You asked for what kinds of items and services nursing homes charge their private pay patients in addition to their per diem (daily) rates.

SUMMARY

Nursing homes vary to some extent in what the private pay per diem rate includes. Generally, it includes room and board, nursing care, and necessary help with activities of daily living. All patients, including Medicaid recipients, must pay separately for their own telephone, cable TV, and barber or beauty shop services.

Items that nursing homes generally bill separately for private pay patients include such things as pharmacy costs, physician services, various therapies, laboratory tests, dental services, optometry and audiology services, durable medical equipment, and, in some cases, certain medical supplies and other resident-specific items. But in many cases, Medicare or private medical insurance can pay for some of these separate costs, even for patients who privately pay the per diem rate.

OPM PRIVATE PER DIEM RATE SURVEY

The “per diem” rate that nursing homes charge their private pay patients can vary among different facilities. So can the items for which they charge separately. The latest Office of Policy and Management Connecticut Partnership for Long-term Care survey of private pay rates, published in April 2004, shows an average daily rate in 2003 of $ 252 ($ 92,000 a year). The survey also states that there can be additional fees for items such as prescriptions, “unbundled” services (some facilities may charge extra for certain therapies, like physical therapy), telephone, cable TV, linen services, and hair care. It lists the individual per diem rates for each home but provides no further details on the additional charges. The survey is available at: http: //www. opm. state. ct. us/pdpd4/ltc/consumer/CostofLTC. pdf.

NURSING HOME RESPONSES

The Connecticut Association of Not-for-profit Providers For the Aging (CANPFA) and the Connecticut Association of Health Care
Facilities (CAHCF) both agreed to survey informally a small sample of their nursing home members to determine for what kinds of additional items they charged private payers. CANPFA surveyed seven of its homes and received generally similar responses. Since these were only quick, informal responses, some items may have been left out. We have not yet received a response from CAHCF.

In general, CANPFA found that all residents, whether private pay, Medicare, or Medicaid are responsible for their own telephone, cable TV, and barber or beauty shop services. One home specifically mentioned on-line computer services and another listed snack bar services and guest tray service.

Additional separate fees for private payers at the seven homes include pharmacy charges for prescription drugs; physician services; dental services; podiatry services; rehabilitative therapy services such as physical, occupational, speech, or massage therapy; durable medical supplies such as special beds, special tubing, IV supplies, oxygen, etc. ; laboratory and diagnostic services; ambulance services and non-emergency transportation, including transportation to and from medical appointments; optometry and audiology services; hearing aids; and bed hold charges.

Most of the homes stated that the per diem rate covers room and board, which includes nursing services and help with personal care and activities of daily living. One home specified that the per diem rate also covers facility stock items, ie. , toothpaste, soap, aspirin; housekeeping; maintenance; utilities (heat, light, hot and cold water); meals; laundry; and recreation. Another specified that its per diem rate covers the supplies needed to provide care, such as dressings and adult briefs, but a third listed “medical supplies” as among the items not included in its per diem rate. One facility stated that it bills separately for catheter sets, glucoscan, treatment supplies, consultant fees, and other resident-specific items. One home specified that a separate bill is provided to the private pay patients for medications (including over-the counter medications).

In many cases, some of the separate items, even in the case of private pay patients, can be billed to Medicare, Medigap insurance, or other private health insurance. For instance, pharmacy charges are included in the Medicare Part A rate for a post-hospital stay in a nursing home. Medicare Part B or other third party insurance can also cover some of the expenses excluded from the per diem rate, such as physician services and physical, occupational, or speech therapies.

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