Does Medicare Pay for Respite Care?
Key Takeaways
- Respite care is short-term assistance for the primary caregivers of older adults.
- Options for respite care in your area may include adult daycare centers, in-home care, and various state-sponsored services.
- Original Medicare only covers respite care if your loved one is in hospice. Medicare Advantage plans may provide additional benefits.
- Your state may offer a Medicaid waiver program or a Program of All-inclusive Care for the Elderly (PACE) that could help to access respite care.
Serving as the primary caregiver for an older adult is a rewarding and important responsibility. It can also be time-consuming, challenging, and stressful. Sometimes you have to be away from your loved one so you can work, attend to other obligations, or just take a break.
That’s why short-term help, called respite care, is an essential service for any caregiver. Depending on your loved one’s health needs, financial situation, and where they live, you may be able to access this assistance through insurance or from other sources.
Since most U.S. adults over 65 receive health insurance either through Original Medicare from the federal government or a Medicare Advantage plan from a private insurance carrier, you should understand that Medicare respite care coverage is only available under very limited circumstances.
Let’s explore some of the details you should know about Medicare and respite care.
Sharing Caregiver Responsibilities
If possible, many people prefer to reach out to a family member or friend for caregiving help. If you know someone who is willing and able to pitch in, the National Institutes of Health recommended charting out and dividing the necessary duties. These responsibilities may include:
- Household chores such as cooking, laundry, and yardwork
- Shopping for necessities like groceries, prescriptions, and over-the-counter items
- Assistance with dressing, moving around the home, and bathing
- Providing emotional support, talking, and playing games
- Keeping track of medications and encouraging a healthy lifestyle
- Driving to doctor’s appointments and community activities
Long-term assistance from friends and family makes the demands of caregiving much more manageable, but short-term respite care also has a huge impact. Building a support structure gives you confidence that there are people you can count on to look out for your loved one in your absence.
Finding Professional Respite Care
When you need a rest from caregiving and bringing in another relative or friend isn’t convenient, there are professionals ready to step up. You may have a variety of respite care programs available in your area. The ARCH National Respite Network and Resource Center maintains a respite provider locator that can point you in the right direction.
Some caregivers seek out in-home respite care, either by directly hiring a care provider or working with an agency to find a match. These professionals offer services like:
- Helping your loved one bathe, dress, and use the bathroom
- Assisting with chores
- Administering medications and providing basic medical care
- Transportation to medical appointments
- Keeping your loved one company
Facilities where your loved one interacts with people their own age can be great for both of you. Older people living with physical or cognitive disabilities often spend up to five days a week at an adult daycare center, also called an adult day services center. According to the most recent data from the National Center for Health Statistics, there are more than 4,000 of these facilities across the U.S.
Adult daycare centers provide environments where older adults can enjoy their time together while participating in social activities like games, classes, music therapy, and gardening. The facilities serve meals and may offer certain health services like physical therapy and administering medications.
States sponsor a variety of local respite care programs, either at home or in a community-based or residential facility. Check to see if your loved one is eligible for these services and whether you qualify for a voucher to help cover the costs.
The U.S. Department of Veterans Affairs (VA) also offers respite care if your loved one qualifies. Through these programs, a veteran of the U.S. armed forces receives care at home, at an adult daycare center, or in a nursing home. Nursing home respite, which must be arranged in advance, may be available at a VA Community Living Center or a community nursing home for up to 30 days per calendar year.
Find the Medicare Advantage plan that meets your needs.
Will Medicare Pay for Respite Care?
Medicare respite care coverage is limited to situations where your loved one is in hospice. People on Medicare qualify for hospice benefits when they are terminally ill with less than six months to live and have signed a statement agreeing to receive comfort care rather than continuing other treatment.
Under these circumstances, Medicare Part A, the part of Original Medicare that provides hospital insurance, will pay for occasional respite care. Your loved one can receive up to five days of care at a time in a Medicare-approved hospital, nursing home, or other inpatient facility.
Medicare Advantage plans are required to match Original Medicare coverage and may offer additional benefits that help with the costs of caring for a loved one who lives with dementia or with physical disabilities. Depending on the plan, that can include assistance with paying for adult daycare, arranging transportation to appointments, and buying groceries or over-the-counter items.
Does Medicaid Help With Respite Care?
Medicaid operates separately from Medicare, providing health insurance for people with limited incomes and financial resources. Some people are dual eligible, meaning they qualify for both Medicare and Medicaid. Enrolling in both — or in a type of Medicare Advantage plan called a dual eligible special needs plan (D-SNP) — can give your loved one coverage they wouldn’t have through Medicare alone.
Since every state administers its own Medicaid program, coverage details vary. Depending on where your loved one lives, you may be able to access a Medicaid waiver program that covers the costs of various home and community–based healthcare services for people with certain health conditions. These programs could help with the expenses of respite care.
Respite Care Through PACE
You can get access to respite care and much more if your loved one qualifies for the Program of All-inclusive Care for the Elderly (PACE) through their state. This program serves people who are 55 or older and certified by the state as needing a nursing home level of care but capable of living safely in their community with the right services.
People who are on Medicare or Medicaid and live in areas where PACE is available can receive coordinated, comprehensive care. That may include home healthcare services and adult daycare as well as a range of other benefits like prescription drug coverage.
People enrolled in PACE who are on Medicare but not on Medicaid are charged monthly premiums for their long-term care and prescription drug coverage. Dual eligible PACE enrollees who are on both Medicare and Medicaid pay no monthly premiums. On PACE, there are no deductibles or copays for any medically necessary services or medications.
What’s the Difference Between Respite Care and Companion Care Services?
A companion care service may be a valuable resource for older adults who don’t need constant caregiver support to manage everyday activities, but who could use some company and a hand around the house. These services send a helper to run errands, take care of some light chores, set up electronic devices, or talk and play games.
Companion care services may be available to your loved one through a state program, a private company, or a Medicare Advantage plan. If you can’t see them as often as you’d like, this is a way to ensure they’re getting the assistance and social interaction they need. You’ll know that someone is checking on your loved one and encouraging them to stay on top of any emerging health issues.
When you care for an older partner, relative, or friend, it’s vital to accept that you can’t do everything by yourself and realize that you deserve an occasional break. A range of services are available to make your responsibilities more manageable, helping your loved one enjoy a healthier, better life for years to come.
Sources
Adult Day Services Centers. CDC
Find a Respite Provider. ARCH National Respite Network and Resource Center
Worksheet: Coordinating Caregiving. NIH