Friday, June 26, 2009

Long term custodial care is mostly self-pay, long-term-care insurance or "family responsibility"; mention geriatric care management

It’s important to reiterate that Medicare generally does not pay for many services that tend to be needed for “long term care.” It generally does not cover “custodial care (non-skilled care)”, which is “care that helps you with activities of daily living”.

The main reference on the Medicare site for long term care is here. There is a particularly telling comparison chart called “paying for long-term care” including items related to long term care insurance, and some special programs in some areas like PACE. The URL for that link is here.

There is a general expectation that family members will provide some long-term care, and that patients will have to pay for care that family members are unwilling or unable to provide. In some states, “poor laws” or “filial responsibility laws” could force adult children to pay for this care if parents become destitute, even if the adult children had no children themselves, and the financial crisis makes it more likely that some states will start enforcing these in the future. Ironically, the childless may be more vulnerable to this problem in the future than those with families, which flips some of our ideas upsidedown.

A professional geriatric care manager can help work out some of the potentially sensitive problems of responsibility. The website for the National Association of Professional Geriatric Care Managers is here.

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