By Betty Berry, Tuesday, Sept. 21, 2010 Q: My brother, who is the caretaker for my 99-year-old mother, told me recently that my mother was eligible for Medicare’s hospice benefit. I thought Medicare did not pay for “custodial” care. Where can I get more information about this?
A: You are right — Medicare does not pay for custodial care. However, hospice care is much different from custodial care, and it is covered under Medicare Part A benefits.
To qualify for hospice benefits a patient’s doctor must certify that the patient has a terminal illness and is expected to live six months or less if the illness proceeds at its normal course.
Hospice care coverage includes drugs for pain relief and symptom management. It also covers medical, nursing, social services and grief counseling.
Hospice care can be received in the patient’s home or other living accommodations such as an assisted care or skilled nursing facility. If the care is received in a facility the hospice coverage does not include the cost of room and board.
Hospice services must be provided by a Medicare-approved agency.
Custodial care does not require the services of trained medical personnel or therapists, and it does not have to be provided by a Medicare-approved agency. It can be performed by family members as well as home aides.
A custodial care patient usually requires either stand-by supervision or hands on assistance with one or more of the normal daily living activities.
Daily living activities include bathing, toileting, dressing, eating, transferring to and from a bed and chair and incontinence.
A suggested place to start a discussion about hospice services and to find out if such services would be appropriate for a family member would be with the patient’s primary physician.
Q: My dad is currently in a skilled nursing facility recovering from back surgery. He has Medicare as his primary insurance with a Medigap policy as his secondary coverage. The admissions office informed me that the first 20 days will be paid fully by Medicare and that the next 80 days his Medigap policy would pay the co-pay. Is this true?
A: Basically this is true. There are a few qualifications that must be met to have Medicare pay in a skilled nursing facility.
First, the patient must have been in an acute care hospital for a minimum of three days and then need either skilled nursing care or therapy at a facility.
Medicare will pay the full cost for the first 20 days and partially for days 21 through 100 if the need for that skilled care or therapy continues.
If the need for that care ceases before the 100 days are used up then the Medicare coverage stops. The coverage does not extend beyond the 100 days even if the need for that type of care continues.
Most Medigap policies cover this type of care.
Oct. 2, 9:30 a.m.-1 p.m.: Seminar — Senior Emergency Preparedness at Senior Concerns Day Center, 401 Hodencamp Road, Thousand Oaks. For reservations, call 497-0189.
Oct. 2, noon-3 p.m. Annual Parkinson’s Disease Educational Presentation at Northridge Hospital, Educational Auditorium, 18300 Roscoe Blvd., Northridge. Reservations required; call 818-885-8623. Calls from outside 818 area call 866-499-2732.
— 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; call 495-6250 or e-mail email@example.com (please include your telephone number.) You are invited to submit questions on senior issues.