Spouse care-giving and Medicare; what real reason(s) does Medicare have to exclude spouses?
Hello,
What real reason(s) does Medicare have to exclude spouses from caregiving?
Adult children as far as I know can live in the same home etc. and be eligible. Why can't a spouse? They are checked on the care they provide, why can't we?
I don't know about you, but my husband is terminal and needs a _lot_ of care. I don't work outside the home because I am needed here. I look at the list of services my son could be compensated for by Medicare, and I know I pretty much do *all* of them, and have for over a decade. For free, and while loosing my own access to Social Security Disability should I become disabled myself.
I am not looking for a freebie, I want to be treated equally.
The same checks to avoid abuse could be applied to us. I would be fine with that.
I know there is an option of disability that might cover me, but the payments are much lower, in line with someone who has never worked.
I do work.
I am just neither paid nor recognized for it. I am just expected to do it, and like most by far, I would never deny my spouse all the care I can possibly give.
I don't have to tell you that caregiving is a lot of work, and that you are on the clock 24/7.
I would like to open a discussion on how to challenge what I see as a discriminatory rule.
I realize that people will immediately start talking about childcare, and that parents aren't compensated to care for their infants. children grow out of this intensive type of caregiving in a relatively short amount of time. They will over time become more able to do things independently.
Caregiving for disabled adults can span decades and is often without the expectation of functional improvement. That is why they are on Medicare in the first place.
I know I am definitely not the only spouse going without the same financial and social securities and compensations as anyone else would have if they weren't married to the person they are caring for, because we would neither turn our spouse away, nor pretend our marriage has failed.
I feel the government is counting and banking on us providing the same care -they would pay absolutely anyone else for- for free because we are both the first people asked for help, and the least likely to ever say no regardless.
What are your opinions, and how would we go about challenging this?
Where do we start?
Thanks!
Alexx.
3 Answers
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Or have a serious in your favor prenup done & marry $.
I’m not trying to be all sassy, but the reality is that by & large caregiving in the US is done by family and done for free out of a sense of familial duty with no compensation.
MediCARE does not pay family. MediCARE is insurance & is about paying for hospitalization, physician costs, fees paid to other health care providers and paying towards prescription drug costs. You would need to be some sort of licensed/ regulated health care provider or be employed by one, to be paid as a vendor participating in Medicare and accepting Medicare negotiated rates.
Medicaid can, but your state will need to do waivers from your states Medicaid budget for IHHS (in home health support or services) programs and have administration & training set up for IHHS. Based on what others have posted on AC, most IHHS done by a living in the home child, (so living rent free), who does not have other full time employment & they undergo some sort of health & safety training course & paid slightly above minimum wage for 12-28/30 hrs of care per week. The elder will have a needs assessment to determine the # of hours. It cannot go over a set amount of hours, like be in the 30/34+ hr range, as the cost effectiveness or cost benefit is not there if over 30/34 hrs a week. Seems to be abt $10 hr & 20 hrs a week average and paid by state so all reported taxable income, so maybe $140 actually paid. Some states require part of the elders income paid to state to offset costs.
AZ & CA have established IHHS.
But What states are doing now is moving to PACE - Programs for All Inclusive Care for Elders and away from any 1-on-1 programs. If your area has PACE, really think to have your hubs evaluated for it. PACE will pick them up and take them to a PACE center 2-4 days a week for 6-8 hr day, and includes meals, activities, screenings, transportation. All medical care gets coordinated thru the center. If they need a check in over the weekend, a PACE employee can do a 3-4 hr visit over the weekend. If they get beyond what PACE can provide, they will have the health chart to show a higher level of care is needed. Which enables them to transition to a NH or MC. If PaCE is happening in your area, hubs may need to be evaluated for it as a first step to get into any state supported program. All nonPACE time is on family to do. But the PACE enrollee will have income & can pay for a home health company to provide for care.
Most PACE is set up that they need to be a “dual” which means they are on both Medicare & Medicaid. It would be community based Medicaid that they go onto. Although some PACE centers have had the Medicaid requirement successfully challenged by participants.