Does Medicare Cover Respite Care For Dementia?

Family caregivers play an important role in health care and for their loved ones. It’s a big job with responsibilities and duties that can become overwhelming, especially when the care recipient has Alzheimer’s disease or another type of dementia.

Respite care is an essential component of dementia care. It allows the primary caregiver to have time off for rest, recreation, work, family matters, and more. In this blog, we talk about:

How important respite is for dementia caregivers
Medicare coverage for respite care
Other sources of support and funding for respite care services

Trualta’s library of caregiving resources is an invaluable source of information for family caregivers. Check here to see if you have free access.

Caregiver Burnout & Respite Care

Respite care is temporary care for your loved one. During respite, someone else steps in to take over caregiving duties while you take time off. Respite services are essential for caregiver wellness.

Dementia Caregiver Burnout

Caregivers are susceptible to stress, which, over time, can lead to burnout. Caregiver burnout is a state of extreme exhaustion caused by prolonged stress. Caregivers of dementia patients are at a higher risk of burnout.

Caring for someone with dementia comes with additional stress compared to other caregiving roles. For example, it can be stressful to see your loved one lose their memory or exhibit personality changes. Dementia patients can become aggressive or wander away from home and become lost.

According to research, burnout in dementia caregivers reduces quality of life and causes anxiety and depression. Research also shows that burnout can cause the caregiver to lash out and even become abusive with the dementia patient.

Caregiver Stress & Respite Care Services

According to the Alzheimers Association, respite care is an important way dementia caregivers can reduce stress and prevent burnout. Respite is important because it allows you to take time for yourself.

It’s difficult for caregivers to prioritize their own wellness when they face so many duties and responsibilities for the care of their loved ones. Respite allows you to place their care in the hands of someone you trust so that you can rest.

Respite isn’t always about rest. It can also allow you time for fun and socializing with family and friends. You can use the time to do activities you enjoy or even go on vacation. You can use it to seek mental health treatment, too, which is important for caregivers.

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Original Medicare Coverage For Dementia Respite Care

Using respite care is important, but many caregivers face barriers, including costs. Original Medicare Part A covers respite care as part of hospice care. If your loved one has Original Medicare coverage and is in or qualifies for hospice, the plan will pay for respite.

Medicare Hospice Care & Respite Care Eligibility

Hospice care is care for a patient at the end of their life, which may be the case for some dementia patients. Hospice providers focus on improving the patient’s quality of life in the time they have left. Instead of curative treatments, the patient receives medical services to manage symptoms.

Dementia patients often progress to the stage at which they qualify for hospice care. To qualify for hospice care and for hospice respite care coverage by Medicare, your loved one must meet these requirements:

Your loved one’s doctor and a hospice physician must certify that their life expectancy is six months or less
Your loved one must accept hospice care in place of curative care
They also must sign a statement agreeing to hospice care instead of other Medicare-covered treatments

Once your loved one enters hospice care, they qualify for respite care. Original Medicare Part A pays 95% of the cost of up to five consecutive days of respite care. There are some limitations, though:

Medicare generally doesn’t cover respite services for someone without an identified caregiver
If your loved one already lives in an assisted living facility, nursing home, or memory care center with 24/7 care, they are not likely eligible for respite care
Your loved one must receive respite care in a Medicare-certified facility with skilled nursing care

Using Medigap

The Medicare hospice benefit for respite services covers 95% of the total cost. This leaves your loved one or your family with 5% of the cost of respite care. One way you may be able to cover the cost is with Medigap insurance.

Medigap is supplemental insurance designed to cover extra expenses your loved one’s Medicare plan doesn’t cover. This can include the 5% copay for hospice respite. Medigap is offered by private insurers, so plans vary. If your loved one has Medigap, make sure you understand their coverage and benefits.

Depending on the plan, you may also be able to use Medigap to pay for emergency respite care. Again, plans vary, but they generally don’t cover long term care. They may cover short term, emergency care.

Medicare Advantage & Dementia Respite Care

If your loved one has a Medicare Advantage plan, they may have coverage for respite service under Part C. Medicare Advantage includes the same benefits as Original Medicare. It also includes Parts C and D.

Part C covers some benefits Original Medicare does not. These include in-home care and non-skilled care. Some of the benefits available with Medicare Advantage could be used for your loved one with dementia:

In home care. With home care, you can bring a professional in to care for your loved one when you take a break. This could be a non-skilled home care worker who provides supervision, personal care, and basic supportive care. Another option is hiring a home health care worker to provide more skilled medical care. The choice depends on how long you need respite (a few hours versus overnight) and your loved one’s needs.
Short residential care. Many Medicare Advantage plans cover short stays in residential facilities, such as a skilled nursing facility. This may be a better option if you need respite for a few days or if your loved one needs more skilled nursing home care.
Adult day care. Your loved one’s plan may also cover adult day care services. Adult day care centers provide supervision and light care during day time hours. It’s a good opportunity to get a few hours or a day of respite. Day care can also be used as a regular service. Day care can be especially useful for dementia patients who often cannot be left alone safely even for a short period.

Medicaid & Dementia Respite Care

Medicaid programs vary by state. Contact your state’s agency that administers Medicaid to find out what benefits are available and if your loved one qualifies. Medicaid does not traditionally offer respite as a benefit, but other options exist.

Most states now offer home and community-based services (HCBS) waivers. HCBS waivers were introduced to provide beneficiaries with additional services. These extras are specifically designed to be provided in the home and community and to delay the transition to assisted living or nursing homes.

If your loved one qualifies, they may benefit from HCBS waivers. If your state uses them, they could provide in-home services that help you take time off for respite.

Other Ways To Cover Dementia Respite Care Costs

Your loved one with dementia might not be a Medicare beneficiary or qualify for Medicaid. In this case, you can pay for respite care out-of-pocket. If your loved one has private insurance, it might cover respite care. Most plans don’t offer this benefit, but it’s worth checking.

These are some other options to consider when paying for dementia respite care:

Veteran benefits. Is your loved one a veteran? If so, they might qualify for VA benefits. These include respite care for caregivers. The VA AId and Attendance or Housebound Benefits is another way to cover costs associated with occasional respite care. Contact your local VA office for more information.
National Caregiver Support Program (NCSP). The NCSP is a program administered by your local Area Agency on Aging (AAA). It provides funding for various types of caregivers, including those caring for dementia patients. Contact your local AAA office for more information.
LIfespan Respite Care Programs (LRCP). LRCPs are available in several states. They offer grants and vouchers to help caregivers pay for respite. ARCH National Respite Network lists links to state LRCPs.

Respite care is important for all caregivers, but dementia caregivers can especially benefit from it. If you’re a primary caregiver for someone with dementia, take advantage of respite services available to you. It will help you better take care of yourself and your loved one.

Don’t forget: Trualta’s library of caregiving resources is an invaluable source of information for family caregivers. Check here to see if you have free access.

References

Does Medicare Cover Respite Care For Dementia?