OT: How to cover home-care expenses for a long term disability

[waitingtobuy]

Posting for a friend
His wife recently went thru hospitalization after a sudden brain hemorrhage. She almost got paralyzed due to this and has been unable to move her hands, legs etc. After few weeks of hospital care and follow up therapies in a specialized nursing home, she is beginning to show improvements and is now able to move her arms and lets, is able to take few steps with assistance and walk support. Doctors are advising her to return to home but are advising 24-7 in-home care for at-least few months by hiring a nanny or a private nurse. ( He hubby has a job and is unable to take time off for this long period)

A nanny/private nurse for 24-7 is becoming very expensive (single income family) and my friend is researching for ways to get this expense covered.

Questions:
1. Is there anyway, such expenses ( About 4k) can be covered by any insurance? The lady has medicare insurance plan. The hubby has medical plan from his work.

2.Why is doctor/nursing home advising them to return home while she is not entirely fit and needs assistance. As long as she is in nursing home, her medical plan covers the cost.

3.What typically people do in such situations when someone is needing extended therapy to recover? Is a long term stay in nursing home a better option?

Thanks for your inputs.

[Essbee]

I don’t know the answer to #1 or #3.

#2, Her medical plan (Medicare) probably covers nursing home care for a set number of days (30 days, I believe). After that runs out, the nursing home staff will suggest that she goes home. Otherwise the family has to pay out of pocket.

Medicare does NOT cover indefinite nursing home stays. This is why medical bills can bankrupt a family. They family can choose to “spend down their assets” until they are very poor and she is eligible for MediCal. Then MediCal will cover nursing home care… but in bare-bones kind of facility.

This is why long term care insurance might be a good idea. (That being said, our family doesn’t have this yet).

Sorry about your friend’s wife.

[ucodegen]

As opposed to nursing home, what about assisted care living facilities? They may be lower price and better set up. Insurance may be able to cover some of the costs of an assisted care living facility. It may require a doctors signature stating that they need assisted care. Assisted care living facilities are useful for people with some function, but need assistance.

[carli]

So sorry about this. We recently dealt with a similar situation with a relative. Found out a few things –

1) Medical insurance carriers distinguish between coverage for medically necessary care (which is covered according to the terms of the policy) and assistance with “activities of daily living”, referred to as ADLs (almost always not covered by a medical insurance policy). This is where a long term coverage plan is needed, but most people don’t have one so they end up paying for ADL care out of pocket. It’s such a conundrum because it’s essential care yet it’s considered non-medical…it’s disturbing to find out that this huge gap in our health care exists.

2) Usually there is a social worker or someone at the nursing home/rehab center who helps families segue to the next stage of care before discharge, even/especially if the next stage is not covered by insurance. We found this person to have a lot of good contacts and was a great resource for our situation. Maybe there’s a social worker at your friends’ facility who can help them?

3) They’ll probably want to consider either a stay in an assisted living center or else use an in-home provider. We found a great in-home provider for $25/hr. She is the caregiver while the spouse was at work. This person bathes, dresses, makes meals, takes walks/drives with the recovering person, sits and reads, whatever is needed/wanted. Lots of advantages to this, and it’s way less expensive for our relative than being in an assisted living facility, also much more comfortable. But, there are disadvantages, most significantly, the spouse is “on duty” when he arrives home and is without help during the night, and as such, there is never any down time for this person. Also, some homes are just not set up for this kind of care if the person has mobility issues.

In any case, it’s very difficult for all, but so important and nice that you’re helping them out. They need you now! So sorry. Best of luck.

[Author]

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