Caregivers spend much of their time caring for someone else. While many enjoy helping others, being a primary caregiver is physically and emotionally draining because the person they care for needs continual care, leaving little time for a break. This is where respite care comes in.
Unfortunately, caregivers who could benefit from respite care to get the break they need fear that they or the one they care for cannot afford the additional cost. This is why it is important to understand whether or not Medicare pays for respite care and what options are available to those who may not be eligible.
The following is a complete overview of Medicare coverage as it relates to respite care for elderly individuals, those who are in palliative or hospice care or others who require assistance with daily living for another reason.
What is Respite Care?
Respite care is a temporary break given to caregivers. Respite care professionals carry out the same essential daily tasks that the caregiver does to ensure the one receiving the care gets the best possible assistance without it affecting their regular routine.
It assists caregivers who are physically or emotionally fatigued and need a temporary break. Respite care is also available if the caregiver is called away for several days for other reasons as well, such as to attend a high school graduation or go on a weekend trip with friends.
It can be provided in-home or at an assisted living facility, although the place in which the care is offered may affect whether or not insurance covers the cost.
Medicare Coverage for Hospice Care – What Are My Costs?
Hospice care is palliative care provided to patients with a terminal illness, specifically those who are given a life expectancy of six months or less. Hospice care most often involves the need for a primary caregiver to assist the patient with daily tasks such as hygiene practices, cooking meals and taking pain medication.
Medicare Part A covers respite care for patients who are in need of hospice care, although there are some conditions. Patients must meet the following criteria to be eligible for respite care coverage under Medicare Part A:
- Diagnosed with a terminal illness
- Must receive palliative care in place of curative care
- Statement of declaration that the patient chooses hospice care
- The hospice care must be provided in an in-patient facility
Oftentimes, the tricky part to having the cost of respite care covered by Medicare Part A is that the care provided must take place in an in-patient facility. However, those who are covered already by Medicare for in-home hospice care, coverage for respite care may not be an option.
For those who receive hospice care in an inpatient facility, Medicare Part A should cover most of the cost of respite care. However, Medicare Part A does not always cover the entire cost of respite care. Recipients of inpatient respite care as a part of hospice care may be responsible for up to five percent of the Medicare-approved cost.
Additionally, Medicare considers respite care to be five days of care or less. This means they will provide coverage for up to five days at a time. If the hospice patient requires inpatient respite care for more than five days, the recipient is responsible for the additional cost.
What Options Are Available if I’m Not Eligible?
If Medicare does not cover respite care, then there are other options available. Of course, the most obvious option if Medicare does not cover the cost is self-funding. Since respite care occurs on a temporary basis and does not involve long-term care, many save money throughout the year to pay for the temporary breaks the caregiver needs.
Another option is an adult day service organization. Transitioning into long-term in-home care assistance may be an option as well if the caregiver will need more time away. Lastly, the patient may consider entering into an inpatient facility if they are currently in need of hospice care and meet all other requirements to have Medicare pay for the respite care.
How Should I Decide Which Care Provider to Use?
Choosing the right respite care provider is essential to ensure the one you care for gets the assistance they need while you are away. If you are a caregiver searching for the right respite care program, then compare the services they offer to the services that you perform daily. Several common services you may need the respite care team to provide include:
- Meal preparation
- Bathing assistance
- Oral and skincare
- Getting dressed
- Hair washing and shaving
- Physical exercise
- Toileting assistance
If the respite care provider you are considering does not offer essential support for activities of daily living (ADLs), then consider searching for a different provider.
Additionally, the respite care professional should be friendly and someone the person you care for gets along with well. Lastly, if the one you provide care for lives in their home, then you should seek a respite care provider that offers in-home services.
By finding the right provider, you can worry less while you are away from your caregiving duties and enjoy the time you have off, knowing that the one you care for is happy and in good hands.
Contact Comfort Home Care for a Free Evaluation
You can reach our team at Comfort Home Care for a free respite in-home care evaluation. We respond to all who are in need of respite care services in a timely manner. We are happy to discuss respite care with you and help you decide on the best course of action if you are a caregiver that needs some support or time away.
We have a friendly team of respite care members that understand the importance of providing relief to caregivers and ensuring the one receiving the care has the best experience possible while their primary caregiver is away.