MyGericare

Alzheimer's Care | Dementia | Memory Care

QUICK OVERVIEW: Some Alzheimer's or Dementia care can be provided by Homecare - Medical Nursing Agencies. Often, care for the senior with Alzheimer's or Dementia is available in a dedicated Alzheimer's/Dementia facility, or within a separate area of Assisted Living or Skilled Nursing Facilities.

APPROPRIATE FOR: The Senior who

  • Exhibits challenging behaviors, confusion, forgetfulness
  • Requires complete personal care services for most Activities of Daily Living (ADLs) such as
  • bathing, dressing, grooming, eating or toileting
  • Has accidents in the home or forgets to use safety equipment like walkers, grab bars, etc.
  • Has difficulty recognizing loved ones and familiar faces
  • Gets agitated, combative, refuses care or is abusive
  • Wanders away from home, requiring a secure facility
  • Is unable to use proper judgment in an emergency, due to unpredictable and unreliable behavior

SERVICES PROVIDED: The disease stage and personal care needs will determine the care that is provided. Care is administered in a secure and usually locked wing or area of the facility, for the safety of the person with Alzheimer's or Dementia. All assistance with every Activities of Daily Living (ADLs) such as bathing, dressing, grooming, eating or toileting, is provided.

COST RANGE: $3,500 - $8,000 per month

FUNDING SOURCES: Private pay, Long-term Care Insurance (LTCI), Managed Care (HMOs), Veteran's Benefits, Medicare, Medigap & Medicaid. Medicare initially covers most skilled nursing care at a facility. Once Medicare coverage stops, your options are Long-term Care Insurance (LTCI), Medicaid, private pay or a combination of sources.



PRIVATE PAY SOURCE:

Coverage

Conditions & Limits

-All-

-None-

 

 

LONG-TERM CARE INSURANCE (LTCI) SOURCE:

Coverage

Conditions & Limits

  - Depends on policy, some cover in-home care based on impairment of Activities of Daily Living (ADLs)  

- Some policies pay benefits in a skilled nursing facility, but the $ coverage depends on the policy.

- For information on how to determine what kind of LTCI policy is best, consult with one of our Advisors For Seniors

  -   Depends on the policy, as some only cover Skilled Nursing care for a limited number of days, daily amount, total dollar amount, etc.,

- For information on how to determine what kind of LTCI policy is best, consult with one of our Advisors For Seniors

 

 

VETERAN'S BENEFITS SOURCE:

Coverage

Conditions & Limits

- The Department of Veterans Affairs (VA) provides skilled nursing care to eligible veterans through VA and Community Contract facilities.

- Veterans who do not meet eligibility criteria may still be eligible for nursing care when space and resources are available. 

- We recommend you consult with one of our Advisors For Seniors i.e., Veterans Organizations

- Veteran must meet these eligibility criteria:

  • Require skilled nursing care for a service-connected condition; or
  • Have a service-connected disability rating of 70% or more; or
  • Have a service-connected disability rating of 60% and be considered unemployable

- Skilled nursing care for non-service connected veterans is limited to 6 months

 

 

 

 

MANAGED CARE (HMO) SOURCE:

Coverage

Conditions & Limits

- Managed Care policies cover everything that Medicare covers (see Medicare Option).

- Some require a 50% co-payment for days 21-100

- In addition, no prior hospital stay is required

 

- The skilled nursing facility must be certified by Medicare, and

- Client/resident must get services pre-authorized from

- We recommend you consult with one of our Advisors For Seniors

 

 

 

MEDICARE SOURCE:

Coverage

Conditions & Limits

- First 20 days in a Medicare-approved skilled nursing facility

- Days 21-100: Medicare pays for all covered services except for an annually adjusted daily coinsurance rate of $128/day (2008)

- Doctors' visits

- Nursing care

- Semiprivate room rates

- All meals (including special diets)

- Physical, occupational and speech therapies

- Lab and X-ray services

- Prosthetic devices

- Prescription drugs

- Some medical supplies and equipment

- We recommend you consult with one of our Advisors For Seniors (i.e., Medicare/Medicaid Consultants or Eldercare Attorney's)

 

- There are strict limitations to Medicare coverage in skilled nursing facilities.

- Beneficiary must be in hospital for 3 consecutive days, not counting day of discharge

- Must be admitted to skilled nursing facility within 30 days of hospital discharge

- Services must be related to condition that was treated in hospital

- Must require daily skilled nursing or rehabilitation services

- Must be determined that services can only be provided on an inpatient basis

- Doctor must specify need for daily skilled care services; and

- Doctor must re-certify need at day 5 and day 14 after admission, and every 30 days thereafter

- Medicare must review and approve continued need for skilled care services

- Skilled nursing stay must be 100 days or less; and

- Medicare must approve the length of stay (100 days are not automatically granted)

 

 

 

 

MEDIGAP SOURCE:

Coverage

Conditions & Limits

- 8 of 10 basic Medigap policies (Medigap Plans A-J) cover the coinsurance $ amount of days 21-100 of skilled nursing care.  Medigap Plans K-L cover a portion of the coinsurance $ amount.

- Three states have their own Medigap plans.  Massachusetts' core plan doesn't cover skilled nursing facility coinsurance, but a supplemental plan does. Skilled nursing facility coverage is provided in Minnesota both with basic and extended basic plans and in Wisconsin with the basic plan

 

- There are many limitations.  We recommend you consult with a GeriCareFinder Advisory Resource  (i.e., Eldercare Attorneys, Medicare/Medicaid Consultants, etc.)

 

 

 

MEDICAID SOURCE:

Coverage

Conditions & Limits

- Skilled nursing facility service costs and medical equipment deemed necessary by a doctor (usually a person will need help with at least two Activities of Daily Living (ADLs)  

- To hold a bed usually a one- to two-week period, if a resident requires temporary hospital care

- For a leave of absence of up to 18 days per year for visits with family or friends

 

- There are many limitations.  We recommend you consult with one of our Advisors For Seniors