Ask an advisor: Will Medicare help care for my 97-year-old mother?

October 19, 2022 4:50 PM

Elder care is a major concern for retirees with living parents.

Welcome back to "Ask an Advisor," the advice column where financial pros answer pressing investment questions. The topics can range from retirement to taxes to wealth management — or even advice on advising — and the questions are from real people.

This week's query comes from a 63-year-old psychotherapist in New York City, now entering a phase she calls "partial retirement." She and her husband have substantial savings and are vivacious and active, but their plans also have to account for an older family member. Here's what she wrote:

Dear advisor,

My husband and I are vibrant, solvent early retirees who provide care to my independent, but fragile, 97-year-old mother (also solvent). In order to pursue our own interests and travel plans, we are considering engaging a licensed home health aide to assist her with tasks she can no longer manage. For budgeting purposes, we'd like to understand whether such services are paid for by Medicare, and to what extent?

— Navigating in New York

Here are the answers we heard from advisors:

Sorry, you're not covered

Diane Omdahl, RN, MS, and Melinda Caughill, CSA, co-founders of the Medicare advice website

65 Incorporated

:

"Unfortunately, Medicare does not cover the home health aide services in this situation — not a penny.

That's because the care needed in this case is considered 'custodial care.' Assisting with activities of daily living (ADL), such as bathing, dressing, using the bathroom, eating, getting in and out of bed, etc., can be done safely and reasonably without professional skills or training. All this falls under long-term care, which Medicare never has covered.

That said, Medicare will cover limited home health aide services if the individual also needs skilled care. These are healthcare services that must be provided by or under the supervision of a registered nurse or therapist to be done safely. For example, a person recovering from a stroke receives physical therapy services from a Medicare-certified home health agency. Medicare will then cover a home health aide to assist this person with ADLs.

Recent policy changes now allow Medicare Advantage plans to cover supplemental healthcare benefits for 'daily maintenance,' which may include ADL assistance. Not all plans have these benefits. If a plan includes them, be sure to read the fine print carefully. Most benefits will have limits, such as up to four hours in a day for a maximum of 31 days in a year after receiving authorization by the insurance company.

Before making any changes to your Medicare coverage, be sure you understand all benefits, coverage rules, costs and restrictions of the plan you have and the plan you would switch to. We never recommended changing your Medicare coverage simply to get an extra 'free benefit.'"

Explore other options first

Anne Marie Webster, CFP, financial advisor at

Curated Capital & Planning

:

"Custodial care is not covered by Medicare. Check to see if your mother purchased a long-term care insurance policy. Sometimes these were purchased decades ago, and the beneficiary has lost track or forgotten about them, so dig deep. LTC policies are often easier to extract benefits from than Medicare.

If your mother is independent and needs only a low level of assistance, hiring a home health aide while you travel is completely appropriate and strongly encouraged. This can be more affordable than you think, especially if she does not require around-the-clock care. Remember, too, that providing most of the care for a parent may make them eligible to be claimed as a dependent for tax purposes, so talk to your tax professional to see if she qualifies in your situation.

If your mother declines and requires intermittent skilled nursing, Medicare would then become an option to explore."

Don't forget to set boundaries

Jay Zigmont, PhD, CFP, founder of the RIA

Childfree Wealth

:

"When caring for elderly family members, there are a series of issues, including financial, boundaries and more.

Medicare may pay for part of the care, but it will most likely be limited. Long-term care is normally paid via Medicaid after Medicare reaches its limits. The benefits your mother may qualify for are going to vary greatly based on her own financial situation and the state you are in. Contact your state and see what she may qualify for. You may also want to reach out to an aging care manager for help. An aging care manager can help with the coordination of the healthcare services, determining what she qualifies for and being an advocate for her.

Be sure that you and your husband set good boundaries of what you will and will not pay for or do for your mom. It may sound harsh, but caregiver fatigue is real, and setting boundaries now will help set limits and make sure your mom gets the best care."

Consider assisted living

Mary Johnson, Medicare policy analyst at the

Senior Citizens League

:

"Unfortunately, Medicare does not cover most long-term care services, and that includes routine in-home healthcare services required for help with daily living tasks. The cost of in-home healthcare can be quite pricey out of pocket, especially if you are planning a trip of more than a few days away from your mom. If your mother is enrolled in a Medicare Advantage health plan or has some long-term care insurance, call the customer service number listed on her plans to learn if there is any additional coverage offered for in-home healthcare services. But what you might find is pretty meager.

In fact, you may want to consider comparing in-home care to the cost of a short-term or temporary stay in an assisted living facility. The costs of an assisted living facility may be a better deal and it may be easier than trying to schedule multiple aides at home. One of the biggest challenges you are likely to encounter is simply locating an adequate number of experienced, screened, in-home healthcare staff to cover the period while you are gone, or finding a temporary apartment in an assisted living facility.

Having done plenty of caregiving myself, I would suggest you first try out your options — home health aides or a short term-stay in an assisted living facility — before taking a prolonged trip. Things happen. When I was caregiving, my grandmother locked her caregiver out and would not allow her back into the house. I lived 250 miles away when I received that call.

Once you get the in-home aides or assisted living question answered, you still need to budget for travel insurance. While your mom is independent at age 97, what would happen if you got to your destination only to receive a call that there's a medical emergency and you are needed at home?"

Ask an advisor: Will Medicare help care for my 97-year-old mother?

Sorry, you're not covered

Explore other options first

Don't forget to set boundaries

Consider assisted living

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