SSI & Assisted Living

Seniors who receive Social Security benefits will often use those payments to help cover their living expenses. Elderly people who are considering moving to an assisted living community or those who are already in a facility may want to use their SSI dividends to help pay for assisted living fees. Before we go any further, you should know that SSI can be used to help pay for assisted living costs in most states. This is usually through Optional State Supplements and there are eligibility criteria that must be met.

Sometimes, it can be difficult to understand if SSI benefits can be used for assisted living care, or the in’s and out’s of proper SSI benefit usage. There are also a lot of acronyms such as NMOHC, SSI, RCFE, and OSS that can bewilder even the savviest senior. If you are looking for a simple guide that will help you sort out optional State Supplements, Supplemental Security Income, residential care, assisted living, nursing homes and non-medical care, we are here to help.

Terms, Acronyms & Definitions

Before we get into our guide, let's break down a few common terms to help you better understand their meanings.

OSS (Optional State Supplements) – These are state-based assistance funds given in addition to those paid out by SSI. The final amount each person receives will depend on their living arrangements and level of need. Social Security can’t pay for assisted living directly and will often use OSS as a method of offering payment assistance. OSS may also be called SSP (State Supplementary Payments) depending on your location.

Assisted Living – This is a residential community or facility that offers long term care for seniors and other adults. The care provided is not medical and only assistive in nature. This can include help with bathing, grooming, mobility, meals and other general daily tasks.

Social Security – This is a form of income provided for citizens once they retire. There is a certain number of credits a person must pay into the program over their lifetime in order to qualify. You can read more about the specifics of Social Security here.

SSI (Supplemental Security Income) – SSI is a form of financial assistance for those who have a limited number of assets and lower-income. This program will evaluate a senior's total income and offer a supplemental balance to bring their income to a pre-arranged monthly amount. The benefit will vary from person to person depending on their income level.

SSD (Social Security Disability) –  SSD is a form of SSI benefit that is awarded to seniors or adults who suffer from a medical disability. This disability must be a full disability anticipated to last at least a year or result in the death of the person.

What Exactly is SSI?

SSI or Supplemental Security Income is a state and federally funded initiative. The purpose of the program is to ensure that seniors over the age of 65 maintain a certain monthly income. The program targets seniors and senior couples that are disabled, have a limited income, are blind, or who have fewer resources at their disposal. For single seniors, the limits are $2,000 while the limit for a senior couple is $3,000. A senior’s home, car, and a few other resources are exempt from limit calculation. Any other resources than those that are specified as exemptible may cause a senior to lose their qualification for SSI. SSD is another form of SSI which is available for disabled seniors who qualify. Those with a disability are able to apply their SSD benefits directly to the cost of their assisted living situation.

How Can a Senior Apply for SSI or SSD?

Applications for SSI and SSD are processed though any local Social Security Administration office. It is important to bring all of your qualifying documents, admission agreements for those residing in an RCEF, income source documentation, and identity documentation for your application.

Social Security benefits are awarded to seniors over the age of 65. They are also awarded to adults who are unable to work due to a medical condition with a one-year expected duration, or when the outcome is likely death. SSD benefits are not awarded to seniors or adults who only suffer from a short term or partial disability. Some specific conditions are classified as being eligible for SSD which can be used to pay for the cost of care in an assisted living facility. Some of these conditions are:

• Speech and sense impairment
• Cardiovascular conditions
• Respiratory illnesses
• Sjogren's Syndrome & Marfan Syndrome
• Musculoskeletal problems
• Immune system disorders
• Cancer
• Neurological disorders
• And others

How Much SSI Benefit Can a Senior in Assisted Living Receive?

SSI offers a special rate for RCFE seniors that is called the Non-Medical Out-of-Home Care Rate. The main difference is that seniors who are living at home will get a lower benefit than those who reside in an assisted living facility. Overall, the SSI benefit for a senior living in an assisted living community is about 15% higher than traditional payments. This is important because it shows that the government understands the cost that living in an assisted living facility may generate. It also shows that it values the benefits offered to seniors and the reduction in medical visits required by living in a monitored care situation.

SSI, SSD, OSS Payments & Assisted Living

When it comes to optional state social security supplements, SSD, and other government funding, things can become even more confusing when thinking about long term care. To make it simple, there are two levels of help states offer seniors to help them pay for their assisted living care or their adult foster care expenses. The most common is paying benefits to seniors who qualify for the cost of room and board in an assisted living facility. This is usually achieved through OSS payments. SSI is a set payment that is provided to the senior, while OSS payments are separate and given directly to the assisted living home or the adult daycare location.

The actual amount of a person’s benefit depends on their state and their income. In most places, the maximum OSS payment for assisted living is $1,200. States are also able to limit the number of assisted living facilities that accept Medicaid and are allowed to charge those who pay with SSI, SSD, & OSS benefits. These limits will only apply to the cost of room and board and they are also limited only to facilities that accept Medicaid payments. Not all assisted living communities accept Medicaid nor are all facilities Medicaid approved.

Paying for Senior Care With SSI

Social Security Supplemental Income payments are provided on a monthly basis and can be used for a variety of expenses. Some seniors may choose to use their payments to cover the cost of their food, entertainment, shelter, clothing or even medical care. An income threshold must be met in order to qualify for SSI. Most seniors who are able to receive SSI also qualify for Medicare.  The government benefit eligibility screening tool is a great way to see if you or your loved one qualifies for SSI, SSDI, Medicare, veterans’ benefits or any other federal senior assistance programs.

Most assisted living communities will have several different payment options for seniors, including those who would like to use SSI, SSD, or OSS benefits. In some facilities, seniors may use their full SSI benefits to cover their full expenses. Not every assisted living community will provide subsidies for their monthly fees for those on SSI, so it is important to check the location's rules prior to enrollment. Seniors who require skilled nursing care can use a combination of Medicaid and SSI for their care. Other senior care payment options are PACE, Long term care insurance, veterans aid, and life settlements. Every senior will face a different set of circumstances, and it is important to keep current and future health complications in mind when choosing a payment option.

SSI Quick FAQ’s:

• Unless you are disabled or blind, you must be at least 65 in order to receive SSI benefits.
• Once a person has applied for SSI, it can take as long as 6 weeks to receive the first payment.
• SSI payments can be used for any purpose.
• SSI can be used for assisted living, in-home care, adult day care, skilled nursing home care & memory care facilities.
• Most SSI benefit payouts average around $700 a month per person.
• If you live in the following states and receive SSI, you won’t qualify for OSS: West Virginia, Arizona, Mississippi, North Dakota, and Northern Mariana Islands (territory).
• Some long-term care facility stays will result in a lower SSI payment if Medicaid covers any amount of your expenses.
• Seniors over 65 years of age with a limited income may receive SSI regardless of their work history.
• You may receive Social Security payments and SSI payments.

Assisted Living Admissions & SSI

By now you probably have already discovered what an average stay in an assisted living facility will cost monthly in your area. While some seniors are able to manage the cost on their own or with the help of family members, over time it can become expensive. SSI, SSD, & OSS are effective ways to help reduce the cost of living in an RCFE, but it also makes you wonder if all assisted living locations accept these types of payment options.

Assisted living communities will accept seniors who utilize SSI, SSD, & OSS. However, the rate of acceptance is lower than those who use private insurance and self-payment options. There is no law that requires RCFE’s to accept admissions from seniors who are on SSI, but usually, seniors with lower care requirements will be readily admitted.

The disparity in acceptance of seniors on SSI, SSD, & OSS is mainly caused by the lower payment amounts as opposed to their care needs. Most assisted living facilities are for-profit, so it makes sense for them to admit residents who offer them a higher profit margin. While this may seem unfair, there are many assisted living homes that will accept residents who will use SSI payments to cover costs of care.

For seniors who enroll using self-pay, insurance, or some other form of payment and later start to receive SSI, there are changes that will be made. The assisted living home will have to lower its rate to match the maximum allowable SSI charge in their state. In addition, facilities are not able to evict a senior based on their switching payment methods to SSI. Some less than honest assisted living homes may ask or even require supplemental payments on top of SSI payments. While many family members and seniors agree to these terms, they are actually illegal. Seniors or their families may offer to contribute donations or any other amount above the SSI payment, but it is not required nor can it become part of a formal residency agreement.

Choosing an Assisting Living Home While On SSI

The decision to move into an assisted living home is never easy. Choosing a facility that fits the needs of the senior as well as one that creates an uplifting environment is critical. The level of care needed and your budget also plays a big part in which assisted living facility you ultimately choose.

When starting your search for a suitable assisted living community, you should start by considering the care needs of the senior. Assisted living homes are intended for relatively independent seniors who may benefit from assistance with daily tasks. Wheelchair-bound seniors or those who have mobility issues are also good candidates for assisted living. If you or your loved one has a medical condition that requires skilled nursing or more regular assistance, then a nursing home would be a more suitable choice.

Once you understand the level of care needed, the next step is finding an assisted living home in your area that offers amenities such as guided social gatherings, physical therapy programs, prepared dining arrangements and anything else required to thrive. Visiting each location in person before enrollment and asking the right questions is a good way to get a feel for the facility while also evaluating how the staff and residents get along. After witling down your list to a top 5 or top 3 locations, then base your choice on the overall cost and the assisted living facility’s acceptance of SSI, SSD and OSS payments.