What Qualifies a Person for a Nursing Home in Massachusetts

One of the most challenging conversations for families in Massachusetts often involves the subject of nursing home care. Many factors come into play when determining if someone qualifies for a nursing home. While physical and cognitive impairments are significant indicators, financial eligibility and state rules also play a crucial role.

The Role of Physical and Cognitive Impairments in Nursing Home Eligibility

The health and ability of an individual often dictate the need for skilled nursing care. If an individual requires substantial assistance with basic Activities of Daily Living (ADLs), such as bathing, dressing, feeding, toileting, transferring from bed to chair, and managing continence, a nursing home may be necessary.

Further, chronic illnesses that require continual monitoring, like diabetes or heart disease, can also warrant the need for skilled nursing care. Cognitive impairments, including diseases such as Alzheimer’s and other forms of dementia, often make independent living difficult, if not impossible. In these instances, a nursing home may provide the round-the-clock care needed for the individual’s health and safety.

Understanding Financial Eligibility in Massachusetts

MassHealth provides significant support for nursing home care, but there are income and asset limits to consider. An individual must demonstrate financial need to qualify for this support. As of 2023, the income limit for an individual is $2,382 per month, whereas the limit for a couple is $4,764 per month.

In addition to these income limitations, an individual’s assets must also not exceed $2,000, or $3,000 per couple. Some assets are exempt from this count, such as the primary residence if it is valued under $906,000; personal belongings; and burial plots. If a person’s income or assets are above these limits, they may need to “spend down” their assets, essentially lowering their financial resources to meet these limits and qualify for MassHealth assistance.

Assessing Functional Eligibility

In Massachusetts, a person’s need for nursing home care is not only determined by physical health and financial need but also by their functional ability. This assessment involves evaluating their medical condition and ability to perform ADLs.

MassHealth uses the Comprehensive Screening and Service Assessment (CSSA) to evaluate this. The CSSA takes into account the person’s physical condition, cognitive status, and behavioral health. It determines whether they are functionally eligible for nursing home level care and what services they might need.

The Importance of Legal Assistance in the Process

Entering a nursing home involves a complex interplay of health and financial requirements. Understanding MassHealth regulations, deciphering the terms of nursing home contracts, and executing crucial legal documents like a power of attorney or healthcare proxies can be a daunting task.

That is where legal guidance becomes invaluable. The experienced team of attorneys at Casey Lundregan Burns, P.C. have a deep understanding of the rules and regulations surrounding nursing home admissions. They can provide you with the necessary assistance to ensure a smooth transition to nursing home care, helping you and your family every step of the way.

Partnering with Casey Lundregan Burns, P.C.

The decisions that you will make require careful consideration. With over 80 years of experience helping families find their best way forward, the team at Casey Lundregan Burns  is here to support and guide you through the process of preparing for long-term care. To learn more, talk to us today to schedule your case evaluation online or contact us at (978) 878-3519. Work with the compassionate attorneys at Casey Lundregan Burns, P.C. to set your plans in motion. We can help you every step of the way.