Nursing homes provide around-the-clock professional medical care for patients with chronic illnesses or patients recovering from acute illnesses who need skilled nursing care but do not need to be hospitalized.
Also known as "long-term care facilities," nursing homes vary by the level of care
provided. There are three levels of care:
- Skilled care
- Intermediate care
- Custodial care
The level of care is directly related to whether Medicare will pay for the care and services that you or your loved one receives in a nursing home. So, if you're in need of long-term care and you are dependent on Medicare, you need to know some things about the levels of care that nursing homes provide.
What is Medicare?
Medicare is a health insurance program that is run by the federal government. The agency in charge of running Medicare is the Centers for Medicaid and Medicare Services ("CMS").
Medicare is divided into several "parts." Medicare "Part A" provides for hospital insurance, which includes inpatient care in "skilled nursing facilities." Generally, Medicare doesn't pay for long-term care in a nursing home. Rather, it will help pay only for skilled nursing home health care.
Skilled care is nursing and rehabilitative care that is prescribed by a physician and is delivered on a daily basis by skilled medical personnel such as nurses or therapists. Skilled care is generally provided to assist patients during recovery following hospitalization for treatment of acute conditions.
Medicare Part A covers all expenses for skilled care. Some examples of things that qualify as "skilled care" and Part A coverage include:
- Intravenous or intramuscular injections and intravenous feeding
- Insertion and sterile irrigation and replacement of suprapubic catheters
- Application of dressings involving prescription medications and aseptic techniques
- Rehabilitation services, but only if the service requires a qualified therapist, such as therapeutic and range of motion exercises
Medicare will pay for up to 100 days of skilled care. But, because skilled care is so narrowly defined, Medicare payments will usually last for only a short time, and are temporary.
Intermediate care is provided intermittently, or periodically, for patients who are recovering from acute conditions but do not need continuous care or daily therapeutic services. Intermediate care is provided by skilled professionals such as registered or licensed practical nurses, and therapists, under the supervision of a physician.
Medicare Part A does not cover intermediate care in nursing homes. Some examples of intermediate care include:
- Cooking of meals
- Housekeeping and laundry services
- Providing and delivering medications
Custodial care provides assistance to patients in daily activities such as bathing, dressing, toileting, and eating. Custodial care is often needed as a result of chronic illnesses that decrease an individual's ability to remain independent. While custodial care must be supervised by a physician, not all custodial care must be delivered by skilled professionals and is frequently provided by nurse's aides.
Medicare Part A does not cover the costs of custodial care.
Other Ways to Pay
If the level of care that you or your loved one needs does not does not qualify for Medicare coverage, of if you're trying to plan ahead for long-term care, there are several ways to help pay for care, including:
- Long-term care insurance
- Managed Care Plan health insurance, if the nursing home has a contract with the Plan
- Medigap, or Medicare Supplemental Insurance, which can be purchased privately and helps pay for things that are not covered by Medicare Part A
Questions for Your Attorney
- How do I check on my parent's eligibility for Medicare?
- What can I do if I don't agree with Medicare's decision that my parent doesn't need "skilled" care
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