Dementia is a growing problem as we all grow older and live longer. During a discussion here in the UK someone claimed that "dementia care" is not seen as needing specialist skills under Medicare, as other physical debilitating conditions might be. Is this true?
Alzhimer’s patients, as the disease progresses, generally need custodial care. Medicare, of course, will pay for any underlying diseases and conditions that are eligible, but Medicare does not pay for custodial care beyond a certain number of days. So if custodial care becomes too much for family, a nursing home or in-home round-the-clock professional caretaking or mixture of both is the only option. Medicare does not pick up those costs.
If the patient has assets, those assets go first to cover nursing home costs, as an example. When they are exhausted (there are some rules to prevent impoverishing a spouse), Medicaid will step in and pick up all nursing home costs.
Medicaid beds in nursing homes are most often restricted because Medicaid pays so little. In our area, a good nursing home, one you’d want to leave mom in, costs upwards of $9,000 a month. That high cost helps the nursing home defray the Medicaid shortfall.
Often, children don’t want to see their parents’ assets disappear for nursing home care, so a few things might happen. The worst is that the patient is left alone when he/she shouldn’t be, poorly taken care of, etc. I actually know a family who, it was later found, left their mother alone at home while the “caretaker” worked. She was locked in, windows nailed shut, left to stay dirty all day because the person had no bowel or bladder control, etc. It is pathetic to think that her three children would try so hard to conserve her assets that they wouldn’t even pay for a PART-TIME in-home caretaker. When she died, they divided up over $400,000,which still left a home that the caretaker lives in to this day.
The next thing family will try to do is to mis-appropriate a person’s assets and split them up ahead of time so that they can then claim Medicaid benefits and the children still get a parent’s money. Medicaid is on to this, though, and will claw BACK those stolen assets or, much worse, exempt the person from any coverage at all until the stolen money is made up. Example...
A patient has $90,000. Her three children gift themselves $30,000 each to impoverish her so she’s eligible for Medicaid. They apply. Medicaid does a forensic examination of the patient’s finances, finds the $90,000 missing, and demands payback before mom will be covered by Medicaid. If they cannot pay it back, then Medicaid will use a regional average monthly rate of, let’s say, $7,000 a month, and, with that example, would require mom to pay her own way for approx. thirteen months before they would step in.
Of course, no one in the family can pay for those thirteen months, so the family must scramble to find a nursing home willing to take mom for 13 months free anticipating Medicaid’s eventual takeover of mom’s expenses. Can you imagine the ****hole they find?
There are other ways, other horror stories. But the upshot is that Medicare does not pay for custodial care, not even in their generous and wonderful hospice program.
