At Episcopal Church Home, we do our best to help family caregivers understand what they can do to provide for their relatives' care. And our promise, as a person-centered, not-for-profit retirement care organization, is never to ask an ECH resident who has outlived his or her monetary resources to move.
In today's blog post, let's look at what families can expect, from a financial perspective, as their loved ones transition into residential memory care.
Does Medicare cover memory care?
In some ways no, and in some ways yes. It's nuanced.
Centers for Medicare & Medicaid Services (CMS) programs do not cover outpatient memory care services or adult day care for dementia patients. They do not cover temporary respite care admissions. Neither do they cover residential memory care placement, if the only reason for placement is custodial care for patients with degenerative memory loss.
That said, some private insurers do cover such services. Typically, such coverages, when available from private insurers, are provided under long-term care policies. Those would had to have been purchased when your loved one was healthy — because post-diagnosis patients are usually excluded from new coverage — or by special riders added on to an existing health care policy.
If your parent has been diagnosed with dementia or Alzheimer's, the first thing you need to know is what insurance he or she carries, and what it covers. Our memory care experts recommend that your family consult with your loved one's health insurance agent to determine what coverage he or she carries, and whether there are any ancillary coverages he or she might be eligible to add.
Be careful to choose a provider that has a safety net program in place, like Episcopal Church Home's Promise Fund. Such programs will prevent your loved one from being asked to move if he or she outlives the financial assets that pay for his or her care.
What will Medicare cover?
Medicare will cover inpatient hospital care, some physician fees and medical equipment for dementia patients age 65 or older. It also covers up to 100 days of skilled nursing care for some medical (not memory-related) issues.
Medicare Part D will cover some — but not necessarily all — prescriptions. Check with Medicare for coverage eligibilities. You'll need to work with your parent's doctor to find alternative, covered medications if the initial prescription is not covered.
Medicare will also pay for hospice care services (in-home or in a residential facility) for end-stage dementia patients.
How can I pay for my parent's memory care if it's not covered by insurance?
The best advice we could give any family member of someone who has been diagnosed with dementia or Alzheimer's is to be judicious about balancing budget against needs.
Some families have the resources immediately available to pay for their loved one's memory care out-of-pocket. Some seniors planned well during their working years and are privately well-insured.
Unfortunately, neither of those scenarios is very common. But, when circumstances arise, we must play the cards we are dealt.
Some adult children of parents with dementia pool their resources to provide for their parent's care. Other families opt to spend down the loved one's assets, such as selling a home, to pay for care.
For families who don't immediately have the resources available to pay for residential memory care, there are options. Some choose to provide care on their own for their loved ones, until medical needs exceed the ability to safely provide that care in the home.
Many families try to divvy up care responsibilities between adult siblings, with one serving as primary caregiver and/or power-of-attorney. The others might agree to provide care in their homes for several days a month, several weeks a year or a few months at a time to give the primary caregiver some time off.
How do we know which residential memory care provider would be best for our loved one's needs?
Whichever method your family is using to pay for your loved one's care, be sure that the residential memory care home you choose is reputable. Make sure that it's warm, welcoming and person-centered. You'll want to rigorously investigate a provider's safety record, accreditations and inspection scores before you sign a care agreement.
Familiarity and routine are tremendously important in a loved one's memory care. Disruptions can increase the likelihood of behavioral outbursts, depression, or other negative symptoms that are associated with dementia and Alzheimer's.
So, you should also be careful to choose a provider that has a safety net program in place, like Episcopal Church Home's Promise Fund. Such programs will prevent your loved one from being asked to move if he or she outlives the financial assets that pay for his or her care.
If you still have questions about paying for memory care, about what memory care is, or about what to do now that your parent has been diagnosed with Alzheimer's or dementia, we have more help for you. Download our free Dementia Guidebook here.
And, as always, the Episcopal Church Home memory care experts are available to answer your family's questions, whenever you need us. Contact us here.