Medicare Isn’t for Long-Term Care

My mother has been in the hospital and is now in a rehabilitation facility. She will be coming home soon, and I am sure that my dad will be unable to provide all the care she needs. She will be in a wheelchair for the first time, and she won’t be able to get into the bathtub or do many things for herself that she used to.

I have talked to the social worker at the rehab facility, and she says that Medicare will only provide a little help to her when she first gets home and needs to continue her physical therapy and occupational therapy. How will Dad manage? They don’t have the means to pay for someone to come into their home every day to help out. We, the children, can only help on weekends and holidays, because we all work and have families of our own.

As a part of the sandwich generation, you and your siblings are now facing the reality of caring for aging parents in a society that has not yet developed a plan to meet the needs of a growing aging population.

Medicare is a comprehensive health program designed in the mid- 1960s to serve the needs of those who were 65 or older who no longer had health insurance coverage. Medicare covers medically necessary care.

Though it was later expanded to cover the disabled, it still has no long-term care component, so when a Medicare beneficiary reaches the stage that he or she needs custodial care to undertake the activities of daily living, that person has to make arrangements privately.

Your mother may receive some Medicare services as long as she qualifies for the home health-care benefit. She must meet the criteria for home health care, which means the type of care she needs must be intermittent skilled nursing care, physical therapy, speech therapy or occupational therapy. She must also be homebound, and under the care of a physician who sets up a home health-care plan for care provided through a home health agency which participates with Medicare. Medicare home health services do not include coverage for general household services such as laundry, meal preparation, shopping or other similar personal and domestic needs.

Before your mother leaves the rehab facility, you need to discuss options with the social worker there to see what advice can be offered.

You also should contact the Department of Aging and Disabilities, which has a Maryland Access Point program that can provide you with information about services provided by DOAD as well as other county and state departments, including Social Services and the Department of Health. The MAP phone number is 410-222-4257.

Also ask DOAD for an adult evaluation and review for your mother. Through this service, a nurse or social worker will come into the home and do a comprehensive nursing and psychosocial evaluation. A care plan will be developed based on your mother’s needs, and recommendations about programs and services that can help provide for those needs will be given to you. You should prepare a list of questions for the evaluator so that you can gain a better understanding of what is available and how to set up those services.

Now that you know more about the aging process and are aware of what you can encounter, you and your siblings need to look into long- term care insurance for yourselves in order to be prepared for your own needs in the future.

Susan Knight is a senior health insurance consultant. If you have questions about the information in this column, contact the county’s Senior Health Insurance Program at the Department of Aging and Disabilities at 410-222-4464 or ship_program@aacounty.org. {Corrections:} {Status:}

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