If you've noticed that your parent has become frail and in need of care, then you've probably noticed something else ... this care is really crazy expensive!
For example, if you hire someone from a home care agency to help your mom with cooking, laundry, transportation or personal hygiene, it can costs around $20 per hour. If that person is helping out three days a week, four to six hours per day, your weekly costs will be $240 to $360!
And, you've probably also noticed that your parent's health insurance program, Medicare, doesn't cover it.
So what do people do? Well, one of two things. They pay for this care out of their savings or income... OR
Much of the time, DAUGHTERS PROVIDE THE CARE THEMSELVES.
Daughters end up providing care when the money to pay for help runs out. They do it because their parents refuse outside help or don't want to move to assisted living. Or, because even the paid help is not enough ... there is always more care to provide. It's just bottomless ... this need.
Whatever the reason, these women sacrifice a lot to give their parents the daily care they need. It's an amazingly beautiful thing this daughterhood. But it's also an incredibly hard thing.
Unfortunately, this work, these sacrifices are too often overlooked and invisible. So, to all of you daughters out there doing the impossible every day, in this moment, as you read this, know that YOU ARE SEEN.
But you need so much more than to be seen. You need help, lots of it. And even though I JUST SAID that Medicare doesn't pay for much of this care, you need to know that it does pay for more than just hospitals and doctors.
In the interest of getting all of the support you possible can, you MUST know about these special, sometimes hidden benefits in the Medicare program. They can provide some pretty important gap-filling and support for very frail, older adults.
In a way, these are the secret weapons of the Medicare program.
Secret Weapon Number 1: Medicare-Covered Home Health Care.
Medicare created the home health benefit with the idea that it would be cheaper and better if people could get some skilled services at home and not just at hospitals and skilled nursing facilities.
Here are some cool things about Medicare home health:
No copay. That's right. There is NO copayment for Medicare home health.
No hospital stay required. Your parent does not have to have been in the hospital first to qualify for home health.
But, it's not a slam-dunk, easy-peasy thing to get. Medicare has some strict rules to keep the program costs under control.
First of all, your parent has to be in such a frail condition that leaving the house to get care is near impossible (called "homebound" in Medicare), AND secondly you need a doctor willing to declare that the care they need requires professional skills -- like nursing, physical, occupational or speech therapy.
The good news is that if your parent meets these criteria, a Medicare-approved home health agency can provide services and supports for up to 60 days at a time (before you have to be re-qualified).
If you think this might be something you'd like to explore, the first place to start is with your parent's doctor. If your parent's physician seems clueless -- which is always a possibility -- call one of the agencies that provides home health in your area and see what their process is for evaluating your parent. Use this tool for finding an agency and make sure to pick one that has high Medicare quality ratings. You can use this checklist to evaluate the service you're getting.
Secret Weapon Number 2: Medicare Hospice Benefit.
Hospice is the shining light of the Medicare program.
It's set up to do what the whole rest of Medicare should do, serve the needs of frail elders in a holistic and sensible way..rather than rely on family members to perform heroics just to avoid disastrous care.
Unfortunately, your parent has to be physician-certified as having only six months left to live to qualify for Hospice. You also have to be willing to give up continuing treatment for the illness. In other words, you're trading curative treatment for what's called "palliative treatment," which is designed to address needs for comfort rather than provide heroic interventions.
But, what you get is a system of support for the family caregiver and the dying person that ensures a multitude of needs are met. It provides physician and nursing care but can ALSO include a social worker, care aides, and grief counseling. And, best of all, these are often provided at home.
I highly recommend that any daughter taking care of her parent -- no matter what stage of illness or need, even if your parent isn't anywhere close to end of life -- read this resource and get informed about this amazing part of the Medicare program.
Secret Weapon Number 3: Medicare Skilled Nursing Facility Care.
in a previous blog, I mentioned that many frail older adults leaving a hospital go first to a skilled nursing facility for rehabilitative care.
Some of these facilities are just ok but some are excellent providing much better care than a hospital for routine medical issues. Outstanding facilities will know how to prevent delirium and help you get past it if it occurred during a hospital stay.
Unlike home health, Medicare only pays for skilled nursing facility care after an inpatient hospital stay of at least three nights. Also unlike home health, there's a copayment after the first 20 days which could be covered under supplemental insurance so be sure to check on that.
Let's be clear, none of these options will come close to meeting what is almost certainly an overwhelming need and expense in your life. But, know that you're facing a situation that most women face at some point in their lives. Learning how Medicare works will ensure our parents get all the benefits to which they are entitled.
This is quickly becoming a universal experience. You are not alone!!
Visit the daughterhood website and let us know what your biggest challenges are in paying for your parents' care. By sharing our stories we can be seen and we'll all feel less alone.