Reality Check-Know What Medicare Does Not Cover, Ever

When Jackie called for advice about her mother in assisted living, she had been told that there was “a Medicare solution”. Her Mom, Perla, had been in a memory care home for three years and was running out of money. Someone had fed Jackie a falsehood. She had been told that the home would never kick out a long-term resident like Perla. She had consulted with someone on the internet about “Medicare and Medicaid payments for assisted living” and she wanted to find out more. I had to be the bearer of bad news.

Fake Promises

Jackie’s so-called consultation via the internet about payments for assisted living in some fake program was clearly a scam. Medicare, since its inception in 1965 has never paid for assisted living nor memory care. Medicaid (government insurance for low income persons only) does not pay for it either. From our vantage point at AgingParents.com, with legal and health care advice, we see this false hope of a government-paid program all too often. Families place their aging loved ones in assisted living, or its same-license cousin, memory care, with no thought to how long the elder’s money will last. They may not realize that the cost of being in assisted living or memory care typically rises every year. Furthermore, as an elder’s care needs increase with aging and progressive disabling conditions, these homes usually raise the monthly bill for that as well. No wonder an elder with limited assets is going to deplete their savings eventually. Sometimes it’s much faster than expected.

The Reaction

Jackie was shocked! “You mean Medicare doesn’t cover this and even if Perla gets onto Medicaid, that won’t cover it either?”she asked incredulously. “No” I said. neither will cover it and anyone who told you they had a special program for this was just trying to trick you into giving them money. Ask the home where she lives, I advised. They’ll tell you the truth.

The answerer to her next question was one she found even more disturbing. “But they can’t just kick her out of there after three years of paying on time every month, can they?” Sadly, they can, I told her. They evict people for non-payment of rent just as any landlord does. Assisted living and memory care homes depend on rent from every resident to stay in business. There is no charity fund (some rare exceptions exist). There is no free stay. Indeed, they can and will legally evict a person who does not willingly leave when they can’t afford to stay there anymore. The law is clear on this. “No pay-no stay” applies.

The Limits of Medicaid

We discussed what Jackie could do for Perla. We discussed Medicaid. It is an insurance program paid for by a combination of federal, state and county funds. If the state legislature where your elder lives has voted to limit, prevent expansion of the program or make it harder to get on it, an aging parent may not even be eligible to get it at all. It’s not simple to understand and I directed Jackie to get advice on the Medicaid program in her state from their social services department. She would do so, she said. She expressed frustration and anger at the circumstances. “How are people supposed to get care when they run out of money??” I had to tell her that we, as a society do not devote sufficient resources to help someone in Perla’s circumstances very much. Either family has to pay for needed care, provide it themselves, or wait until the elder is so low income and low on funds that they do become eligible for Medicaid. Then, if they need care and have no other choice, they are forced into the one situation left—a low end nursing home. No one wants that but it is covered by Medicaid for long term stays.

The Takeaways

No one can predict how long our loved ones will live. When their health and independence declines, we want them to be safe. Decisions about how to get care or where to put an elder when basic, non-skilled care is needed, must be made with a long view. Consider all these factors before you choose anything.

1. Long Term Cost: The attractive, well appointed senior home may appeal to family as a good place for an aging parent go, but consider the total assets available from all sources to pay for it and decide on that basis. If they can’t afford it for long, don’t place your loved one there.
2. Kind of Care Needed: Assisted living usually costs less than memory care. Memory care has more restrictions and generally more staff on hand than assisted living without memory care. Recognize that if your elder has dementia, it is a progressive disease and the costs of care will increase over time. If you want memory care, calculate how long your loved one (or you) can pay for it.
3. Compare Home Care To Other Options: Costs of labor are rising across the country including home care worker pay. Most elders want to remain in their own homes rather than go to one of those “places for old people”. But their home needs to be safe for them. Home modifications can be costly and maybe not worth it. On the other hand, it may be a better choice for your aging parent who can bear the cost of things like putting in ramps, enlarging doorways and reconstructing showers to accommodate wheelchairs.
4. If There Is Other Family, Enlist Their Help: sometimes, when family join forces and all contribute something every month, the cost of a modest seniors’ home will work. This assumes that everyone can and will pitch in. It is not for every family but it is a possibility that can keep an aging loved one out of a nursing home.

In my own family, we have several siblings, and one is disabled after a stroke. He has no money. He can’t live independently and must be housed in a supervised environment. He is on Medicare and Medicaid (called MediCal in CA). Neither program pays for his stay in the modest studio apartment in his seniors’ home. His girlfriend provides weekend assistance that would make up assisted living, so his cost is lower in this “independent living”apartment. Every sibling pays in unequal amounts each month to keep him there. It works, not without rancor, complaints and resistance from siblings. Selfishness rears its ugly head. But, he is stable, safe and one sibling living relatively near visits every week. This disabled brother will not go to a nursing home. He is fortunate.