The biggest surprise for people enrolling in Medicare is that the program won’t pay for custodial care in a nursing home.
If you break a hip, and need rehabiliation, and then a long-term stay somewhere, Medicare will pick up the tab.
If you become forgetful, let the papers and the mail pile up, almost set the house on fire when your forget to shut off the stove, and you need to go to a nursing home, forget about it: Medicare won’t pay. It is an acute care system, for illnesses that can be treated.
Under custodial care, where you are in the nursing home because it isn’t safe for you to be home alone, Medicare will not pay the bills.
Consumers get confused because they are not clear on what acute means. If you need skilled nursing and therapy, Medicare pays the bills. Jean Smith ,87, breaks her hip. She goes to the hospital and gets a new hip, then goes to a skilled nursing facility, or rehab center, where Medicare will pay for care for 100 days, with no charge for the first 20 days.
After that, her doctor says she still needs care at home, perhaps physical therapy, or someone to administer drugs. Medicare pays.
Sally Vandergriff is also 87, by contrast, goes into a nursing home, after she is declining in her own house, often forgetting to eat, and sometimes wandering the block. She needs long-term care, perhaps assistance with bathing or dressing, or using the toilet. These are called activities of daily living, and Medicare won”t pay for them. Sally or her family must pay the tab at the nursing home, which can cost $70,000 a year or more.
After Sally has “spent down,” using all her savings, cash, stocks and bonds, and has only $2,000 left, then her nursing home bills will be covered by Medicaid, the federal-state health program for the poor. Nursing homes are filled with people, usually elderly women, who started as middle-class, wiped out their savings and are now on Medicaid.
And this is the shock that comes to Medicare beneficiaries and their families if they are unlucky enough to need long-term care.
“Clearing up this misperception about Medicare is crucial,” according to a report by Harriet Komisar, senior strategic policy adviser at the AARP Public Policy Institute. “First, Americans need to understand the limits of Medicare coverage as they make decisions about long term care. Second, policy leaders, including the Commission on Long-Term Care, need an accurate picture of how long-term care is financed. The Commission should be clear that most Medicare enrollees, like most Americans, have no insurance protection for long-term care.”
The rising cost of health care , including long-term care, is a threat to the economic security of millions of Americans as they move into the years of retirement.
“If these trends continue, many people who had been middle-class throughout their working years risk not having sufficient financial resources to maintain a middle-class lifestyle during their retirement years, ” according to a report by Komisar, “The Effects of Rising Health Care Costs on Middle-Class Economic Security.”
Here’s the report.
