Nursing Homes in Vermont
Seniors currently make up roughly 20% of the population in Vermont. While many seniors are able to age in place, some require regular supervision or assistance with day-to-day tasks that only a nursing home can provide. Over 2,200 seniors are currently living in nursing homes throughout Vermont today, and 35 nursing facilities are operating in the state.
As people age, they're more likely to experience mental decline, vision and hearing problems and medical conditions that limit their mobility. When family members aren't able to provide the level of care a senior needs, nursing care becomes the most viable option.
Seniors considering whether to seek care at a nursing facility may have questions regarding whether they can afford ongoing care and what benefits Vermont provides its senior population. This guide reviews whether Medicaid and Medicare pay for nursing care, what services they cover and what additional resources are available to seniors in Vermont.
Cost of Vermont Nursing Homes
The average cost of nursing homes in Vermont is $280 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 Vermont?
Seniors may be able to qualify for financial assistance through the Medicaid program. There are currently over 192,000 people enrolled in Vermont's Medicaid program, which offers coverage for medical care and short-term stays at nursing facilities.
Vermont's Choices for Care Program allows seniors or their families to choose where they receive long-term care. One of the options they can select is nursing home care. To be able to participate in the program, Vermont residents must meet clinical and financial requirements to receive Medicaid assistance.
Eligibility for Medicaid in Vermont
To qualify for Medicaid, seniors need incomes that remain within the state's income threshold each year. In 2023, single seniors qualify if they make under $32,904 per year. For married seniors, their household income must be under $65,808 annually. Seniors also must have less than $2,000 in assets for individual benefits or $4,000 as a couple.
Many people who don't qualify for Medicaid can participate in Vermont's spend-down program, which may allow them to be eligible if they spend most of their monthly income on medical expenses.
To enroll in Medicaid in Vermont, residents must also:
- Be over 65 years old or have a physical disability
- Be a United States citizen or legal resident
- Not have saleable assets which can pay for their care
Applying for Medicaid in Vermont
There are multiple options for applying for Medicaid in Vermont. Residents can apply online, print an application and mail it to Vermont Health Connect or call 855-899-9600 to ask for an application through the mail. If mailing an application, residents should send it to:
Vermont Health Connect Application and Document Processing Center
280 State Drive
Waterbury, VT 05671
What Information You Will Need
When applying for Medicaid, you may need to provide the following information:
- Your name and address
- Your driver's license or ID card
- Your Social Security card or Green Card
- Income and tax statements from the last year
- Investment or retirement account statements
Additional Medicaid Support & Resources in Vermont
Seniors needing information about or assistance applying for Medicaid can contact local agencies for aid.
|Vermont Health Connect
|Vermont Health Connect helps all residents who need assistance applying for health insurance or medical aid. Residents may request a certified assistant to help them complete their Medicaid application.
|Vermont Association of Area Agencies on Aging
|The Vermont Association of Area Agencies on Aging connects residents with their local agencies on aging. Seniors may call for information on eligibility for Medicaid and request assistance through their local agency.
|Department of Vermont Health Access
|The Department of Vermont Health Access oversees the health insurance marketplace. One function of the marketplace is to help residents enroll in Medicaid.
Can You Use Medicare to Pay for Nursing Home Care in Vermont?
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 Vermont
Seniors in Vermont who need to enroll in Medicare can get help from the following organizations:
|Vermont Health Connect
|Vermont Health Connect also helps residents looking for assistance applying for Medicare benefits. Residents may request additional information or someone to assist them directly with their application.
|Vermont Association of Area Agencies on Aging
|The Vermont Association of Area Agencies on Aging can help residents file for Medicare coverage once deemed eligible.
|Department of Vermont Health Access
|The Department of Vermont Health Access also oversees Medicare enrollment and can help residents applying for Medicare coverage.
|Age Well Vermont
|Age Well Vermont offers educational materials and support for seniors in the northwestern part of the state. Residents may call the hotline with Medicare-related questions and concerns.
|Vermont Department of Disabilities, Aging and Independent Living
|The Vermont Department of Disabilities, Aging and Independent Living helps aging residents explore their care options. Residents needing advanced care can also inquire about assistance enrolling in Medicare coverage.
Other Financial Assistance Options for Nursing Home Care in Vermont
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 Vermont
|Nursing homes need to renew their licenses annually to continue operating in the state of Vermont. Renewals can be completed online.
|All nursing homes must have a licensed administrator and a medical director who is a licensed physician. Nursing homes must also be staffed with a director of nursing and enough nursing staff to provide 24-hour care.
|Staff Training Requirements
|Staff members with less than four months of experience must pass a state-approved training and evaluation program. All aides need to be registered with the Vermont Nurse Aide Registry. Staff members are subject to annual performance reviews and mandatory training.
|Nursing homes may only admit new residents beyond their operating capacity if it's for an emergency or they receive temporary authorization from their licensing agency. All new residents must receive options counseling before their initial stay at a nursing home.
|Care Planning Requirements
|All patients must have a care plan that accurately describes the services they receive and how it benefits their physical and mental health. Patients and their family members may participate in creating the care plan and request adjustments as needed.
|Dietary and Nutritional Services Requirements
|Each nursing home resident will receive a meal plan that aligns with their medical and dietary needs. Nursing homes must employ a dietician or have a director of food service who consults a professional nutritionist regularly.
|Specialized Rehabilitative Services
|Any specialized rehabilitative services, such as mental health treatment, physical therapy or occupational and speech therapy, must be administered as directed by a patient's doctor and in accordance with the patient's care plan.
|Medication and Pharmaceutical Services
|Residents in nursing homes need to have their medication lists reviewed annually to ensure they're not taking any unnecessary medications. Nursing homes must also keep medication error rates below 5%.
|Nursing facilities must provide adequate activities to meet residents' physical, mental and social needs. The director of activities needs to be a licensed recreation specialist or activities professional.
|Infection Control Requirements
|Vermont nursing homes must have infection control plans to reduce the spread of infectious diseases. Protocols must include isolation measures, records of incidents and proper hygiene.
|Seniors who can't afford nursing home care may be eligible to receive assistance through the Choices for Care program. This option is available for all seniors who qualify for Medicaid coverage.
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