An Overview of Care Options

Sometimes after a hospital stay for an illness or accident, additional care is needed for a period of time. The following is a summary of care options, when they might be appropriate, the usual costs, and how the care might be paid for. Your physician and a hospital social worker can talk with you in greater detail about your individual situation, giving you additional suggestions and information to help you reach the best decision for you and your family.

All rates are dependent on individual care needs. You should discuss your needs with the provider. Information and prices are subject to change without notice. For further information on any of the following services, please contact your local Northwest Regional Council office.

Northwest Regional Council
600 Lakeway Drive, Suite 100
Bellingham, WA 98225
Type of Care When Appropriate Usual Costs Who Pays
Part-time help at home (personal care, household tasks) When you can be alone for periods of time, can get to the bathroom by yourself, can call for help if needed  Varies greatly

$9 per hour and up 
Private pay, Medicaid (if qualified)
24-hour help 24-hour supervision needed, can't stand or walk alone, can't call for help $120 a day and up  Private pay,  Medicaid in limited situations 
In-home skilled services

(Home Health)
When skilled nursing (RN) care or assessment is needed or when therapy (PT, OT, speech) is needed  $28 per hour and up  Private insurance, Medicare, private pay, Medicaid (in limited situations) 
Adult Day Services Family support not available during the day

Interested and able to attend program and receive services
$25 to $55 per day and up  Private insurance, Medicare (to authorized agencies), Private pay
Assisted Living If semi-independent $1500 per month and up Private pay, Medicaid (if qualified)
Adult Foster Home or Residential Care 24-hour supervision

Help with activities of daily living

Incontinence not a major problem

Only minimum assistance needed at night
$1200 to $2400 per month and up  Private pay, Medicaid (if qualified)
Nursing Care Facility, intermediate care (See definition below)  24-hour supervision needed with activities of daily living; assistance needed at night (e.g., incontinence) $2500 per month and up plus medications, supplies and extra care needs  Private pay, Medicaid (if qualified), Insurance (a few offer coverage, most do not) 
Nursing Care Facility, skilled care (See definition below) Care requires RN or licensed therapist. Frequent and significant care needs  $85 to $150 per day and up plus medications, supplies and extra care needs  Medicare (limited), Insurance, Medicaid (if qualified), Private pay 



Skilled Care: Care that must be ordered by a physician, and that can be performed only by, or under the supervision of, licensed personnel (Registered Nurse, Physical Therapists, Occupational or Speech Therapists). Examples of skilled care include: intravenous feedings (IVs), intravenous or intramuscular injections, tube feedings, wound care requiring special techniques, care of extensive decubitus ulcers, intensive rehabilitation of a stroke or hip fracture.

Intermediate or “Custodial” Care: Care that can be provided by nurse aides (CNAs) and may include some skilled services, but not on a daily basis. Examples of this type of care are: medicines by mouth, general maintenance care of colostomy, routine catheter care, daily insulin injections when diabetes is well-regulated, general supervision of exercises which have been taught to person, changes of dressings of non-infected post-operative or chronic conditions.
Activities of Daily Living: These include bathing, dressing, walking, getting in and out of bed, eating, meal preparation and household tasks.
Medicaid: A state-administered program that pays for medical services to those who are financially eligible. Contact the hospital social worker or the Senior Services Division or Disability Services Office for further information.
Medicare: A federal health insurance program for people 65 or older, and persons with longer-term disabilities. Local Social Security Administration offices take applications for Medicare and provide information about the program. The medical center social work office also has informational brochures available. Medicare insurance pays only for skilled services in the hospital, at nursing care facilities or at home. (See definition of skilled care.) Unfortunately much of the care that is needed after hospitalization is intermediate or custodial care and not covered by Medicare.
Insurance: Coverage that is purchased by individuals through private insurance companies. Most insurance companies pay only for skilled services (in the medical center, at nursing care facilities or at home). When checking your policy, look to see whether they include or exclude "custodial"/intermediate care. A call to the insurance company could verify benefits.
Private Pay: Out-of-pocket expenses for you.
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