Nursing Home Care
A nursing home provides 24-hour clinical oversight and professional nursing care for individuals who require medical treatment alongside assistance with daily activities. The government applies strict standards to ensure the safety and quality of care for residents.
Key Services
- Medical and Nursing Care: Professional medication management, wound care, monitoring of blood pressure and diabetes, etc.
- Rehabilitative Therapy: Physical therapy, occupational therapy, and speech therapy to restore physical functions.
- Personal Support: Assistance with Activities of Daily Living (ADLs) that are difficult to perform independently, including eating, bathing, dressing, and mobility.
- Dietary and Management: Customized diets designed by nutritionists and 24-hour safety monitoring.
Cost and Coverage
Short-Term Rehabilitation
Contrary to the common perception of nursing homes as permanent residences, many nursing homes also function as specialized Short-Term Rehabilitation Centers. They provide intensive professional care designed to help patients regain functional strength after surgery or hospitalization, ensuring a safe and successful transition back to their homes.
*For details regarding costs and coverage for short-term stays, check Rehabilitation & Skilled Nursing.
Long-Term Care: MLTSS
If continued residency in a nursing facility is required after the 100-day Medicare benefit period concludes, Medicaid-enrolled patients receive long-term coverage through Managed Long-Term Services and Supports (MLTSS).
- Coverage: Unlike Medicare, MLTSS covers long-term Room and Board and assistance with activities of daily living without a specific time limit.
- Financial Eligibility (2026)
- Income: $2,982/Month
- Assets: $2,000 for individuals / $3,000 for couples
- Excluded Assets: Primary residence (valued up to $1,130,000 in New Jersey), one vehicle, and personal effects.
- 5-Year Look-back Period: At the time of application, the state examines all financial records from the previous 60 months to identify any assets gifted to family members or sold below fair market value.
- A state-appointed clinician conducts an in-person assessment NJ Choice, a comprehensive assessment tool used to determine clinical eligibility for Nursing Facility Level of Care (NFLOC).
- The applicant must require significant assistance with at least three Activities of Daily Living (ADLs), such as eating, bathing, or mobility.
*Spousal Protections: Under the Community Spouse Resource Allowance (CSRA), a spouse living at home may protect assets up to a maximum of $162,660 (as of 2026) to prevent spousal impoverishment.
- Cost Structure: Beneficiaries must contribute nearly all of their monthly income toward the facility’s costs. They are permitted to keep a $50/month Personal Needs Allowance (PNA). MLTSS covers the remaining balance of the facility’s fees.
Important Considerations
- Application Timing: Begin preparations 2 to 3 months before short-term rehabilitation benefits end. The approval process typically takes 3 to 9 months, though coverage is applied retroactively to the date of application.
- Distinction from Standard Medicaid: Holding a NJ FamilyCare Medicaid does not automatically grant access to long-term care. You must undergo a specific clinical and financial review to be authorized for the MLTSS program.
- Professional Consultation Advised: Due to the state’s rigorous audit of all financial records from the 60 months (5 years) preceding your application, it is strongly advised to consult with a professional social worker or an elder law attorney before submitting your application.
*For details, check LTC Medicaid (MLTSS).
Prescription Drug Benefits (Medicare Part D) — For Medicare Beneficiaries
For individuals receiving long-term care in a nursing home, prescription medications are covered under Medicare Part D.
- Out-of-Pocket Costs (2026): The annual out-of-pocket cap is $2,100. Once you reach this limit, you will have $0 copays for all covered drugs for the remainder of the calendar year.
- Medicare Advantage (Part C) Enrollees: If you are enrolled in a Medicare Advantage plan that includes drug coverage (MAPD), you maintain your benefits through that plan. You do not need to enroll in a separate Part D plan.
- Patients Without Part D: Individuals without a Part D plan are responsible for the full cost of their medications out-of-pocket.
- Special Enrollment Period (SEP): Nursing home residents have a Special Enrollment Period, allowing you to join, switch, or drop a Part D plan or Medicare Advantage plan that better suits their needs at any time during their facility stay.
Find a Nursing Home Facility
Korean-Speaking Nursing Home Facilities in Bergen County, NJ
Considerations for Selection
- Check the 5-Star Quality Rating: Review the 5-star ratings for each facility on Medicare.gov Care Compare. The rating consists of three domains:
- Health Inspections
- Staffing
- Quality Measures
- Review Survey Reports: Request the most recent state inspection report kept at the facility, or view it online via Medicare.gov Care Compare and state government websites.
- Consult the Long-Term Care Ombudsman: The Long-Term Care Ombudsman is an independent advocacy agency appointed by the Governor to protect the rights of residents in long-term care facilities and investigate reports of abuse, neglect, or complaints. The Ombudsman is the direct, confidential line for intervention and protection for residents, family members, or concerned parties.
Rights Residents and Families Must Know
- Participation in Care Plan: The right for the individual or family to participate directly in establishing the direction of treatment and care plans.
- Protection of Assets: The right to manage one’s own funds or to receive transparent reports when entrusting fund management to the facility.
- Defense Against Improper Discharge: The right to not be arbitrarily evicted. Must receive written notice and the right to object to and appeal unilateral discharge actions by the facility.
- Prevention of Abuse: The right to be protected from physical and mental abuse or neglect. Facilities cited for abuse are identified with a warning icon on Medicare.gov Care Compare.
*For details check Long-Term Care Ombudsman.
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