Navigator Homes’ expected daily rates above state average

Private-pay residents will supplement losses. 

The expected daily rates of Navigator Homes are above the state average.

The expected daily rates for Navigator Homes are a little higher than the state average. 

Navigator Homes, which is planned to be built in Edgartown and replace the outdated Windemere Nursing & Rehabilitation Center, is slated to host 66 beds for senior residents with varying rates, depending on a person’s health insurance. According to a presentation shown to the Martha’s Vineyard Commission (MVC) earlier this month, expected daily rates are $328 for Medicaid residents, $689 for Medicare residents, and $515 for private-pay residents. These costs were a source of concern for MVC commissioner Michael Kim, who argued that even the “affordable option” was costly. 

The new project will be more expensive for residents than the current Windemere, which is owned by Martha’s Vineyard Hospital. According to Martha’s Vineyard Hospital spokesperson Marissa Lefebvre, 90 percent of Windemere payments come from Medicaid. In Massachusetts, Medicaid is encompassed in the MassHealth program. 

“Medicaid falls well short of covering the daily cost of care provided at Windmere,” Lefebvre said in an email. “In fact, the hospital must subsidize Windemere for its losses — at about $3 million a year.” 

The average daily rate for residents on Medicaid is $245. According to Lefebvre, the “actual cost of 24/7 skilled nursing care” at Windemere per resident is around $450 a day. 

“Based on the 90 percent Medicaid payments and the outdated facility, there is very little private pay at Windemere, which could offset some of the costs,” Lefebvre said. “That is one reason why we are looking to the Navigator Green Home Model to develop a more updated skilled nursing facility that could attract more private payers. In the new skilled nursing facility, at least half the residents will be on Medicaid or Medicare.”

According to the American Council on Aging, the statewide average daily rate for a private nursing home room in Massachusetts is $445. The council also showed the average private daily rate for regions and some cities in the state, one of which was the town of Barnstable at an average private daily rate of $467. The rest of the state, without these specified areas, had an average private daily rate of $500. For shared rooms, the statewide average daily rate for private shared rooms was $415. 

Among the states, Missouri had the lowest statewide average private daily rate at $195, and Alaska had the highest average private daily rate at $1,036. 

The Massachusetts Executive Office of Elder Affairs states that Medicaid covers individuals who will live in a nursing facility long-term “based on financial need.” To qualify, the individual “may have no more than $2,000 countable assets. If an individual has a spouse who remains in the community, the spouse at home is allowed to retain an amount of the combined countable assets and also a spousal allowance from their combined incomes. Also, the individual must be assessed and determined to need long-term care services provided in a nursing home setting.” Additionally, individuals will need to pay a “patient paid amount” to cover for items not readily available at the nursing home, such as “clothing, hair styling, or a favorite lotion.” 

Meanwhile, Medicare, a federal health insurance program for individuals over the age of 65 or with “certain disabilities,” will cover limited nursing home services “when it is determined that the individual needs daily skilled nursing or rehabilitation services,” and following a three-day “in-patient admission for a related illness or injury.” Medicare covers care for the first 20 days, after which until the 100th day it “pays for covered services except for a co-pay that is recalculated annually.” If it is determined that the individual no longer needs care before the 100th day, coverage stops.