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It is one of the hard facts of life, that if we are alive, we will continue to age. As we grow older, things we never thought twice about may start to become difficult to accomplish on our own. While most of us probably hope—and even expect—that our loved ones will help us when we cannot manage on our own, in fact, it does not always end up as we hope. You may require more assistance than family and friends can provide, in which case you might have to consider long-term care in a nursing home or other skilled facility.
Long-term care is most often services and support for personal care needs rather than medical care—receiving assistance with everyday tasks—although medical care may be a part of your long-term care. Unfortunately, many seniors are under the impression that Medicare will cover any long-term needs they may have. In fact, Medicare typically does not cover day-to-day living assistance, but may cover the following, depending on the specific circumstances:
- Long-term hospital care—Part A Medicare covers care in a long-term care hospital, which specializes in treating patients with more than one serious condition, but who could potentially get better over time, and with proper care, even possibly returning to his or her home.
- Skilled nursing facility medical care—Medicare Part A (also known as hospital insurance) may cover skilled nursing care when that care is provided in a skilled nursing facility if the services are necessary to allow you to meet your health goals. Services provided could include a semi-private room, meals, medications, therapy, medical social services and ambulance transportation.
- Limited home health services—Getting Medicare Part A and/or Medicare Part B to cover home health services can be a bit trickier. In some situations, Medicare will pay for “intermittent” skilled nursing care, some types of physical or speech therapy, and some occupational services, but will not pay for 24/7 home care, meals, homemaker services or personal care assistance. In order to be eligible for home health services, you must be under a doctor’s care and must have a care plan which is regularly reviewed by your doctor. You must need only intermittent skilled nursing care, and physical, speech, or occupational therapy are only covered when your condition is expected to improve within a predictable period of time.
- Hospice or respite care. Hospice is end-of-life care and may be covered under Medicare, whether in your home or in a hospice inpatient facility, depending on your terminal illness and your related conditions. Once hospice benefits are approved under Medicare, they will no longer cover any treatment intended to cure your terminal illness, any prescription drugs to cure your illness (only prescription drugs for pain management), care from any other hospice provider than the one set up by the hospice medical team, room and board, emergency care services or ambulance transportation. In order for Medicare to pay for hospice or respite care, you must have your doctor certify you are terminally ill and have less than six months to live, and you must sign a Medicare statement which says you choose to receive hospice care rather than other Medicare-covered treatments for your terminal illness.
You, like many people, may wonder why you should spend time and money planning for something that might never happen. While it is true that you may live to be a ripe old age, fully able to take care of yourself until your death, this is often the exception, rather than the rule. Planning for long-term care can be a complex process, requiring a highly knowledgeable attorney who has a solid understanding of Ohio Medicaid requirements, tax laws, probate and estate laws.
Of course, there are additional ways to plan for long-term care; you can pay for nursing home or skilled care through private, long-term insurance. There may be other options as well, such as Medicaid, retirement benefits, personal assets and/or veteran’s benefits. The long-term care planning attorneys of Lovett & House can help you develop an integrated plan which will ensure you receive the care you need while protecting assets your family members may also need. An experienced Lovett & House attorney can discuss a comprehensive estate plan which could include a Living Trust, a Last Will, and Testament, a Life Insurance Trust, a Durable Power of Attorney, a Health Care Power of Attorney, a Living Will and a Medicaid Trust.