Will Medicare or Medicaid Cover Respite Care?
Submitted by Beth Rush
Founder and Managing Editor
Body+Mind Magazine
An Alzheimer’s disease or dementia diagnosis devastates the person affected and everyone who loves them. The symptoms require your loved one to have a caregiver, and respite care often plays a vital role.
It’s admirable for family members to take on caregiving responsibilities, but it’s hard to do it alone. Respite services can be costly, but there are ways to get coverage.
What Is Respite Care?
Respite care providers offer family caregivers short-term relief from their duties. Different programs provide services for various lengths, allowing you to take care of other responsibilities while still being there for your sick loved one.
Types of Respite Care
Your loved one can attend three main types of respite care.
In-Home Respite Care
This method of respite care doesn’t require your family member to leave their home. A trained professional will tag-team your days, giving you a break to do other things.
About 77% of adults over 50 want to stay home as long as possible. If your family member gets an early diagnosis, they can express their wishes to you. If not, you can often tell this preference by your loved one’s attitude toward being outside their environment. You want to keep them as comfortable as possible while you all navigate this disease.
Adult Day Centers
Many people think of day centers as adult day care. Though that’s technically true, they provide a safe space for your loved one to hang out and socialize. It’s a safe space to get some time out of the house while you run errands, get some sleep or fulfill your own social needs.
Your loved one is only there for the hours you choose during the day while keeping their home. These can be an excellent solution for someone who is medically well but whose condition requires round-the-clock supervision.
You or another caregiver must drop them off or pick them up each day, like taking your kids to school or day care. In fact, this could be a way for your children to help with the transition process since they’re also going to another place for the day.
Respite Facilities
These places your loved one can go during the day or overnight provide more advanced care than a day program can. They accommodate short- and long-term stays, taking the pressure off families with more on their plate than they can handle.
Nursing and other medical professionals are often there 24/7 to handle any issues that might arise. These skilled nursing facilities are essential for many families needing more complex care than they previously did.
Some older adults may struggle with being removed from their homes and familiar people. Finding suitable inpatient respite care and creating as much stability and personalized care as possible can help.
Why Respite Care Exists
Respite can significantly benefit your care recipient with Alzheimer’s disease or dementia, but it’s mainly for you. Providing full-time care can put your life on hold.
While it’s an incredibly selfless thing to do, you have to have breaks to maintain your physical and mental health.
Research shows that one in three American caregivers provides more than 20 hours of care. Many juggle this with another job, leaving little time for self-care and other life responsibilities.
Respite services allow you to go to health care appointments, take care of financial matters, vacation with a partner or children, recover from an illness or injury, catch up on rest, socialize with others and engage with your hobbies.
You can only fill someone else’s cup if yours is full. Nurturing your well-being to give your best to your sick loved one is essential. Respite care is necessary for many families, and you shouldn’t feel ashamed of taking advantage of it.
Good respite care services also offer plenty of enrichment for your loved one. It provides a new friend and partner in their care, whether inside or outside their home. Respite services often offer opportunities for patients to socialize, play games and rediscover hobbies.
Just as you sometimes need a break from taking care of someone, your loved one might need a break from being cared for by the same person in the same place.
Respite Service Coverage Options
You can get respite care coverage through Medicare and Medicaid, allowing you to practice self-care and complete other home and family responsibilities.
Medicare
Original Medicare Part A provides respite coverage as part of hospice care. Your loved one must first qualify to receive hospice benefits. They will need to meet specific eligibility requirements, including:
- A Terminal Diagnosis. Terminal illness is generally classified as fewer than six months to live.
- Palliative Care. The patient accepts comfort care measures instead of medical treatment.
Medicare Part A only covers respite care through a residential facility. However, Part C and supplementary insurance may pay for other options.
Medicare covers 95% of the cost for most live-in facilities, with the rest out-of-pocket.
Medicaid
Medicaid is more complicated since it is administered through state funding, with coverage varying through each state government. Many states use Medicare’s Home and Community-Based Care Services (HCBS) waiver program to offer a full or partial range of respite care.
Some Medicaid programs offer coverage for in-home caregivers or care at a live-in facility. You can look at your state’s profile on the HCBS website for information on what your program offers. You can also contact your state’s Medicaid office about potential coverage options.
Out-of-Pocket Costs
The costs of respite care can pile up without coverage. Whether a few hours or daily care opportunities, it will likely cost hundreds of dollars a week.
Short-term respite care services cost around $75 per day. An assisted living facility averages $140 daily, with home health care costing the most at about $150 per day. These amounts will vary based on your location.
The right coverage can significantly reduce these costs, putting funds toward other ways to improve your and your loved one’s life, such as activities and accessibility tools.
Other Payment Options
There are other options if you can’t afford the out-of-pocket cost of respite care and don’t have coverage through Medicare and Medicaid.
Veterans’ Affairs
Veterans can enroll in VA medical benefits, which will provide 30 days of respite care each year. You can split these days between in-home and overnight care.
ARCH National Respite Network
ARCH doesn’t provide payment but has a compiled list of resources by state that can help you secure funding.
Long-Term Care Insurance
This is a form of private insurance that covers some respite care services. Most policies require you to be covered for some time before they will pay for respite care.
Caregiver Grants
A handful of organizations and grant programs offer free or low-cost options for respite care. The U.S. Department of Health and Human Services provides grants to most states through its Administration for Community Living. You can contact your local health and human services department for information on these opportunities.
What to Look for in a Respite Care Program
Some respite care programs are better suited for your loved one than others. You should speak with other families and multiple respite care providers to determine the right services for them.
A quality respite care provider provides the following:
Respect
Regardless of their disease progression, your family members deserve respectful treatment by all who care for them. Care partners should help their patients maintain their dignity without over-infantilizing or taking over for them.
Patience
Alzheimer’s disease and dementia can cause your loved one to say and do mean or inappropriate things. A good respite care provider knows not to take these things personally while having the patience and experience to redirect their patient positively.
Stimulation
A safe place to be is the minimum a respite care service should provide for your family member. Many activities nurture their body and mind, and respite care is often a better experience for your loved one if they engage in it. Everyday actions include taking walks, listening to music, preparing food, doing their hair and nails, discussing their interests and playing games.
Responsibility
A respite care provider must care for your loved one’s medical, hygiene and nutrition needs while you’re away. This includes providing agreed-on meals, administering medication, and performing personal care like grooming and toiletry needs. They also need to provide a consistently safe and clean environment.
Compassion
A good respite care service is compassionate toward your entire family. They will want to do everything they can for your loved one and understand the struggles you might face.
These qualities provide a positive experience for your loved one.
Why Respite Care Is So Important
Respite care is an essential service for your loved one and family. It provides you with professional care for your family member, taking some of your weight off your shoulders.
You want to be everything your loved one needs, but you are only human. Caregiver burnout is a condition that impedes your ability to care for yourself, let alone someone with Alzheimer’s disease and dementia.
The condition happens when you provide constant care for someone incapable of doing so themselves. Just as it takes a village to raise a child, it also requires multiple people to care for someone with a deteriorating mental and physical state.
Symptoms of caregiver burnout include losing interest in caregiving and other parts of life, feeling numb or frustrated with the person you’re caring for, increased anxiety, irritability, physical exhaustion, insomnia, poor immunity and appetite changes.
It’s common for primary caregivers to need mental health support, and there is nothing wrong with that. However, having a break from your duties and giving some of the load to someone experienced and trustworthy can relieve some of these symptoms.
Taking Advantage of Respite Care Services
Respite care is an excellent opportunity to help you care for someone with Alzheimer’s disease or dementia. However, it can get costly. Medicare, Medicaid and other programs can help you get coverage for the services to help you and your loved one live the best life together.
Beth Rush
Body+Mind Magazine
Beth Rush is a Founder and the Managing Editor at Body+Mind and a lover of all things health and wellness. She is a well-respected writer in the personal wellness space and shares knowledge on a variety of topics related to nutrition, fitness, holistic health and disease prevention.
In her spare time, Beth enjoys cooking healthy recipes and trying out new fitness trends.
