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Millions of us have been there — researching care options for ourselves or aging loved ones. It’s easy to get lost in the sea of acronyms and jargon: Medicare, Medicaid, in home care for elderly, assisted living… it’s enough to make anyone’s head spin.
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In this article, we’ll clear up the confusion around elderly care. By understanding the different levels of care available, you can take the first step to finding the right solution for your needs.
What Exactly is “Elderly Care”?
Elderly care is a broad term encompassing a wide range of services and support for older adults. Adults aged 65 and older are generally considered elderly, but some care facilities host adults as young as 55, depending on their needs.
Over 1.3 million elderly adults live in nursing homes, with another 818,800 residing in assisted living facilities.
Considering the numbers, it’s no surprise that elder care is not a one-size-fits-all solution. Rather, it’s a spectrum of options that can ideally cover every individual’s specific circumstances.
You can receive elderly care in various settings, including your own home, assisted living facilities, nursing homes, and specialized memory care units.
The goal of all of these options is to enhance the quality of life for seniors by:
- Promoting independence: Helping older adults maintain their autonomy and stay in their homes as long as possible.
- Assistance with daily living: Offering support with Activities of Daily Living (ADL) such as bathing, dressing, meal preparation, and mobility.
- Addressing health concerns: Managing chronic conditions, providing rehabilitation services, and coordinating medical care.
- Offering social and emotional support: Combatting loneliness and isolation through companionship, activities, and peer engagement.
How Does Medicare Fit In?
Medicare, the federal health insurance program, helps cover the costs of certain types of elderly care.
According to Genworth’s Cost of Care survey, the monthly median cost of assisted living in 2023 is $4,774. However, these costs vary by location, facility, and service. In Washington, D.C., the monthly median is $6,310, whereas in Boise, Idaho, it’s $3,804.
Medicare’s coverage is not unlimited. While it can cover certain aspects of elderly care – such as skilled nursing care or home health services under specific conditions – it typically doesn’t cover long-term care, like custodial care in an elderly home or a nursing home.
It’s imperative to thoroughly learn about your options before choosing a plan.
What are the Levels of Elderly Care?
The type of elderly care appropriate for you or your loved one will vary depending on health status, cognitive abilities, and personal preferences.
Here are the main categories:
In Home Care for Elderly
In-home care allows elderly individuals to receive support while staying in their own homes. Services for elderly living at home can range from help with daily activities to skilled nursing care.
This option is ideal for those who prefer the comfort and familiarity of their own homes but need assistance with certain tasks.
Assisted Living
Assisted living facilities provide a middle ground between independent living and full-time nursing care. Residents typically have their own apartments and can receive help with daily activities such as bathing, dressing, and medication management.
These facilities offer a balance of independence and support.
Nursing Homes
A nursing home, or an elderly care home, offers 24/7 care for those who require a high level of medical and personal care. Their comprehensive services include meals, medical care, and social activities.
Currently, there are over 15,000 nursing homes in the US. Usually, only individuals who need constant supervision or have complex medical needs choose this option.
Memory Care
Memory care is a specialized type of care designed for individuals with Alzheimer’s disease or other forms of dementia. These facilities are equipped to handle the unique challenges associated with memory loss and provide a safe and structured environment.
Hospice Care
Hospice care focuses on providing comfort and support for individuals in the final stages of a terminal illness. This type of care can be provided at home, in a hospice facility, or a hospital.
The goal is to ensure the highest quality of life possible for the remaining time.
Does My Medicare Plan Affect What Level of Care I Can Get?
Your specific Medicare plan doesn’t dictate the types of care available (home health, skilled nursing, etc.) nor prevent you from choosing any.
However, it does influence your out-of-pocket costs, making certain options less accessible. Here’s a quick overview of plans:
- Original Medicare (Parts A and B)
If you’re homebound and a doctor certifies your need for select services, then Medicare Part A and/or Part B may cover part-time or intermittent:
- Skilled nursing care
- Physical therapy
- Occupational therapy
- Speech-language pathology services
- Medical social services
Medicare Part A may cover short-term stays in a skilled nursing facility (SNF) if you require skilled care (such as wound care, intravenous therapy, or physical rehabilitation) after a qualifying hospital stay.
However, you may be responsible for copayments or coinsurance.
If you have a terminal illness and a life expectancy of six months or less, Medicare Part A may cover hospice care, which can be provided at home, in a hospice facility, or in a hospital.
- Medicare Advantage (Part C)
Some Medicare Advantage plans offer additional benefits not covered by Original Medicare, such as vision, hearing, dental, and fitness programs. Plans might even cover services like transportation to medical appointments.
Medicare Advantage plans often have programs to help manage chronic conditions like diabetes, heart disease, or COPD. These programs may include care coordination, medication management, and education.
- Additional Medicare Programs:
Program of All-inclusive Care for the Elderly (PACE) is a Medicare and Medicaid program that provides comprehensive medical and social services to certain vulnerable seniors who are eligible for nursing home care but wish to remain in their community.
Frequently Asked Questions (FAQ)
Q. What About Covering Long-Term Care?
Neither Original Medicare nor Medicare Advantage typically cover long-term care services like help with daily activities in a nursing home.
For this, you might need:
- Medicaid: A state and federal program that can help with long-term care costs for those with limited income and assets.
- Long-Term Care Insurance: A private insurance policy covering various long-term care services.
Q. How do I choose the right Medicare plan for my needs?
Picking the best Medicare plan for you goes beyond just ticking boxes. Consider your current and future health outlook, the doctors and hospitals you prefer, and how much you’re comfortable spending on premiums and out-of-pocket costs.
You can compare plans online at Medicare, seek assistance from a licensed insurance agent, or use a platform like CoverRight, which acts as a personal concierge for Medicare.
Q. What if I can’t afford the out-of-pocket costs for Medicare-covered care?
Several programs, including the Medicare Savings Program, Extra Help for prescription drug costs, and Medicaid, may help with Medicare costs.
You can explore these options on the Medicare website or contact your State Health Insurance Assistance Program (SHIP) for guidance.
