Nursing Homes in Oregon
America's increasingly aging population has a higher risk than previous generations of developing chronic conditions, such as arthritis and type 2 diabetes. Consequently, today's seniors are more likely to need long-term care (with 20% requiring five years or more, according to the latest data). Nursing homes play an important role in providing them with specialized care. They're staffed by a combination of licensed medical professionals and caregivers who deliver round-the-clock support in homelike environments. Like hospitals, nursing homes have all the equipment needed to provide high standards of care.
The 2020 Census revealed Oregon's population to be just over 4.2 million, with adults aged 65 and older making up 18.6%. The state has 130 nursing homes providing care to approximately 6,195 residents, comprising about 0.8% of Oregon's seniors. Nursing homes can be found statewide, but are naturally concentrated in more populated areas.
This guide reveals how Oregon's Medicaid program can help seniors pay for nursing home care and lists some of the other financial options available to seniors and their families. It also provides information about additional free resources available in the state and briefly explains the laws and regulations governing Oregon's Medicaid.
Popular Cities in Oregon
Cost of Oregon Nursing Homes
The average cost of nursing homes in Oregon is $263 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 Oregon?
Oregon Health Plan (OHP), the state's Medicaid program, can pay up to 100% of nursing home costs for seniors who meet the eligibility requirements. Since Medicaid is an entitlement program, seniors who have been approved can start benefiting from it almost immediately. As of December 2022, almost 1.375 million Oregonians are enrolled in Medicaid and CHIP (although this accounts for all age groups, not just seniors). The benefits for nursing home residents include 24/7 medical care in a facility that delivers near-hospital levels of support while retaining as much hominess as possible. Residents live in private or semiprivate rooms cleaned and maintained by staff, while chefs prepare meals and activities managers organize mentally, physically and intellectually stimulating events.
Seniors who require nursing home care may apply for one of two waiver programs. However, as they're not entitlement programs, there may be a waiting list. K Plan beneficiaries receive case management services, which tailor the care needed to the individual. These can include personal care services, assistive technology devices, home modifications and adult day care. Seniors who qualify for Medicaid and Medicare might consider the Program of All-Inclusive Care for the Elderly (PACE). Generally speaking, Medicaid pays the skilled nursing costs, while Medicare pays for remaining expenses, such as prescription drugs. However, the program isn't available statewide, so interested seniors will need to live in a PACE area.
Eligibility for Medicaid in Oregon
To be eligible for Oregon Medicaid, the applicant must satisfy the program's strict financial guidelines. For example, a single person, or one person applying from a two-person household, can't have an annual income exceeding $32,904 or assets over $2,000. Most income types apply to this limit, which includes the majority of pension payments, although there are exceptions such as Aid and Attendance pension payments made to veterans. Generally, belongings such as one car, personal items, household furniture and the applicant's primary home are not counted as assets. Countable assets include real estate that isn't the primary home, stocks, bonds and savings. As per the Spousal Impoverishment Act, the spouse from the two-person household can keep up to $148,620 in assets.
| Income Limits* | Asset Limits | |
|---|---|---|
| Single Person | $32,904** | $2,000 |
| Two-Person Household | $32,904 (for applicant)** | $2,000 (applicant)$148,620 (non-applicant)*** |
*Per year
**The applicant can retain enough finances to pay their Medicare premiums and have a personal needs allowance of $74.75 to pay for personal expenses
***The non-applicant in a two-person household is allowed a spousal income allowance of up to $3,715.50 per month.
In addition to satisfying the financial criteria, the applicant must also be:
- A U.S. citizen or legal immigrant
- An Oregon resident
- At least 65 years of age
- In need of nursing home levels of care
Applying for Medicaid in Oregon
The fastest way to apply for Oregon Health Plan is to follow the step-by-step instructions at ONE.Oregon.gov. Seniors who want help completing their application can call OHP Customer Service at (800) 699-9075. Those who prefer to use traditional methods can download an application form and mail it to:
OHP Customer Service
P.O. Box 14015
Salem, OR 97309
What Information You Will Need
As part of the qualification process, seniors must produce evidence that supports their application. Preparing the documents beforehand may speed up the processing time. These may include several of the following.
- Birth certificate
- Medicare card
- Social Security card (or proof of citizenship if not born in the United States)
- Property deeds
- Policy numbers of all life insurance for the entire household
- Proof of real property sold or transferred during the 60 months prior to the application
- Car registration and insurance details
- Proof of pensions, as well as a verification letter from the providers
- VA discharge papers if a veteran
- Copies of trusts, wills and powers of attorney
- Preneed burial contract
Additional Medicaid Support & Resources in Oregon
Understanding the complexities of Medicaid can be challenging, so the following table contains some resources that provide comprehensive information and support free of charge to seniors and their families. Communicating directly to Oregon Medicaid is often the best choice, but these organizations can also assist in different ways.
| Contact | Service | |
|---|---|---|
| Medicaid Planning Assistance | Online Only | Medicaid Planning Assistance provides an abundance of information about applying for Medicaid or Oregon's program, as well as the benefits they provide. Experts on the subject write and maintain the content and the site has useful tools to help people do their own research, including a Medicaid eligibility test. |
| Benefits.gov | (800) 359-9517 | This U.S. government site can help seniors discover the benefits they might qualify for and makes the application process speedier. Visitors can quickly learn if they're eligible for Medicaid, Medicare and other federal benefits. |
| Oregon Area Agencies on Aging | (503) 945-5600 | Oregon's Area Agencies on Aging help seniors get in-home and community-based services if their preference is to avoid nursing home care, when possible. The agencies also work with the Aging and Disability Resource Connection of Oregon so seniors can get full access to local resources. |
Can You Use Medicare to Pay for Nursing Home Care in Oregon?
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:
- Meals
- A semiprivate room
- Medications
- 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 Oregon
Medicare doesn't cover long-term care costs, but there are programs that can reduce or cancel out-of-pocket expenses for seniors who qualify.
| Contact | Service | |
|---|---|---|
| Oregon Medicare Savings Connect | (855) 447-0155 | Oregon's Medicare Savings Connect program can help pay for Medicare Part B and D premiums, as well as co-payments, deductibles and prescription costs. To qualify for Part B assistance, a single person's monthly gross income shouldn't exceed $1,660, and for Part D, $1,843. |
| Senior Health Insurance Benefits Assistance (SHIBA) | (800) 722-4134 | Trained and certified volunteers representing the State Health Insurance Benefits Assistance program provide impartial advice and support to seniors about Medicare. They explain the different plans and supplementary supports, such as Medigap, and help seniors find the right plan for their needs. |
| BenefitsCheckUp | (800) 633-4227 | Medicare's federal government website contains extensive and up-to-date information about the state health insurance program. Seniors are able to create an account from which they can manage their insurance coverage and any upcoming medical screenings and other preventative care services. |
| Medicare.gov | (800) 633-4227 | Medicare's federal government website contains extensive and up-to-date information about the state health insurance program. Seniors are able to create an account from which they can manage their insurance coverage and any upcoming medical screenings and other preventative care services. |
Other Financial Assistance Options for Nursing Home Care in Oregon
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. |
| Reverse Mortgages | 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 Oregon
| Licensing Requirements | To be licensed by the Oregon Department of Human Services, the facility must pass a series of checks. These include a criminal background check, a demonstration of financial credibility and proof that policies and procedures satisfy patient care, health and safety and fire safety regulations. |
| Staffing Requirements | Oregon's nursing facilities must be staffed by a licensed nursing home administrator working full-time. If the facility has less than 40 beds, the administrator can temporarily take on additional roles during periods of low staffing. A licensed charge nurse must be on-site for every shift. |
| Staff Training Requirements | Staff must receive training relevant to their roles and participate in continual training every quarter thereafter. The RN Care Manager must pass exams on long-term care subjects, such as rehabilitation. Certified Nursing Assistants must be given at least three hours of in-service training quarterly. |
| Admission Restrictions | Seniors with conditions the nursing home can't treat won't be admitted. A physician must sign a direct order before any senior can be admitted and a legal representative is required before persons with mental illnesses or developmental disabilities can be cared for in the facility. |
| Care Planning Requirements | A Registered Nurse must complete an assessment of each resident within 14 days of their admittance to identify their capabilities and determine their care needs. The facility then has seven days to formulate a care plan that addresses their medical, psychological and personal care needs. |
| Dietary and Nutritional Services Requirements | There must be a dietary services department run by a registered dietitian or another person with equivalent qualifications and experience. The department must ensure all food is safe and catered to residents with physician-approved diets. |
| Specialized Rehabilitative Services | Rehabilitative programs administered by qualified therapists must be available to restore human functions (when possible), such as physical, occupational and speech therapies. Seniors attending rehabilitative sessions must have a personalized care plan that records and monitors their progress. |
| Medication and Pharmaceutical Services | There must be a licensed pharmacist on staff who is responsible for managing medications and developing and implementing a medication use policy. Medications must be stored in a locked cabinet or room and only administered by a licensed nurse or other authorized personnel. |
| Activities Requirements | An activity director must develop a program of activities that stimulate residents physically, mentally and socially. There must be a minimum of three per day, combining indoor and outdoor activities. Appropriate activities should be incorporated into the resident's personal care plan. |
| Infection Control Requirements | Nursing homes must have a written infection control plan that must be implemented and monitored by a qualified infection control professional. There must also be a Quality Assurance and Assessment Committee tasked with creating and reviewing the infection control program. |
| Medicaid Coverage | Medicaid will cover the nursing home costs of seniors who satisfy the Oregon Health Plan's eligibility requirements. Qualifying criteria covers numerous subjects, including personal finances, medical need, citizenship and age. |
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