Medicare and Respite Care – What Does it Cover?

When it comes to our loved ones that may be living with health conditions that hinder their ability to perform everyday functions, we want to provide them with the best care. Statistics show that often, it is a family member that takes on this role as a full-time caregiver.

Being a caregiver is one of those jobs that not everyone can do. It requires compassion and patience in addition to nurturing and problem-solving skills. The role as caregiver can often be stressful and daunting, which is why respite care exists: to give full-time, at-home caregivers a break when they need one.

What is respite care?

First, let’s define and outline what respite care is and why it’s beneficial. Respite care can come in many different forms and can last for either hours or even days, depending on the situation. Respite care can take place at home or in an inpatient hospital, long-term care facility, or an adult day care center.

Respite care providers are trained and qualified to handle managing basic living activities and functions for those disabled or medically unable. In addition to basic care, respite care providers can administer medications and even tube feedings. For those extremely ill, a registered nurse can serve as a respite care provider.

Not only is respite care beneficial for the primary caregiver needing a break, but many seniors needing extra support and medical attention enjoy seeing new faces as they receive their care.

Does Original Medicare cover respite care?

Medicare does pay for respite care under Part A as part of your hospice care benefits. However, Medicare only pays for respite care when the person in need has a prognosis of six months or fewer to live.

Additionally, a signed statement is required declaring that the beneficiary is choosing hospice care instead of medical treatment for the terminal disease. Another thing to note is that Part A hospice care generally only covers respite care in a hospital inpatient setting.

If the beneficiary has been admitted to a hospice program, Medicare Part A will pay for up to five days of inpatient respite care at time. However, sometimes you may be required to cover a 5% coinsurance amount. Beneficiaries who are covered by a Medigap plan may have this 5% covered for them.

Respite is only covered on an occasional basis, so be mindful of how frequently you use these benefits. Medicare guidelines don’t clearly specify what qualifies as “occasional,” but Medicare typically approves most respite care for hospice patients.

What is covered under a Medicare Advantage plan?

As explained above, Original Medicare will only cover respite care under necessary conditions and Medicare-approved hospice benefits. However, about one-third of beneficiaries are enrolled in Medicare Advantage plans instead of Original Medicare.

Medicare Advantage plans are required to provide the same services as Original Medicare, but since these plans are entirely separate from Original Medicare and are private plans, they have the freedom to provide additional services that Original Medicare does not.

As of 2019, Advantage plans can now offer a variety of in-home care services, including respite care. Some Advantage plans will cover respite care in the form of in-home care, adult day care and short-term respite care in an approved facility.

Each plan that chooses to include these benefits will allot a certain dollar amount or number of hours of respite care that will be covered each year. Since every Advantage plan is different, cost and hours coverage may vary for respite care.

The great thing about this is that under certain Advantage plans, beneficiaries have more freedom when it comes to their choice of care.

Conclusion

It’s never an easy situation to be in when a loved one needs hospice care or any kind of additional medical attention. The advances that CMS is making with allowing coverage of respite care is a breath of fresh air for many families. Although advances to respite care coverage are being made, it’s always a good idea to really assess the situation before dipping into those benefits, no matter what kind of Medicare plan you have.

Much like everything else under Medicare, it is always recommended that you call a professional or your insurance provider to confirm what is covered and what isn’t covered before getting locked into an insurance plan.

Thank you, Danielle Kunkle for contributing this article today.

 

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A Caregiver Asks – Mom Refuses to Change Her Clothes – What Can I Do?

clothing

Mom refuses to change her clothes? It’s been four days!

Five reasons why this often happens and what may help change her mind: 

  1. She thinks she just put them on. Days may run together for her and sometimes her mind has taken her back in time. Try telling her the day of the week and suggesting it’s time to change her clothes. “Good morning, Mom. It’s Monday, clean clothes day.” If she resists, don’t insist. Give her time to think about it. She may surprise you later by changing her clothes on her own. It’s become her idea.What is four days to you could be only moments ago to her.
  2. She doesn’t understand why you are trying to take her clothes from her. She is warm and comfortable as she is. She may have body issues, (don’t we all) and not want you to see her unclothed. Set out some clean clothes and walk away. Curiosity may result in her checking them out and trying them on. Again, don’t insist. Let it become her choice.
  3. She doesn’t remember how to take them off.  Buttons and snaps are hard for her. She can’t figure out how to get her arm through a sleeve or the leg of a pair of pants. Dementia friendly clothing is available for women and men from sites like this and others: https://www.silverts.com
  4. She can’t tell that they are dirty.  Dementia affects vision and her clothes look fine to her. People with dementia often have very limited peripheral vision. When she looks down, it’s like looking through a pair of binoculars. She can’t see that her shirt has multiple stains. Gently tell her that there is a spill that may stain and suggest she put the item in the laundry. Now she is doing something she has done many times, putting clothes in the laundry, and you are not making her change her clothes.
  5. She doesn’t recognize what a shirt, a pair of pants, or skirt are.Muted colors are sometimes hard for someone with dementia to see. Try laying out clothing in bright colors. Reds, deep blues, yellows, greens, and purples for instance. If her selections clash, who cares? They are clean and you have avoided some stress. Things of different shapes and sizes that move on hangers when she tries to touch them frighten her. Too many choices confuse her.

Note: These suggestions may work once or twice and then never again. Some may not work at all for you. However, giving them a try may help and can’t hurt.

If you have a suggestion for other caregivers, please post it here. Caregivers get it in a way no one else can.

Bobbi Carducci is a Certified Caregiving Consultant, CCC and a Certified Caregiving Educator, CCE.  To schedule a FREE 30 minute consultation or for details on how to schedule a presentation, send and email to info@bobbicarducci.com

 

 

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