Nursing Homes in South Carolina
Nursing homes are designed for individuals who are recovering from surgical procedures or those who need constant care for a chronic or long-term condition but don’t require hospitalization. Often, these individuals can’t be cared for at home. These communities also provide skilled nursing, rehabilitation, IV therapy and wound care. They can also assist with personal care needs such as bathing, grooming and mobility, as well as help in the bathroom, at meals and with transportation.
Approximately 19% of South Carolina’s population is aged 65 and older. This creates a need for long-term care, including nursing homes. The state has 188 nursing homes that house just over 15,000 seniors, and the average monthly cost is $7,285 for a semiprivate room.
This guide covers financial assistance options for those who need help paying for nursing home care, including details about Medicaid and Medicare. It also offers detailed information on nursing homes and what can be expected from these facilities.
Cost of South Carolina Nursing Homes
The average cost of nursing homes in South Carolina is $190 per day. This is higher than the national average which is $228 per day.
Can You Use Medicaid to Pay for Nursing Home Care in South Carolina?
In South Carolina, Medicaid pays for the cost of long-term care in a nursing home as long as a physician has ordered this level of care. The program provides coverage to approximately 1,296,844 individuals. It covers the costs related to skilled nursing and medical treatments. For assistance paying for personal care needs, including bathing, grooming, toileting and mobility, the Community Choices Waiver is available, but the program has limits, so there may be a waiting list to receive coverage.
Eligibility for Medicaid in South Carolina
South Carolina Medicaid applicants must meet income and asset limits to be eligible for coverage. These limits are 213% of the federal poverty level. Single applicants must have an income of no more than $2,742 per month, with assets totaling no more than $2,000. In a two-person household with only one person applying, the income and asset levels are the same as a single applicant, but the nonapplicant may have assets totaling up to $66,480. If both household members apply, the income and asset limits are doubled.
|$2,742 per month
|Two-Person HouseholdOne Spouse Applying
|$2,742 for a single applicant
|$2,000 for the applicant$66,480 for the nonapplicant
|Two-Person HouseholdBoth Spouses Applying
|$5,484 per month
Along with income and asset information, other qualifications for Medicaid include:
- Must be 65 years of age or older or disabled
- Resident of South Carolina
- U.S. citizen or qualifying immigrant
- Require nursing home care
Applying for Medicaid in South Carolina
Medicaid applications may be filled out online through the Health Insurance Marketplace or through the Healthy Connections citizens portal. Seniors may also download and print an application and fax it to (888) 820-1204 or mail the signed document to:
SCDHHS - Central Mail
P.O. Box 100101
Columbia, SC 29202-3101
To apply in person, seniors can locate their local South Carolina Department of Health and Human Services office online or by calling the helpline at (800) 726-8774.
What Information You Will Need
Some of the information that’s needed to apply includes:
- Social security numbers of each applicant
- Income documentation
- Copies of bank statements for the past 3 years
- Policy numbers for health and life insurance
- Proof of property ownership
- Citizenship documentation
- Photo identification
Additional Medicaid Support & Resources in South Carolina
Applying for Medicaid can be a complicated process. There are several organizations that can support seniors when they are looking for help. These organizations offer counseling and education about Medicaid and supplemental insurance.
|Benefits.gov is the federal website for all benefit programs in each state. Trained counselors can offer information on Medicaid, what it is and what it covers, and help seniors determine whether they are eligible. The site includes basic program information and contact details.
|Healthy Connections is the state website for Medicaid coverage. The official website provides details on coverage amounts and offers referrals to physicians and health clinics that accept Medicaid as payment.
|South Carolina Department of Health and Human Services
|The South Carolina Department of Health and Human Services operates offices throughout the state that help seniors apply for Medicaid and other public benefit programs. Counselors are available in person or over the phone and can provide help with applications. They also offer information on other state and federal benefit programs.
Can You Use Medicare to Pay for Nursing Home Care in South Carolina?
Medicare provides limited coverage for short-term stays in a skilled nursing facility following a hospital stay, but seniors must meet a number of specific requirements. This benefit is available to beneficiaries who have been hospitalized for at least three days, excluding the date of discharge, so it's most valuable for those who are recovering from an injury, illness, or surgery.
Once seniors meet the hospitalization requirement, Medicare will pay for up to 100 days of skilled nursing per benefit period. The first 20 days are covered in full. Starting on day 21, beneficiaries must pay a daily coinsurance rate. After day 100, seniors are responsible for the entire cost.
What Does Medicare Cover?
Medicare covers a number of specific services, including:
- A semiprivate room
- Skilled nursing
- Physical therapy
- Occupational therapy
- Speech therapy
- Audiologist care
- Medical supplies
- Medical social services
- Nutritional counseling
- Ambulance transportation
What Isn't Covered by Medicare?
Medicare does not cover long-term custodial care that addresses seniors' day-to-day needs. This includes help with daily activities, such as bathing, dressing and using medical equipment.
For more information about Medicare and when it covers Nursing Home Care, read our Guide to Nursing Homes.
Medicare Support & Resources in South Carolina
Seniors may receive assistance comparing Medicare and other insurance choices by contacting one of the following agencies. These resources provide insurance counseling and help with the application process. They also help seniors understand their rights during the process.
|South Carolina State Health Insurance Assistance Program
|This program provides free counseling to seniors and their families who are researching Medicare options. Counselors help answer questions about the different parts of the program and offer insight into eligibility requirements and the application process. They can also provide education on how to detect and prevent insurance fraud.
|South Carolina Consumer Assistance
|South Carolina Consumer Assistance works to ensure all individuals throughout the state are fully insured and able to afford proper medical care. The agency offers information on Medicare and the application process and advises seniors on the parts they need most.
|National Council on Aging
|The National Council on Aging helps seniors understand their available insurance options to pay for nursing home care. Coverage may include Medicare or Medicaid and private insurance. It also provides information on supplemental insurance, including prescription drug coverage.
Other Financial Assistance Options for Nursing Home Care in South Carolina
While Medicaid and Medicare are two of the most common programs used to pay for Nursing Home Care, there are other financial assistance options available, depending on your unique situation.
|How to Apply
|How It Works
|Aid and Attendance
|Learn more and apply online at va.gov.
|Veterans who receive a VA pension may also be eligible for the Aid and Attendance benefit, a monthly cash allowance that veterans receive in addition to their standard pension amount. The benefit is intended for veterans in need of long-term care services and may be used towards paying for skilled nursing care.
|Learn more about your options and how to apply at ftc.gov.
|If you own a home, you may be able to use a reverse mortgage to help pay for nursing care. Reverse mortgages are loans that one can take out against the value of their home, essentially converting some of the home's equity into cash. This type of funding can be especially useful for married couples when only one partner needs nursing care, as the other residents of the home may continue living there. Reverse mortgage loans do need to be repaid with interest, typically within 12 months of receiving the loan.
|Long-Term Care (LTC) Insurance
|Learn more about Long-Term Care Insurance and how to apply for a policy at acl.gov.
|Seniors who already have long-term care insurance may be covered for skilled nursing care. Most policies cover at least a portion of the cost of nursing home care, but it depends on the specific policy terms. Note that older adults who are already in need of skilled nursing care will not be eligible to sign up for a LTC insurance policy.
Nursing Home Laws and Regulations in South Carolina
|Nursing homes in South Carolina are licensed and regulated by the South Carolina Department of Health and Environmental Control, Division of Nursing Homes. Prior to licensure, all facilities must undergo an inspection and must agree to subsequent inspections at least once every 3 years.
|The staff-to-patient ratio for nursing homes in South Carolina must be at least one to nine during the day and one to 22 at night. Each facility must employ a full-time licensed administrator.
|Staff Training Requirements
|LNs and RPNs must maintain the requirements for their license. All other staff must submit to a background check and must complete basic first aid training and classes on infection control, vital signs, residents’ rights and confidentiality.
|Nursing home residents must require assistance with at least two personal care activities or require around-the-clock medical monitoring. Ideal candidates must require assistance in a clinical environment.
|Care Planning Requirements
|Care plans must be in place for all residents within 7 days of admission and must include details about the level of care. This plan must be compiled with input from the resident, family members, a legal representative, the resident's doctor and the nurse administrator.
|Dietary and Nutritional Services Requirements
|Nursing homes must provide at least three hot meals per day and must accommodate the special diet plans recommended by residents' doctors.
|Specialized Rehabilitative Services
|Rehabilitation services, including speech, occupational and physical therapy must be provided by a licensed provider on-site or arrangements must be made for residents to receive services at a local clinic.
|Medication and Pharmaceutical Services
|All licensed nurses and personnel may administer medications as needed to residents in a nursing home. Unlicensed staff members may help seniors who administer their medications on their own by providing reminders and supervision.
|Nursing homes must employ a full-time activities director who plans and administers senior-appropriate activities and religious services to residents. This calendar of events must be posted in advance.
|Infection Control Requirements
|The CDC provides guidelines for all long-term care communities to help prevent the spread of disease and illness. The maximum occupancy for each room is three and at least one toilet should be available for every six residents.
|Medicaid pays for room and board and personal care services in Medicaid-certified nursing homes and medical centers. Individuals must meet the eligibility requirements for Medicaid and must require a nursing home level of care.
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Nursing Homes Articles and Resources
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