Nursing Homes in Vermont
Vermont is the country’s second least populous state with a total population of more than 620,000, yet it has a significant senior population, with 20% of its residents 65 and older. The Green Mountain State projects an increase in this age group by 2030, when over one out of four Vermonters are expected to be seniors. Thankfully, Vermont is among the highest ranking states when it comes to health care access, and a large majority of its long-term care facilities accept Medicaid. Likewise, a majority of Vermont’s nursing home residents are Medicaid recipients.
Nursing facilities accommodate individuals who may need 24-hour nursing services in an institutional setting. Based on Genworth Financial’s 2020 Cost of Care Survey, Vermont’s average monthly cost for nursing home care in a semiprivate room costs $9,779, while the private-room option averages $10,311 per month.
This guide offers helpful information about nursing home care in Vermont, its associated costs, available financial support programs and licensing regulations. A list of free statewide resources is also provided.
The Cost of Nursing Home Care in Vermont
Compared to most states in the American Northeast, Vermont is on the moderate side with an average nursing home care cost of $9,779 per month. According to the Genworth Financial’s 2020 Cost of Care Survey, this amount is about $2,000 more than the national average of $7,756. However, Vermont’s neighboring states are significantly more expensive. New Hampshire’s average cost of $10,646 is nearly $900 more expensive than the Green Mountain State, while New York, at $12,319, costs over $2,500 more. Massachusetts is the most expensive bordering state at $12,623, costing seniors approximately $2,800 more per month than Vermont. Maine is less expensive at $9,642, which is only about $130 less.
The United States
Burlington, which is Vermont’s largest city, is more expensive than most areas in the state with an average monthly nursing home care cost of $10,737. This is slightly greater than the average cost of New Hampshire’s Manchester area at $10,646. The nearby New York areas are even more expensive. Glens Falls and Albany, both in New York’s Capital District, have respective nursing home care costs of $14,068 and $12,973. In neighboring Massachusetts, Pittsfield and Springfield have costs of more than $11,100 per month. Seniors opting for Maine can expect to pay $10,220 monthly in the Portland area.
Manchester Area, NH
Glens Falls, NY
Albany Area, NY
Portland Area, ME
Several noninstitutional care options in Vermont may be considered based on budget and the required level of care. Assisted living at $5,310 costs slightly lower than in-home care and home health care, which cost $5,434 and $5,529, respectively. The costs for these three types of care are somewhat comparable, but assisted living includes monthly accommodations, meals and most utilities. Adult day care at $2,979 is the cheapest option and may be amenable to homebound seniors who need intermittent nursing or moderate levels of medical care instead of 24-hour skilled care.
Home Health Care
Adult Day Care
Assisted Living Facility
Nursing Home Care
Does Medicaid Cover Nursing Home Care in Vermont?
The state Medicaid program benefits over 180,000 individuals. Nursing home residents are covered for the cost of nursing care services, along with living accommodations and housekeeping costs. On-site visits with physicians and rehabilitation therapists are also charged to Medicaid, in addition to medically related social and pharmaceutical services.
In Vermont, there are over 160 nursing homes, with over 6,400 beds collectively. There are alternatives for qualifying seniors who need skilled nursing care but may not need to reside in an institutionalized care setting. Choices for Care is Vermont’s Medicaid program dedicated to long-term care services. Through the program, the waiver allows seniors to age in place at home or in other residential settings while also receiving skilled nursing and personal care services.
Medicaid Eligibility in Vermont
There are a few requirements that applicants must meet to qualify for Medicaid coverage. Single applicants’ monthly income can be no more than $2,523 and they can have no more than $2,000 in assets. The income and asset limits are the same if only one spouse is applying; however, the Spousal Impoverishment Act allows the non-applicant to have up to $137,400 in assets. Couples can make up to $5,046 per month and have $4,000 in assets at most.
2022 Medicaid Income Limits for Seniors in Vermont
Annual Income Limits
Two-Person Household (Only One Person Applying)
$2,000 for applicant, $137,400 for non-applicant
Two-Person Household (Both People Applying)
Along with the financial requirements, applicants must be residents of Vermont and need hospital-level nursing care. To qualify for Medicaid in Vermont, applicants must:
- Be 65 years of age or older
- Be a United States citizen
- Reside in Vermont
How To Apply for Medicaid in Vermont
Seniors and families can use the Vermont Health Connect website to submit an application or call (855) 899-9600 to request a paper application to send by mail. The program also offers one-on-one assistance with certified application counselors. Directories for professional application counselors can be found on the Find an Assister page. There are some cases when an application may need to be updated or changed due to a lack of proper documentation, which can add three weeks to the waiting period. To avoid a longer wait time, be sure to collect all the necessary documents before starting the application process.
Information You Will Need:
- Birth certificate
- Medicare cards
- Social Security card or other proof of citizenship, such as a green card
- Proof of earned and unearned income up to 60 months prior to the date of the application
- Bank statements for the previous 60 months
- Proof of private or government pension(s), including a letter of verification from the provider
- Copies of life insurance documents
- Car registration and insurance
- Proof of real properties sold or transferred in the previous 60 months
- VA discharge papers (DD 214) for veteran applicants
- Any other documents supporting the applicant’s claim
Additional Medicaid Support & Resources in Vermont
While the Medicaid application process may seem difficult, there are a few resources for families in Vermont for application assistance, including Medicaid Planning Assistance. Medicaid also manages additional programs, such as Medicare Savings Programs, to help low-income seniors with out-of-pocket medical expenses.
For seniors and families who need assistance paying for Medicare premiums, Medicare Savings Programs cover the cost of Parts A and B. There are four programs for different levels of income and other eligibility factors. To find out if an individual or couple qualifies, contact the Vermont Medicaid program.
The Medicaid Planning Assistance website has an in-depth guide on Medicaid eligibility in Vermont and HCBS waivers, as well as an online tool to determine an individual’s eligibility. Seniors and loved ones can also read about estate planning and the role of elder law attorneys. The website has search tools to find Medicaid nursing homes and a VA pension planner.
Benefits.gov is the official website for public benefits provided by the U.S. Government. Users can search by category or for a specific program. Categories range from financial assistance to educational opportunities. Partnered with numerous federal agencies, the website has a Benefit Eligibility Screening Tool (BEST) provided by the Social Security Administration.
Does Medicare Cover Nursing Home Care in Vermont?
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:
- A semiprivate room
- 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 and Resources in Vermont
Medicare may not cover the cost of long-term care, but it can help seniors pay for the first 21 days. This gives families more time to find ways to pay in the long term without delaying care to seniors who need it. Below are a few resources that help seniors learn about Medicare and manage their benefits.
With five offices located throughout the state, the Area Agencies on Aging provide workshops at local senior centers regarding nutrition and wellness. Seniors can also contact the agency for help finding a local health insurance counselor or long-term care ombudsman. Case managers can assist families with assessing long-term care needs and resolving issues with Social Security and other public benefits.
The State Health Insurance Program (SHIP) offers free and unbiased counseling to Medicare beneficiaries. Seniors and loved ones can find assistance with maintaining benefits, along with learning about the basics and supplemental coverage options. Counselors have experience with appealing denials of claims and reporting fraudulent transactions on the beneficiaries' behalf. Additionally, qualifying individuals can apply for financial aid to cover out-of-pocket medical costs.
BenefitsCheckUp is a free website that provides a list of statewide and nationwide resources to users based on their location and a short questionnaire. There are financial assistance programs that can help seniors and families cover the various costs of living, including state supplemental income programs. Seniors can also find programs, such medication assistance and in-home chore services, that can promote independence.
The official Medicare website has a self-service portal for applying for benefits, as well as viewing enrollment status and medical history. Individuals and families can find articles and guides about Medicare and supplemental health plans, in addition to information on how to find help from a local Medicare professional. Users can find detailed guides about managing benefits, such as how to file an appeal and the free “Medicare & You” handbook.
Other Financial Assistance Options for Nursing Home Care in Vermont
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.
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. 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 able to use it to pay for skilled nursing care. Most policies cover at least a portion of the cost, but it depends on the specific policy terms. Note that older adults who are already in need of skilled nursing care will not typically be eligible to sign up for a LTC insurance policy.
Free and Low-Cost Resources for Seniors in Vermont
Finding a nursing home placement and ways to pay for care doesn’t have to be a difficult process with the help of professionals from the agencies listed below. The Vermont Department of Disabilities, Aging and Independent Living (DAIL) and the Community of Vermont Elders (COVE) are statewide organizations dedicated to helping seniors apply for benefits that improve quality of life.
Available in several languages, DAIL has a wide variety of programs for Vermont residents, ranging from Medicaid to legal assistance. The agency can assist seniors with finding housing and health care programs as well as transportation services. To reach a representative who speaks their language, seniors can call 2-1-1 and request an interpreter.
Community of Vermont Elders (COVE) offers a free hotline and website to access resources and information. The agency has education and support programs for caregivers, in addition to scam and fraud education for seniors. Building Bridges provides in-person discussions and presentations about common tactics and how to avoid them, including consumer fraud and online dating scams.
For veterans needing skilled nursing level care, the Vermont Office of Veteran Affairs offers a state-operated veterans home and covers the cost of nursing care in homes that accept VA benefits. Home and vehicle modifications can be made for veterans with disabilities. Seniors and loved ones can contact their local VA office to speak with a trained service officer about the application process.
The Vermont Assistive Technology Program loans a wide variety of assistive devices and other nonmedical assistive equipment for free to qualifying individuals. Provided by the Department of Disabilities, Aging and Independent Living, the program has 30-day loans for those who want to try a piece of equipment, such as voice-activated lights or amplified and captioned telephones.
Ombudsmen advocate for the rights of seniors residing in nursing homes on behalf of the residents or their loved ones. Certified by the state, they have experience with investigating and mediating a wide range of concerns, including neglect and care mismanagement. The volunteer-based program can help seniors explore their long-term options for nursing care.
COVID-19 Rules for Nursing Homes in Vermont
The following information is based on research done on several government websites, including healthvermont.gov/covid-19. These rules apply to Independent Living Communities and other types of senior living facilities. We’ve most recently updated this data on 2/15/2022, but since COVID-19 is a rapidly evolving pandemic, contact your local senior living facility or Area Agency on Aging for more specific and up-to-date information.
Are loved ones allowed to visit to provide emotional support?
Are relatives allowed to visit for end-of-life care?
Are residents required to quarantine after visiting with a loved one?
Are visitors required to wear PPE (including masks) in order to visit residents?
Are non-medical contractors (such as hairdressers and entertainers) allowed in senior living facilities?
Are visitors checked for elevated temperatures?
Are visitors required to answer questions about health, travel, and potential virus contact?
Outings & Social Activities
Are residents allowed to leave (errands, visiting family, etc.) for non-medical reasons?
Are residents who leave required to quarantine when they return?
Are senior living communities required to cancel all group outings?
Are residents allowed to eat meals together in a common area?
Are residents allowed to gather in common areas for group activites?
COVID-19 Safety Measures for Staff and Residents
Are staff members regularly required to do a temperature check?
Are staff members regularly tested for COVID-19?
Are staff members members regularly required to do a health and safety screening, including questions about travel, contact with positive cases, etc?
Are residents regularly screened for COVID-19 symptoms?
Are residents regularly checked for elevated temperatures?
Are residents regularly tested for COVID-19?