As adult children, there is often a point in life where responsibility begins to transition from our parents taking care of us to us taking care of them. This transition is sometimes gradual and other times happens suddenly and unexpectedly.
Whether gradual or sudden, caring for a family member can be an immense undertaking. The responsibility often not only requires our time but also financial resources. With so many decisions to make it is good to have a guide including what Medicare will cover and what it won’t.
Choosing the right kind of full-time care
First, if you know what kind of care your loved-one prefers, you are one step ahead. This information can come up in conversation (if they are still making some decisions on their own) and/or may be explicitly listed in a will or legal document.
Many times, we haven’t had these conversations and our loved ones are resistant to leaving their own homes. If full-time care is required, you may have to really consider all of the options to find the best ones for your situation.
In-Home Care Options
Let’s look at what options you can consider if your loved one wants to stay in the comfort of their own home.
In-home caregiving – if your loved one wishes to remain at home and requires full-time care, a caregiver or caregivers will be necessary. Many times, this role falls to a family member. This kind of care can be taxing for both the patient and the caregiver, making services like respite care and adult day care great options for temporary relief.
Home health care – this is sometimes also referred to as skilled nursing care. This type of care would be like the care your loved one would receive in a nursing home. The type of care ranges from minimal care like administering medication and changing bandages to more complex care like managing intramuscular injections and intravenous feeding for the patient.
Hospice and palliative care – this kind of care come into play when a patient’s condition is terminal and will need end-of-life care. Every situation is different, but this kind of care is most often provided in the comfort of the patient’s home if possible. A nurse or home health aid will either periodically assist a family member/caregiver or in some situations will remain in the home continuously.
Long-Term Care Facilities
If in-home care is not an option for your loved one, there are a variety of full-time care facilities. The facility will depend upon your loved one’s healthcare needs.
Skilled nursing facility – these facilities are also referred to as nursing homes. This kind of care is for individuals who need a higher level of attention or care than a traditional assisted living home but also are not to the point of needing hospice or end-of-life care.
Memory care facility – a memory care facility is distinctly different than other long-term care facilities in the way care is provided. Often for patients who have dementia or Alzheimer’s, these facilities have 24-hour care to guarantee the safety and supervision of the patient.
Hospice care facility – as with at-home hospice care, an inpatient hospice facility is designed to provide comfort and medical attention around the clock during the end stages of life. If the patients’ health escalated quickly or unexpectedly, an inpatient facility is often the best option.
What options does Medicare cover?
There is no question that the financial aspect of full-time care weighs heavily into the full-time care decision for many families. Many people do not plan for the out-of-pocket costs that long-term or full-time care requires.
Too often, people believe that Medicare will cover this type of care. If your loved one is eligible for Medicare and receiving Medicare benefits, some of their care may be covered but certainly not in full.
For example, Medicare will pay for up to 100 days in a skilled nursing facility preceded by a qualifying hospital stay. This coverage is not without additional out-of-pocket costs unless you have a Medigap plan to pick up the additional coinsurance.
Additionally, Medicare Part A will cover hospice care if:
- You are terminally ill and have less than 6 months to live (as determined by your primary doctor and hospice doctor).
- You are accepting care for comfort rather than a cure.
- You accept and agree to the terms of forgoing other treatment covered by Medicare (to cure your illness) and choose hospice care alone.
If all of these conditions are met, Medicare will pay for all of your loved one’s hospice care.
Ultimately, as you navigate these tough decisions, you must keep the well-being of your loved one in mind while also weighing what kind of responsibility you can take on. Do your research and reach out to community groups of people who are in a similar situation to yours. Having the support of others in a time like this is invaluable.