Medicare WILL NOT pay room and board for in home care or nursing home. If your hospice team determines you need short term in patient care (majority of patients) or respite care Medicare WILL PAY for your stay at the facility including room and board.
This is being done because the person is “in patient” in a facility. Being “in patient” is beyond different than being a “resident” at a facility.
Its not the average hospice situation. Folks need to realize this as it gives false hope to families wallets….
If you do not realize the difference, please hang with me on this as it’s not straightforward…. Hospice is 100% a MediCARE benefit. Wherever hospice is done. HOWEVER MediCARE will not and does not pay for custodial care. Custodial care, e.g. the room & board costs to be in a bed in a NH is private pay, or LTC insurance or via LTC Medicaid. The room & board costs for AL or MC is private pay unless your state pays for these under a Medicaid waiver program. BUT MediCARE will pay the costs - including the daily bed costs - for anyone considered “in patient”; so Medicare pays if you are in-patient at a hospital, or in-patient in a NH for rehab, or are in-patient in an acute care facility. The acute care facility tend to be LTACH - Long Term acute care hospital (Kindred is a big player for LTACHs). BUT… there are smaller places that will have a small limited set # of in-patient beds that are Acute Care and so are MediCARE eligible as it is more intensive medical supervision that could ever be provided at home or in a NH or MC. It is end of life care so Medicare hospice benefit can be billed as well and it’s intensive medical oversight so MediCARE hospitalization benefits can be billed. So costs covered fully by Medicare.
These are not the usual in a NH or MC type of elders who are there under custodial care and oversight. MediCARE won’t pay for room&board or bed costs on this population. They are instead those with significant medical issues so need “in-patient” care which MediCARE will cover.
Samaritan - if this the one in NJ - mentions this in their website. Where I am, Catholic Charities has a big in-patient hospice facility. Where I grew up, VITAS has a couple of in-patient hospice both freestanding and within a couple of NHs. My late MiL got bad pneumonia at her NH then went into the hospital got worse, got sepsis and cascading organ failure then moved as “in-patient” into a LTACH and under hospice that was adjacent to the hospital, was there a. 3 weeks then died. MediCARE will pay for all this as serious involved health care needing medical / MD supervision. But this is not what most who are on hospice are at; most get their hospice benefit limited to durable medical equipment hospice brings in (pneumatic mattress, geri chairs) and a hospice caregiver dropping by 2 or 3 times a week, checking vitals, helping with bathing, medication management type of stuff. Hospice Chaplin & their RN coming by once or twice a mo.
Medicare is not going to pay for room&board at a facility.
Hospice is covered by Medicare, Medicaid and most all other Insurance. It will cover in home Hospice. If the patient is in a facility the "room and board" will not be covered though.
Yes, but first the patient must be accepted by Hospice. That means that a doctor must "recommend" Hospice and must vouch for the fact that, in his opinion, this patient has likely less than 6 months of life remaining, and faces now the end of life for a condition that cannot be successfully treated. THEN the Hospice must do interviews and assessment and "accept" the patient, indicating that Hospice agrees with the doctor. Often today things get fudged for the extra care Hospice represents. If the patient is still living at the end of 6 months there is a reassessment for Hospice, and on things go. The POA should discuss this with the treating MD.
Hospice has to come up with the right "Medicare Code" for your mother, and I do believe Alzheimer's Disease is one of them. My mother had vascular dementia, which is not a "Medicare Code" for hospice, in and of itself, so the nurse had to get creative, and came up with "Senile Degeneration of the Brain" to use as a valid "Medicare Code" to get mom approved for hospice care last December.
So yes, Medicare will cover hospice care costs for an advanced AD patient.
lealonnie1 my mom's doctor used this same medicare code of "Senile Degeneration of the Brain" for hospice admission. Otherwise she wouldn't have qualified.
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Its not the average hospice situation. Folks need to realize this as it gives false hope to families wallets….
If you do not realize the difference, please hang with me on this as it’s not straightforward…. Hospice is 100% a MediCARE benefit. Wherever hospice is done.
HOWEVER
MediCARE will not and does not pay for custodial care. Custodial care, e.g. the room & board costs to be in a bed in a NH is private pay, or LTC insurance or via LTC Medicaid. The room & board costs for AL or MC is private pay unless your state pays for these under a Medicaid waiver program.
BUT
MediCARE will pay the costs - including the daily bed costs - for anyone considered “in patient”; so Medicare pays if you are in-patient at a hospital, or in-patient in a NH for rehab, or are in-patient in an acute care facility. The acute care facility tend to be LTACH - Long Term acute care hospital (Kindred is a big player for LTACHs).
BUT…
there are smaller places that will have a small limited set # of in-patient beds that are Acute Care and so are MediCARE eligible as it is more intensive medical supervision that could ever be provided at home or in a NH or MC. It is end of life care so Medicare hospice benefit can be billed as well and it’s intensive medical oversight so MediCARE hospitalization benefits can be billed. So costs covered fully by Medicare.
These are not the usual in a NH or MC type of elders who are there under custodial care and oversight. MediCARE won’t pay for room&board or bed costs on this population.
They are instead those with significant medical issues so need “in-patient” care which MediCARE will cover.
Samaritan - if this the one in NJ - mentions this in their website. Where I am, Catholic Charities has a big in-patient hospice facility. Where I grew up, VITAS has a couple of in-patient hospice both freestanding and within a couple of NHs. My late MiL got bad pneumonia at her NH then went into the hospital got worse, got sepsis and cascading organ failure then moved as “in-patient” into a LTACH and under hospice that was adjacent to the hospital, was there a. 3 weeks then died. MediCARE will pay for all this as serious involved health care needing medical / MD supervision. But this is not what most who are on hospice are at; most get their hospice benefit limited to durable medical equipment hospice brings in (pneumatic mattress, geri chairs) and a hospice caregiver dropping by 2 or 3 times a week, checking vitals, helping with bathing, medication management type of stuff. Hospice Chaplin & their RN coming by once or twice a mo.
Medicare is not going to pay for room&board at a facility.
It will cover in home Hospice. If the patient is in a facility the "room and board" will not be covered though.
Often today things get fudged for the extra care Hospice represents. If the patient is still living at the end of 6 months there is a reassessment for Hospice, and on things go.
The POA should discuss this with the treating MD.
So yes, Medicare will cover hospice care costs for an advanced AD patient.
Good luck to you.