Nursing Homes in Rhode Island
Seniors with complex health problems often need extensive medical care or observation but don’t actually need to be in a hospital. However, these types of care typically are not available in the home or at an assisted living facility. This is where nursing homes come in. Skilled nursing facilities operate at a level between assisted living and hospitals. The facilities keep medical personnel on-site, and nurses are available around the clock. Medical services such as physical therapy are offered, and staffers help manage chronic health conditions such as cardiovascular disease. Residents can also get assistance with grooming, bathing and other daily activities. Social and recreational activities help combat loneliness and keep seniors engaged.
Rhode Island is home to slightly more than 1 million people, and 18.1% are 65 and older. Of these senior residents, about 6,500 live in the state’s 76 nursing homes. This guide has details about paying for nursing home care in Rhode Island and applying for Medicaid assistance. It also covers the rules and regulations that govern nursing homes in the state.
Popular Cities in Rhode Island
Cost of Rhode Island Nursing Homes
The average cost of nursing homes in Rhode Island is $255 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 Rhode Island?
Medicaid in Rhode Island provides free or low-cost health coverage for people who meet certain eligibility requirements. Its Long-Term Services and Supports (LTSS) program pays for nursing home care for all eligible seniors. Long-term services are designed to help people with chronic illnesses or disabilities who need a high level of support. Nursing home care is available to those who need the highest level of care, and Medicaid covers all costs associated with care, including room, board and medical care.
People who need a nursing home level of care have the option of receiving home and community-based services. There is also a managed care arrangement for people eligible for both Medicaid and Medicare. Almost 362,000 people are enrolled in Medicaid across the state. This number includes children enrolled in the Children’s Health Insurance Program. The number of Medicaid enrollees has risen by almost 90% since the state expanded coverage.
Eligibility for Medicaid in Rhode Island
In Rhode Island, a single applicant must have an income of less than $2,742 per month, or $32,904 annually, and assets of less than $4,000. For married couples where both spouses are applying, the income limit is $5,484 monthly, or $65,808 annually, and the asset limit is $8,000. In cases where only one spouse is applying, the income and asset limits are the same as single applicants. However, the nonapplicant spouse can have assets of up to $148,620.
| Income Limits* | Asset Limits | |
|---|---|---|
| Single Person | $32,904 | $4,000 |
| Two-Person Household | $65,808 | $8,000 |
*Per year
Applicants must also meet the following nonfinancial eligibility requirements:
- Be 65 years or older
- Be a resident of Rhode Island
- Be a U.S citizen, permanent resident or legal alien
- Be assessed as requiring a nursing home level of care.
Applying for Medicaid in Rhode Island
There are different ways to apply based on the type of Medicaid a person needs. Those seeking assistance for nursing home care should apply using a Medicaid LTSS form. This can be printed from the department’s website and returned to:
RI Department of Human Services
P.O. Box 8709
Cranston, RI 02920-8787
What Information You Will Need
The department may ask for the following information when assessing the application:
- Proof of identity
- Proof of Rhode Island residence
- Proof of income such as award letters or previous tax returns
- Proof of resources
- Statement from a medical professional regarding health needs
Additional Medicaid Support & Resources in Rhode Island
Seniors in Rhode Island have several options for assistance with accessing the care they need. The following services can help older adults identify programs they’re eligible for, understand the programs and complete the application process.
| Contact | Service | |
|---|---|---|
| Department of Human Services | (855) 697-4347 | The Department of Human Services operates a call center. Seniors can call it to get help applying for Medicaid. For example, staffers can translate forms, clarify issues with paperwork and offer assistance on how to answer questions. |
| State Health Insurance Assistance Program | (888) 884-8721 | The State Health Insurance Assistance Program has volunteers and community partners to help seniors make decisions about health insurance. In addition to Medicare counseling, the program can help people identify and apply for other programs they may be eligible for, including Medicaid. |
| Point | (401) 462-4444 | Point is a government program that helps people access health care, transport and other services. Trained specialists connect seniors to resources in their area and can help people apply for both public and private programs, including Medicaid. |
Can You Use Medicare to Pay for Nursing Home Care in Rhode Island?
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 Rhode Island
Although Medicare doesn’t cover long-term care in a nursing home, it may help with initial costs in some situations. The following resources can connect seniors and their families to counselors able to provide advice based on their unique situations.
| Contact | Service | |
|---|---|---|
| Rhode Island Office of Healthy Aging | (888) 884-8721 | The Rhode Island Office of Healthy Aging is the designated state unit on aging. It administers the state health insurance assistance program that helps people choose Medicare plans. It can also help people apply for other programs such as the Medicare Savings Program and Extra Help/Low Income Subsidy. |
| RIPIN | (401) 280-0101 | RIPIN is a nonprofit organization that helps Rhode Islanders navigate health care and healthy aging. It operates the Rhode Island Insurance Resource, Education and Consumer Helpline (RIREACH) where operators help people navigate Medicare and understand their coverage. RIPIN also offers care management to people enrolled in both Medicare and Medicaid. |
| RI Elder Info | (401) 585-0509 | RI Elder Info provides comprehensive information and resources in one place. Its website allows people to search for local and statewide support, including local organizations that help people apply for Medicare. It also has information about the types of senior care available and how Medicare can help seniors access care. |
Other Financial Assistance Options for Nursing Home Care in Rhode Island
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 Rhode Island
| Licensing Requirements | Nursing homes must be licensed by the Rhode Island Department of Health. Licenses must be renewed annually. |
| Staffing Requirements | Nursing homes must have enough staff to provide each resident with 4.1 hours of direct nursing care each day. Of these, 2.8 must be provided by certified nurse assistants. Facilities must post their daily staffing levels in a public place. |
| Staff Training Requirements | All staff must be appropriately trained and licensed to provide the services they were hired for. Staff members include a full-time administrator responsible for ensuring residents receive the required amount of care. Facilities must provide ongoing education to develop and improve staffers' skills. |
| Admission Restrictions | Residents must complete a preadmission screening to determine the level of care they need. Facilities can only admit residents if the facilities can provide the services needed to meet the resident’s individual medical needs. |
| Care Planning Requirements | Resident care plans must include problems, measurable goals, interventions and time frames. Residents must also have a medical care plan that details orders from attending physicians and consultants. The two plans should work together and be reviewed at least every 90 days. |
| Dietary and Nutritional Services Requirements | A qualified dietitian must supervise the nutritional aspects of resident care. Facilities must provide at least three meals daily, plus snacks in the evenings. Meals should conform to physicians' orders and provide all nutrient requirements to the extent medically possible. |
| Specialized Rehabilitative Services | Skilled nursing facilities must provide specialized rehabilitative services based on the resident’s care plan. These services can include physical therapy, speech pathology, audiology and occupational therapy. |
| Medication and Pharmaceutical Services | Facilities can administer medication only in accordance with physicians' orders. People administering drugs must have completed an approved drug administration course. Each resident must have an individual medication record that is updated each time a drug is administered. |
| Activities Requirements | All facilities must have an ongoing activities program that promotes physical, social and mental health. Independent and group activities should be offered, and each resident should have an activities plan. |
| Infection Control Requirements | All staff who have direct contact with residents must be immunized against communicable diseases and have an annual influenza vaccination. The facility must also have written procedures to prevent and control infections and maintain an infection surveillance program to help prevent contagious illnesses. |
| Medicaid Coverage | Residents who meet the financial and medical eligibility requirements can have nursing home care paid for by Rhode Island Medicaid. These funds can only be used at Medicaid-approved facilities. |
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