Home health care is an integral component of dementia treatment, and there are various resources that can assist patients in finding appropriate in-home care services. Medicare beneficiaries may be uncertain whether their policy covers such care for dementia patients; the answer depends on various factors including their current medical status and nature of dementia diagnosis.
Medicare currently covers home health care for individuals meeting certain conditions, such as being homebound and needing physical, occupational or speech therapy. Unfortunately, home healthcare coverage only extends to services provided by an agency approved by Medicare; thus it doesn’t extend to family members acting as caregivers. Some states offer self-directed Medicare coverage allowing individuals to hire private caregivers on their own while organizations also provide support for informal caregivers and their families.
As dementia advances to its later stages, an individual’s need for in-home home health care increases dramatically. At these points, individuals experience more confusion and require help with activities of daily living such as meal preparation, bathing, grooming and mobility assistance. Home health teams can provide assistance for these tasks as well as support caregivers with stress coping, caregiver training and care coordination and management.
Medicare Part B may cover some home health services for people living with dementia if they meet specific criteria. To qualify for this coverage, an individual must be homebound and require physical, occupational or speech therapy as well as intermittent nursing care from an in-home provider; their doctor must certify this need and establish their frequency of visits.
If someone with dementia needs more intensive home health care, they can be moved into a skilled nursing facility (SNF). Medicare covers up to 100 days at an SNF before any costs become their responsibility; medications like Aricept (donepezil) and Namenda (memantine) may also be prescribed to manage symptoms like hallucinations and confusion associated with dementia.
Late-stage dementia patients may require hospice care. Medicare will cover this service in any certified hospice facility, provided their doctor certifies they have less than six months left of life expectancy.
Long-term care insurance provides seniors with an extra layer of coverage beyond Medicare benefits, typically used to cover assisted living and nursing home stays. Coverage varies widely based on policy type, amount invested into plan and age at purchase – consumers are strongly advised to research all their options carefully with the assistance of financial advisors before selecting their plan of choice. Some state health insurance assistance programs even provide free one-on-one advice and publications for Medicare users to navigate this complex system more easily.