The Sandwich Generation – Hospice and Medicare – Who pays for Facility Charges

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Medicare and Hospice – Who Pays?

The Christmas Holiday Season will be different this year; bitter, sweet. Your dad’s health has been slipping and he has said “enough” to the medical treatment he has been receiving. While in most cases a person on hospice care can be cared for at home, dad is a big guy, mom is unable to assist him to get up and he just is not safe at home. So, dad is now in hospice care at a LTC facility and the family meal will be in their social room for our Christmas Dinner. Life today is active, especially for women aged 45 – 56 who care for both their parents and children. These people are caught in the “sandwich generation” and these columns are focused on issues affecting you.

Dad has Medicare. When a person goes into hospice, they give up the Medicare coverage for the terminal illness and then have hospice benefits for that illness. Dad will no longer treat to cure his terminal condition, only manage symptoms and control pain; these services are under hospice coverage. Medicare will continue to pay for non-related conditions or falls. Here is where mom says “who pays for care” has gotten complicated. While Medicare Hospice will pay for most services, through the hospice company mom and dad chose, they will not pay for the room and board charges of the living facility that is now caring for dad. Note: Medicare Hospice care may pay for respite care and short-term care for pain and symptom control.

Here is where mom is really confused. She thought Medicare and her Medicare Supplement would pay nearly all of the hospice nursing home costs, however when a person is on hospice neither Medicare, an MA nor Medicare Supplement will pay for the room charges (other than respite care or for short term pain control) Therefore, if a person, however unlikely, met Medicare criteria for skilled care in a facility, they would forfeit the benefit of room coverage in a skilled nursing facility.

While hospice care has provided our family many services and a peace of mind we would not have received otherwise, mom just mis-understood that the facility care would be self–pay. It is tough to have a total understanding of all issues when so much is happening so quickly to the one you love. In addition, as much as the adult children want to be involved life is so “busy” making it tough for them to also catch all details.

To be clear, hospice care is a Godsend to many who use the service. Also, it is important to understand how it works and what services hospice will and will not pay. Helping mom and dad and caring for your children simultaneously is not easy. It is very helpful to discuss and plan for reasonable future events, and a sandwich generationer should guide their parent through these issues and the primary issue of safety, while being careful not to take all control away from a parent. Once again, it is important to start talking, making suggestions and guiding early, do not wait for a crisis.

This year Christmas Dinner will be very special with dad, mom and family. I wish you and yours a very Merry Christmas and Happy Holiday Season. May you find peace, joy and comfort during this season.

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Steven A. Buttice is the president of Medical Reimbursement & Management Services, Inc., a firm specializing in issues affecting seniors, including seminars and consultation on Medicare Plans, Long Term Care and other types of insurance, claims issues, and sales/service of insurance products since 1984.

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