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

 

 

Giveaway for Caregivers

Caregiver Bracelet

Free to Followers of The Imperfect Caregiver

(US Residents Only)

Caregivers need all the support they can get. One way to increase awareness is to show the world how many of us there are, including caregivers, those who have been caregivers, and those who may become caregivers.  Our numbers grow every day and will continue to increase until cures for Alzheimer’s, all the other forms of dementia, and traumatic brain disease are found.  One way to do that is to display our support for all to see.

To receive a free Caregivers Are Heroes bracelet: Follow The Imperfect Caregiver blog and send a request in the comment section below. Include your name and complete mailing address. Address will not be published on this site.   Requests may also be sent to me directly via email at bcarducci@comcast.net  No mailing costs or hidden fees apply. This is my gift to individual caregivers.  Current followers are eligible for this free gift.

Dr. Phil, we need your help! Please use your resources and that of the Dr. Phil Foundation to create a grant to help caregivers most in need receive the help and support they so desperately need.

To add your voice to mine contact Dr. Phil at www.DrPhil.com

 

 

 

Caregivers Are Beautiful

beautiful woman

Caregivers are unique in every way. It is the caring we do that brings us together and links us in a way that cannot be broken. Know that the Imperfect Caregiver understands how special you are, even when you believe you are failing. Blessed be.

Dr. Phil, Help the Caregivers who need it most. http://www.drphil.com

Good Morning Caregivers

It’s your turn again. Please tell me how you are doing. If you’d like to share a bot of your story, please do. It may help another caregiver.

how do you feel today

Good Morning Caregivers

I hope you find a reason to smile today.

dog smiling

If you don’t, feel free to contact me. I’m here to help.

Caregiver Cover Web

 

 

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It’s Too Hard to See Him Like That

Caregivers,  often do you hear those words from family members trying to justify avoiding your loved one. For refusing to help even long enough to give you a few hours or days of respite? They may feel that upon hearing those reasons we will understand that they would like to help but they simply can’t.

Unfortunately, what they are really saying is:

“It’s too hard and it doesn’t matter how it affects anyone else. It’s not about Mom or Dad. It’s not about our brother or sister. It’s about me and how I feel.”

Some common comments and my responses follow. As the Imperfect Caregiver I speak for you so you know you are not alone.

“Mom doesn’t know me anymore so why bother visiting? When I do come by all she does is repeat the same stories over and over. It’s boring and irritating. I can’t take it.

 “I feel that way sometimes too. That’s why I need your help. Why can’t you understand that?”

“She was up all night for the past two weeks and you desperately need sleep? Take a nap during the day when she does. What’s your problem?”

“It’s not safe. If she wakes before I do she could leave the house and wander away or decide to cook something and forget it on the stove causing a fire. Could you nap under those conditions?”

“He’s combative and accuses you of stealing from him? What did you do to set him off? What do expect me to do about it?”

“I didn’t set him off. The disease did. I don’t expect you to fix it. I need you to understand what this terrible disease is doing to him.”

She seemed fine to me the last time I visited.”

If that’s true  and she is fine,why don’t you come more often? Why are you too busy to give me a break?

“My father would never use language like that! Why would you say such things about him? I think you’re the one who has a problem.”

Yes, I have a problem. It’s trying to deal with all this and you too. Would you like me to tape record him for you?

“A nursing home? Never! I promised Mom we would never do that to her.”

“We also promised to take care of her. When did “we” become only me?”

“If things are so bad put her in a nursing home. What do you mean you need help to pay for it? What about her social security and Medicare?”

 “The facilities that would take her for what little she receives are full with long waiting lists and you clearly haven’t seen what goes on in those places. Someone would have to be there every day to make sure she got the care she needs and we know who that would be.”

***

Feel free to share some of the comments you hear from family members in the comment section below. It helps us all to know we are not alone.

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Thunderclap Goal Reached. Thank You!

Thank you everyone who signed on to support my Thunderclap campaign, Family Caregiver Tells All.  Yesterday the campaign reached the required 100 supporters.

On December 21st a message will be sent to 45,296 people telling them about Confessions of an Imperfect Caregiver and help raise awareness of what it’s really like to be a family caregiver.

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Because Your Loved One May Not Be Able to Say It

When I Count My Blessings

Today when my family and I hold hands around the table I will count every one of you among the blessings for which I am thankful. Without you so many would be lost.

Blessed be everyone.

 

Caregiver Cover Web

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NaBloPoMo November 2014

A Bit of Humor To Get You Through

As you continue to care for your loved ones and prepare to recognize the Thanksgiving holiday in a way that is best for you and your family; I offer a bit of humor in the hope of bringing a smile to your face.

survive the week

And in honor of your making it through as I’m sure you will, you are a caregiver after all, here is your sparkling helmet.

sparkle helmet

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NaBloPoMo November 2014

 

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