Does Medicare cover in home care?

KathyF1

I was under the assumption that Medicare Advantage covers in home care, but a friend told me today that they believe it only covers skilled nursing care, nothing less. Currently I feel I need help just so that I can get some relief. I’m sure you all know what I mean. I help him choose his clothes, make sure he showers well, but he can do most things on his own. I’m frankly just worn out. I was hoping his doctor would write a prescription for in home care that would just give me a mental break. And I was hoping it would be covered- do you all know the answer to this? Thank you!

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Ed1937

While I was caring for my wife, my doctor told me that she was eligible for certain services at home, and asked me if I was interested. I was not at the time. He told me if I changed my mind, to let him know. He didn't go into specifics, and I didn't ask, but I'm almost positive that whatever she would be eligible for was not respite for me. But as Victoria said, contact your insurance agent to get details. I would be very surprised if you got what you had in mind. I should mention that he did not specifically say the services he mentioned were covered by Medicare. It could have been some local program.

gampiano

Welcome to our dysfunctional, out of touch, inhumane bureaucracy, American style. Unfortunately I've been dealing with Medicare, Medicaid issues for years, through several generations of family members. I doubt that you will get any help from Medicare. There are some services available if you qualify for Medicaid, but in my area, even if you do qualify, (impoverishment ) there is a six to nine month waiting period due to a scarcity of caregivers. My mom already had caregivers in place, ran out of funds, and Medicaid would not contribute to this.They wanted us to use their agency, even though they had no available personnel. Does this make sense? On the other Hand.....Daycare can be a great help, is usually affordable, if your spouse will accept attending. Mine did not do well there, but lots of people do. Also, if you have senior services , such as a Council on Aging, you can get some help with meal delivery. Meals On Wheels is great, my mom had this service for years, very affordable, sometimes free.At least you wouldn't have to be preparing lunch every day.

I wish you well on this journey, and hope you can get some relief. Me too.

KathyF1

Thank you all for your replies. I’m not sure he would go to an adult day care at least at this point. He really gets anxious if I’m not with him. I do have a friend who comes on Saturdays (that I pay) to stay the day and hang out with him. I can at least take a walk and make a short trip to the grocery store. For now I’ll have to be ok with that. I can see where paying out of pocket for someone to come just so you can get some alone time could be very expensive. We are planning on moving closer to family when our farm here sells. I think that will be necessary so preserve my sanity! It’s hard being with him, all alone, 24/7. I’m finding trips to town for lunch, going to church, anything to be around people is so vital. For him and me. Not an easy journey is it? Grateful for all your advice and support.

Joe C.

Kathy, Welcome but sorry you needed to seek out our community. Like others stated I doubt your Advantage plan will cover any at home care. Depending on where you live and your income level and your income level it is possible there could be other resources available. In my state some people who are still on Medicare (not Medicaid qualified) but meet certain income levels can receive up to 6 hours of home care through state supported elder service agencies. We did not qualify for this help because our income was to high but I know an extended family member who did qualify. I always suggest people join a local caregiver support group because these group are a great resource for what resources are available in your area. You can search for support groups on the ALZ. Assoc. main page.

Rescue mom

I just went through six weeks of hospital, home care, and rehab (with Medicare, not Advantage) and I would be shocked, stunned, if any Medicare or M Advantage covered what you’re talking about—which is what they call “custodial” care. No Medicare help with that. My DH with Alzheimer’s needed skilled nursing for a time, which Medicare handled, but after recovery, no financial help for regular daily care.

Everyone I’ve known with Advantage found it seriously lacking when it was most needed, as Victoria said. (Their sales ads are criminal IMO). But check, you never know.

In general—and there are exceptions to everything—Medicare helps when you have a physical sickness/injury, not for the daily care needed for dementia patients. 

It provided skilled nursing care, and some time-limited home care that was basically what I call skilled nursing at home, for things like cancer or serious injuries. Again, not for the daily caregiving you mention. We are usually on our own for that.

What tripped me up most in my recent experience was that everyone kept telling me our secondary insurance would cover skilled nursing/rehab for 100 days. (Medicare covered the first 29 days) I thought we were good—-but found out that the secondary works only if you meet Medicare qualifications for SN. And the providers go by Medicare guidelines, doing, otherwise is fraud, they say. So, the 100 days did not happen. Anyway, that’s a vent, but details can be complicated to understand fully at first, but matter greatly.

Rescue mom

Kathy, you sound like you’re where I was with DH a couple years ago. I don’t have much advice for you, but tons of sympathy. It’s just hard, and takes a toll on most caregivers.  Many people find day cares help. Others hire someone to come in the home and help; if your DH is open to that. If not, there’s tons of threads here on how to help “convince” him to accept them. Family can be huge help; OTOH many people  find family isn’t around much as disease progresses. 

You also may have various local programs that help; communities and states vary hugely on that front. (I’m in Florida and we have basically nothing. Even if you qualify for Medicaid, the wait lists are in the thousands). But the local Alzheimer’s Association, and support groups, were invaluable in helping me find local resources.