Senior Advocate: Medicare covers some skilled nursing costs
Dec
4
Written by:
12/4/2008 2:06 PM
Q: There is a chance my dad will need to go into a skilled nursing facility, and I've been told that Medicare might pay the costs. Do you know under what conditions this would occur?
A: The reason for your dad's stay in a skilled nursing facility will determine whether or not Medicare will cover the cost. There are three types of care an individual can receive in a skilled nursing facility. They are skilled nursing care, rehabilitation therapy and custodial care. Medicare coverage applies only to skilled care or therapy.
If your dad needs custodial care, Medicare will not cover any of the costs. However, if your dad needs continued skilled care or therapy after having been in an acute care hospital for at least three days, then Medicare coverage is available for a limited period of time. You may have some questions about what constitutes custodial care as compared to skilled nursing care. Custodial care does not require the skills or knowledge of a doctor or registered health personnel. Custodial care is normally provided by an attendant who assists or supervises such activities as walking, bathing, dressing, eating, using the toilet or moving from bed to chair, etc.
Medicare defines skilled care as a nursing or rehab therapy service that requires the special skills of technical or professional health personnel such as registered nurses, licensed practical or vocational nurses, physical therapists, occupational therapists, speech therapists and audiologists.
Examples of skilled services include but are not limited to intravenous feeding, care of catheters, application of dressings involving prescription medications and treatment of bed sores and other widespread skin disorders.
Skilled rehabilitation services include therapeutic exercises or activities, gait evaluation and training, ongoing assessment or rehabilitation needs and potential and maintenance therapy. Both skilled care and rehabilitation therapy services must be required seven days a week to qualify for Medicare coverage in a facility.
There may be some crossover of coverage. A patient who has need of both skilled or therapy care as well as custodial care will likely be considered a Medicare patient. Also a service that is ordinarily considered custodial may at times qualify as skilled if the overall condition of the patient requires the expertise of skilled personnel.
Q: A few weeks ago, Senior Concerns offered a seminar on veterans benefits, and I was unable to attend. Do you know if that seminar will be offered again?
A: That particular seminar was so popular that the waiting list was almost as long as the list of attendees, so Senior Concerns is going to repeat the seminar.
It is scheduled for Dec. 10, from 4 to 6 p.m., at Senior Concerns Adult Day Center, 401 Hodencamp Road, Thousand Oaks.
The session will be facilitated by George Compton, retired Army colonel and county veterans service officer, and will cover eligibility requirements, family survivor benefits and how VA benefits work with other insurance benefits. There also will be information on veterans facilities and the Aid and Attendance program.
For reservations and information, call Terry at 497-0189. Reservations are strongly suggested, but walk-in attendees are always welcome.
If you are a caregiver for a special needs senior and require respite care while attending the presentation, that care is available at the center and must be arranged for when you make your reservation.
Happenings
Medicare Part D Prescription Drug Program one-stop shops for assistance with enrollment:
Thursday — Santa Clara Recreation Center, Ventura, from 10 a.m. to 2 p.m.
Monday — Santa Paula Senior Center, Santa Paula, from 10 a.m. to 2 p.m.
Tuesday — Ventura Avenue Adult Center, Ventura, from 10 a.m. to 2 p.m.
For more information, call the HICAP Office at 477-7310.
— Betty Berry is a senior advocate for Senior Concerns. The advocates are at the Goebel Senior Adult Center, 1385 E. Janss Road, Thousand Oaks, CA 91362; or call 495-6250. You are invited to submit questions on senior issues.