As my FIL was dying, we looked into a care facility for him. I was told by the state agency and Medicare something that shocked me.
1. Medicare only covers 21 days in a care facility after hospital discharge. I had heard 90 days, but both sources said 21.
2. Medicare does NOT cover "room and board" if you're on hospice. They pay for all the drugs and nurses and CNAs, etc., but you're stuck with the facility bill.
My friend, a nurse in a SNF, said a lot of families don't put their LOs on hospice because of this. So those people are left at the SNFs, dying, essentially, but not on the comfort measures hospice gives.
As a hospice volunteer, I know most hospice takes place in the home. But wow! It was horribly eye opening.
MediCARE does not, has not & will not pay for custodial care costs, e.g. room & board costs in a facility. MediCARE is abt patient related costs.
Medicare is health insurance coverage available to all & applied for once you turn 65. For a very sm group MediCARE available before 65, eg, ESRD, over 2 years SSDI, Lou Gerhrig disease, couple others. If you work, you have been paying into Medicare via FICA or SE tax. Once you retire Original MediCARE premium comes from SSA payout & you find secondary insurer for nonPart A Medicare. Or you do a Medicare Advantage plan. MediCARE 100% Federal so it is portable btw States if a vendor participates in Medicare.
Medicaid is an entirely different beyond huge program that is Federal & State. Feds give $ to states based on demographics (why census important). Feds have baseline regulations on programs, States administer Medicaid program’s uniquely for their State. Medicaid is huge, like everything from Healthy Teeth vans that go to elementary schools (CHIP), loan outs of breast pumps (WIC), paying room&board in a NH (LTC). Medicaid “at need” for eligibility. Eligibility on programs set by ea State based on Federal guidelines. Medicaid by law has dedicated (required) funding to pay for custodial care costs for those “at need” medically & financially for skilled nursing care residing in a SNF. States can file for waivers to have some of this dedicated $ to be shifted to another State program that serves same demographic, eg waiver to pay for AL (instead of a NH), to pay for PACE centers (instead of a NH).
LSS Medicaid will pay for long term room&board custodial care costs in a SNF (or a AL or MC if your state does waivers) if “at need”;
&
Medicare via Part A benefits pays for post hospitalization costs in a SNF, eg post hospitalization discharge for rehab. Rehab criteria pretty tight, like they have to show promise to be able to benefit from rehab and it is @ 100% coverage for first 20/21 days and then up to 100 days @ 50% coverage if they are sufficiently progressing in their rehab to stay eligible. Often & sadly, an elder will show in their chart they are unlikely to participate in rehab & so rehab doesn’t happen & this may have been what your dad was evaluated to be. NH really aren’t going to want to have them come in as “rehab” patient then have Medicare terminate it day4 as their chart clearly shows no capability.
Usual scenario is elder breaks hip, goes 2 hospital, has surgery, then 2 NH for rehab… all so far 100% MediCARE… but by week #2 pretty well determined they cannot do rehab aka “not progressing” so Medicare sends out termination letter. & obvious not ok to ever go back home to live so segueway from MediCARE rehab patient to a long term custodial care resident at the facility. LTC is private pay, LTC insurance or file for LTC Medicaid if “at need” eligible to pay for the room & board costs.
When they file for LTC Medicaid to pay for that NH custodial care they also are usually also filing for Medicaid as health insurance.
BUT
Medicare will still exist for them as health insurance & will be paying for some direct vendor costs: like pays for therapists to do twice a week “gait training” or for the NH MD to do his twice a month bedside rounds to see the elder. And more importantly, they can apply for Medicare’s hospice benefits
Most in a Nh are duals - on Medicare & Medicaid for health insurance - and NH billing knows how to bill accordingly. Like flu shot will get billed to Medicare but NH can bill Medicaid a facilitation fee.
Medicare pays hospice whether in a facility (SNF, NH, MC) or in a private home. MediCARE is paying hospice agency for professional services, so the medical director, nursing care director, etc at the hospice are billing Medicare as a bundle.
MediCARE paid my mom’s hospice agency abt $4800 a mo.
"Room and board. Medicare doesn't cover room and board if you get hospice care in your home or if you live in a nursing home or a hospice inpatient facility. If the hospice team determines that you need short-term inpatient or respite care services that they arrange, Medicare will cover your stay in the facility. You may have to pay a small copayment for the respite stay."
1. After a hospital stay and Rehab is needed Medicare pays 100% for the first 20 days. The 21st to the 100th day, 50%. The other 50% is either paid by the patient or they have a very good suppliment that pays the 50%. The 100 days is not a guarantee. If the person is not progressing or has hit a plateau, Medicare will have them discharged. If its found the patient needs to stay over the 100 days, its now private pay.
2. the above shows that Medicare does not pay room and board in any instance other than respite care.
My Mom was a resident in a NH and Hospice was brought in when it was determined she was actively dying. She was on Medicaid for her care. Medicaid paid her room and board and Medicare paid her Hospice care. If she had been private pay, she would have been required to continue paying for her room and board. I do not know what your friends SNF is telling these families but Hospice can be done at home or in a facility. The facility is considered their home, they are a resident not a patient. I have seen Hospice done in Assisted livings where a person resides.
Was your FIL in the hospital when it was found he was dying? So Rehab was out of the question because he was not able to do it. So, you did not want to take him home where you could have had Hospice brought in and Medicare paying? Thats OK, but by placing him in a facility you had to pay privately for that facility. (If no money, not sure if you could have gotten Medicaid to cover his stay or not) Hospice could then be brought in. Your problem would be if the facility would allow admittance for the purpose of Hospice care only. I would think it would need to be a private room because what resident wants to share their room with a dying person.
I am sorry for the loss of your FIL but it seems you received the incorrect information.
There are lots of folks who are depending on inheriting the equity that has been built into a homestead: equally, there are folks whose parents are destitute who believe that NH/Hospice/Medicare/Medicaid are after what little money THEY have.
I know the sticker shock my brothers and I experienced each time an IL/AL/NH told us the price tag.
We were so fortunate to have SIL along who was much more dispassionate and accurate in her assessment of my mom's assets. She was able to see that if mom no longer had the upkeep/taxes inherent in home ownership, she would be fine ayong for LongcTerm Care.