What is Respite Care?
Respite care is care that provides short-term relief for primary caregivers and can be arranged for just an afternoon or several weeks. Respite care can be provided in your home, in a healthcare facility, or at an adult day center. Caregivers, nurses, family friends, and community volunteers can provide respite services.
In-Home Respite Care
Caregivers can come to your home if that is your preferred option. Your home health aide can help with tasks like bathing, dressing, eating, and administering medication. Caregivers can be hired through an agency or through hospice care if the patient has six months or less to live.
Respite Care in an Assisted Living Facility or Nursing Home
Many senior living facilities like nursing homes, assisted living facilities, or hospice centers provide respite care. There are usually rooms within these facilities designed for temporary respite stays. This option makes the most sense for caregivers that need a break for consecutive days at a time, especially when the patient is able to leave the home.
Respite Care at an Adult Day Care
If a caregiver needs temporary relief throughout the day, an adult daycare facility is a great option for respite care. These facilities provide health monitoring, social activities, exercise, meals, transportation, and other support services. This is the ideal choice for a caregiver taking care of a functioning patient with Alzheimer’s or dementia who is still active but requires round-the-clock monitoring.
Does Medicare Cover Respite Care?
When you are a sole caregiver, it is necessary to get support for yourself as well as your patient, as it can be an overwhelming, draining job. For Medicare recipients receiving constant care from a loved one, taking advantage of respite care can give those caregivers a much-needed break.
Medicare Part A covers respite care when it is part of the patient’s hospice care, but the patient must meet Medicare’s requirements for hospice, including getting the certification of a terminal illness from a doctor, the acceptance of palliative care instead of curative care, and a statement declaring the choice of hospice care over any other Medicare-covered treatments.
Medicare insurance only covers respite care taking place in an inpatient facility that is Medicare-approved. Respite care lasting up to five days at a time can be paid for by Medicare, and the care is available on an occasional basis but the number of stays is unlimited. You may be responsible for 5% of the Medicare-approved cost for inpatient respite care.
Respite care is only covered by Original Medicare if a patient is receiving Medicare-approved hospice benefits, meaning the patient’s hospice doctor and normal doctor have determined that the patient has a terminal illness with less than 6 months to live.
Medicare gives a caregiver respite care for a patient in hospice if the caregiver is experiencing exhaustion, has an obligation or event to attend, or if a caregiver becomes ill and can no longer care for the patient.
Medicare will cover necessary respite care for up to 5 days consecutively. Medicare covers respite care on an occasional basis and the patient must be receiving the care in a Medicare-approved facility like a hospice, hospital, or nursing home.
Original Medicare covers the majority of the bill, but the patient is usually responsible for 5% of the Medicare-approved amount for respite care. Certain Medigap policies can cover additional costs that Medicare does not cover.
Medicare Advantage plans are provided by private insurers and members receive all benefits associated with Original Medicare, along with additional services and perks associated with respite care (and other services/supplies).
The Centers for Medicare and Medicaid Services green-lit Medicare Advantage to offer various in-home care services. Respite care is one of the many offerings Medicare Advantage plans now include, and the difference in coverage for respite care with a Medicare Advantage plan is that it is not usually limited to hospice benefits like Original Medicare. Some Medicare Advantage plans include respite care in the form of adult day care, short-term respite care in an approved facility, and in-home respite care.
Every Medicare Advantage plan will allot a certain amount of money and a number of hours of respite care that will be covered each year.
Costs of Respite Care With Medicare
Medicare covers most costs for respite care when it is part of a patient’s hospice care on an occasional basis for no more than 5 days in a row. Medicare will not cover the cost if you require respite care more often or wish to have someone in your home.
The costs of respite care after 5 days outside of a hospice scenario are:
- $135.00 a day for health aid services.
- $130.00 a day for in-home homemaker services.
- $70.00 a day for adult daycare centers.
- $235.00 to $270.00 a day for respite care at a skilled nursing facility.
How To Pay For Respite Care
If your respite care situation is not covered by Medicare, consider paying out-of-pocket or investing in a Medicare Advantage plan. Consult experts from CoverageHaven for more information about Medicare coverage and plan availability, along with great resources such as the ARCH National Respite Network and National Family Caregiver Support Program.