We are often contacted by someone whose elderly spouse or parent is being discharged from the hospital with a doctor's certification that the patient has fewer than six months to live. The discharge staff at the hospital is recommending that the patient enroll in hospice care. The spouse or adult child is concerned about how he or she is going to pay for hospice care. While the patient was in the hospital, Medicare was paying the bills.
The good news is they can reasonably expect that Medicare will continue to pay the medical bills, which includes things like prescriptions, doctor visits and nursing care. You can read more about the Medicare benefit for hospice care here.
HOWEVER, Medicare does not pay for room and board. If the patient is returning home, then this is not a big concern, but unfortunately sometimes home care is not an option. Often the patient requires 24/7 care and this is simply not feasible at home. The adult child might still be working, and there aren't enough other family members nearby to cover three 8-hour shifts per day. Or the patient might require a level of care that the family is unable to perform even with daily visits from a hospice nurse or other healthcare provider. Under those circumstances, the patient might require care in a hospice facility, which could be a different wing of the hospital, or a local dedicated hospital facility, or a section of a nursing home.
There are only four ways to pay for room and board (sometimes called custodial care): Savings, insurance, VA, and Medicaid.
The portion of the care in a facility that is attributable to room and board can, of course, be paid in cash out of pocket, from the patient's savings, perhaps subsidized by family members. However, at approximately $7000 per month in Crossville, Tennessee or almost $10,000 per month in Redding, California, this can add of up a rather tidy sum pretty quickly.
Some people have had the foresight to purchase long term care insurance (such as yours truly) or perhaps have it as a retiree benefit from a former employer. The purpose of long term care insurance is precisely to pay for custodial care when the insured can no longer perform the activities of daily living (such as bathing, eating, dressing, and transferring from one place to another) without assistance. If your spouse or parent needs custodial care, do check to see if he or she has long term care insurance.
Qualifying veterans who are also financially eligible, and their spouses, are entitled to a monthly benefit for long term care expenses.
Medicaid aka TennCare aka MediCal
Medicaid is the state-federal partnership program that pays for, among other things, long term care (custodial) expenses for individuals who qualify. It is called TennCare in Tennessee and MediCal in California. The rules for financial eligibility are complicated and vary greatly from state to state. If you have a loved one who needs professional custodial care, call our office at 931-250-8585 or 530-456-7123 for help determining whether your loved one qualifies for Medicaid or, if he or she does not qualify, for assistance making changes that will accelerate his or her eligibility and potentially preserve assets for the well spouse and children. There are many perfectly legal techniques that can be employed, but it is best to engage a specialist for this type of assistance. We can help you navigate these complicated rules.