Yes, Medicare will pay for a broken hip. No, Medicare will not pay a dime for daily caregiving, but who does pay in this situation?
I am going to do a little Medicare myth busting and dispel some common questions and concerns. Questions and Concerns that could be keeping you from getting the service you need. Addressing these myths can help you plan appropriately for your own long life.
Many individuals think they will have home care when needed, because they have Medicare and a Medicare gap policy. Medicare does not (currently) pay for any daily caregiving. Even if it’s needed for someone requiring help with the activities of daily living. The percentage of people needing this type of care is 50% of those over 85.
However, if you or your family members are in need of care and are low income or even middle income with minimal assets, you could qualify for In-Home Supportive Services through your county, funded by both the Federal & State Governments. You could have a portion of your total costs paid and this is certainly worth exploring. A good website to look at if you are considering this option is California Advocates for Nursing Home Reform.
Many individuals are not aware of all the screenings that Medicare covers annually. Screenings that are needed in order to catch issues before they become serious. You should take advantage of these services. If you are interested in exploring how Medicare could help you and what services they cover check out the Medicare website. Remember: Don’t forget the flu shot – the cost is covered by Medicare.
Skilled Nursing After a Hospitalization
This can get tricky if your family member was not really “admitted” to an acute care hospital. If your family member was only on “observation” status he/she might not qualify. He/she would not have had the qualifying days to be able to access skilled nursing rehabilitation services paid by Medicare. So, be sure your family member is “admitted” and not on observation. Ask; don’t assume!
Some individuals think that Medicare will continue to pay for this level of care. They might think their family member is going to get weeks of rehab. If the individual is not participating or making improvement, these days will come to an end sooner than you think. Be involved and encourage your family member to take advantage of the therapies offered.
One family that I was helping, was preparing for a private pay residency at a skilled nursing facility. Their dad’s highly skilled needs needed to be met by a skilled nurse. They thought that the facility would charge him differently or more because of how he needed his nutrition administered. That is usually not the case. Your nutrition, however you need it administered, is covered in your daily care costs. Each facility will have a different cost system. Again, ask questions; don’t assume the outcome if you have not asked the proper questions regarding your situation.
Qualifying a Family Member for Medi-Cal Long Term Care in Skilled Nursing
I had a potential client that was exhausted caring for her husband who was “full care”. She thought that it was time to place him in a skilled nursing facility. I had only talked with the daughter; the mother didn’t want to spend the money on a consultation with me or one of our staff members and instead she used a “free” placement service.
When I saw the daughter at a local event, she told me her mother had found a place for Dad. The facility cost over $4,000 a month and her mother would be running out of money soon. I asked why she didn’t put him in a skilled nursing facility? She told me the “free” placement agency informed her that her dad needed to be in a hospital for 3 days before moving into Medi-Cal skilled nursing. That is totally wrong! You do not have to be coming from a hospital to move into Medi-Cal covered skilled nursing.
Couples are allowed to have assets over $100,000 for the well spouse and sometimes more if the well spouse has medical needs that require financial help for his or her own care. Because they didn’t want to spend a few hundred dollars on an objective expert, this family spent over $12,000 that they didn’t need to spend. After our conversation, just a few weeks later, she moved Dad into a Medi-Cal facility close to home.
Likewise if a couple has assets beyond the $100,000, a consultation with an Elder Law attorney could help save thousands of dollars and still qualify the individual with needs, for Medi-Cal.
Have a consultation with an expert and get the names of other experts that can help you plan for these costs.
Using Your Long Term Care Insurance
Many policies require that the policy holder must need help with two or three of the activities of daily living (ADLs) before you can begin to use your benefits. These ADLs are: bathing, dressing, toileting, continence and eating.
When families or couples look at these needs, they often think they can’t use their policy. They might believe the beneficiary does not need help in any of those tasks. However, if the person has dementia, it means that he or she is not safe or at least is at risk when cooking or even bathing. Look closely at your policy! Most of them cover dementia to trump all the other activities of daily living, if diagnosed by a medical professional. We often assist our clients in obtaining these and other benefits.
The best advice is to consult an expert! A Professional Geriatric Care Manager (also called an Aging Life Care Expert) can help when you are uncertain about any aspect of living longer lives. If you are unclear about what questions to ask there is no need to worry. We will ask you about all the avenues of care needs that may impact quality of life and that will determine the care you or your loved one need best.