may qualify for Medicaid after spending down their income and assets to meet their state’s financial limits. However, it is best to consult an elder law attorney to craft a personalized spend-down strategy.

For more information on long-term care Medicaid programs, find your state’s Medicaid page using this state Medicaid link finder.

Paying for alternatives to a nursing home using Medicaid waivers

Nursing home care is covered for all eligible seniors by each state’s Medicaid program.

Medicaid waivers extend comparable services to individuals who qualify, but availability and eligibility requirements vary by state. This may enable seniors with significant care needs to delay or avoid placement in a nursing home.

Medicaid waivers offer states the opportunity to create a variety of service options that are not available under Medicaid’s general federal guidelines. While each state is able to customize their waivers as they see fit, there are two waiver programs that tend to be the most common:

The Home- and Community-Based Services (HCBS) waiver is used by states to create community-based programs for individuals who can live independently but need support with daily activities. HCBS can include care in the home or in a Medicaid-certified assisted living community.^[04]
The Program of All-Inclusive Care for the Elderly (PACE) provides low-income seniors with a team of health care professionals. This PACE team helps individuals meet their health care needs while remaining in their own homes, rather than going to a long-term care facility. ^[05]

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Department of Veterans Affairs (VA) benefits

Veterans and their spouses have access to several benefits and long-term care services through the VA.

Veterans pension benefits

VA pensions provide qualifying veterans and their spouses supplemental income that can be used to help pay for the care they need.^[06]

The VA Pension provides supplemental, tax-free income for veterans and their families based on financial need.
The VA Aid and Attendance benefit is intended to offset the cost of personal care services for veterans and surviving spouses who already qualify for the VA pension. These additional funds can be used to pay for care services provided in a community setting like a nursing home or in a senior’s home.
Housebound benefits do not cover nursing home care but can provide additional funding for personal care services for a senior who lives at home.

It’s important to note that a veteran can’t receive Aid and Attendance and Housebound benefits at the same time.

To qualify for pension benefits, a veteran must meet service and financial requirements in addition to at least one of these requirements:

Be age 65+
Have a permanent disability
Be a patient in a nursing home receiving skilled nursing care
Receive Social Security Disability Insurance or Supplemental Security Income

Specific benefits may also have additional clinical requirements.

VA nursing homes

The VA operates numerous nursing homes for qualified veterans.^[07] There are several types of VA nursing homes, which include:

VA community living centers (CLCs). During a stay at a CLC, a veteran can receive skilled nursing and medical care in addition to support with daily personal care. CLCs are typically used for short-term stays.
Community nursing homes. A community nursing home allows a veteran to receive care near their home and family. The VA contracts with privately operated nursing homes where veterans can live full time while receiving round-the-clock skilled nursing care.
State Veterans Homes. Owned and operated by state governments, State Veterans Homes are certified yearly by the VA to make sure they continue to meet VA standards. Each facility provides skilled nursing care, domiciliary care, or adult day care services.

VA nursing homes often have long waitlists, so it pays to plan ahead. Find VA nursing homes in your area using the National Association of State Veterans Homes directory.

Medicare

Medicare is a national, government-funded health insurance program for individuals 65 and older. It is separate from a long-term care insurance policy. Medicare can often be used to pay for short-term skilled nursing care in a Medicare-certified skilled nursing facility after an illness or injury.^[08] It may also cover services like occupational and other rehabilitation therapies, either at a senior’s home or in a senior living community. However, how a senior pays for nursing home care when Medicare coverage ends will depend on their unique situation.

Medicare Advantage

Medicare Advantage is the blanket term used to describe Medicare-approved health insurance plans provided by private insurance companies. Though required to provide the same coverage as Medicare Parts A and B, these plans may differ from Medicare. While Medicare Advantage policy costs and conditions vary, they may offer some coverage options not available with regular Medicare.^[09]

It’s not common for a Medicaid Advantage policy to cover long-term care in a nursing home, but occasionally a patient may receive additional services or care if their insurance provider contracts with the nursing home.^[10] If your parent is enrolled in a Medicare Advantage plan, check with their plan provider to determine the coverage the policy offers.

Alternatives to a nursing home

Depending on your loved one’s care requirements, there may be more affordable alternatives to nursing homes that allow seniors to age in place. Families may use these options as a stand-alone solution or combine several to fit their loved one’s unique needs.

Living with family

For low-income seniors who require a nursing home level of care long term, continuing to live at home is probably not an option. But living with family could be an option, depending on the senior’s needs. Family can often provide support with activities of daily living, transportation, and social interaction.

Medicare may pay for temporary in-home health care for qualified seniors. Medicaid waivers are another option that can help qualified low-income seniors pay for in-home care services.

It is important to understand the needs of your loved one before making a decision about their care. It’s also important to be realistic about your family’s ability to provide care. Care solutions become limited if your loved one requires intensive care as Medicaid and Medicare do not pay for 24-hour care outside of a nursing home.

Residential care homes

Residential care homes offer a homelike setting where residents can receive personalized care services. While many of these communities provide similar services to assisted living facilities, they’re often a less expensive option, depending on location.

In some states, Medicaid may help pay for a residential care home for low-income seniors who meet the income and functional requirements. If you’re considering this option, it’s important to consult with the care home to ensure they accept Medicaid and are equipped to accommodate your loved one’s needs.

Finding assistance for your family

Community resources are available in most cities that can help people find and apply for assistance programs. Use this eldercare locator to find your local Area Agency on Aging.

If you’re unsure of where to start, one of our Senior Care Advisors can help you assess your loved one’s needs to determine if a nursing home is the right fit and explore payment options for senior living — all at no cost to your family.

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References

Centers for Medicare and Medicaid Services.Nursing facilities.
Centers for Medicare and Medicaid Services. Medicaid eligibility.
Centers for Medicare and Medicaid Services. 2023 SSI and Spousal Impoverishment Standards.
Centers for Medicare and Medicaid Services. Home and Community-Based Services 1915(c).
Centers for Medicare and Medicaid Services. Program of All-Inclusive Care for the Elderly.
U.S. Department of Veterans Affairs. (2022, October 13). VA financial benefits.
U.S. Department of Veterans Affairs. (2023, February 15). Residential settings and nursing homes.
Medicare.gov. Skilled nursing facility care.
Medicare Interactive. Medicare Advantage and home health.
Medicare.gov. Health care & prescriptions in a nursing home.

Meet the Author

Kevin Ryan

Kevin Ryan is a copywriter at OurParents. He has written about Medicaid and Medicare, and focuses on creating content for caregivers. Previously, Kevin worked as a freelance writer, a special education teacher, and a counselor for adults with developmental disabilities. He earned a bachelor's degree from the University of Colorado Boulder.

Reviewed byCarol Bradley Bursack

The information contained in this article is for informational purposes only and is not intended to constitute medical, legal or financial advice or create a professional relationship between A Place for Mom (of which OurParents is a trademark) and the reader. Always seek the advice of your health care provider, attorney or financial advisor with respect to any particular matter and do not act or refrain from acting on the basis of anything you have read on this site. Links to third-party websites are only for the convenience of the reader; A Place for Mom does not recommend or endorse the contents of the third-party sites.

Nursing Home Options for Low-Income Seniors