A Sharonville nursing home lawyer helps you to be prepared in case there comes a point in your life when you need nursing home care or when you need long-term care at home. If you reach the age of 65, there is a 20 percent chance you will need to live for five or more years in a nursing home environment before the end of your life. There is also a 40 percent chance that you’ll need at least some care in a nursing home for some period of time, according to the Wall Street Journal, even if that period of time is for less than five years. Since the chances that you will need some kind of care are very substantial, it is important to understand how insurance providers like Medicare treat coverage for nursing home care.
In particular, there is one key concept you need to understand: custodial care. If you know what custodial care is, you can prepare for the fact that this kind of care is difficult to get insurance coverage to pay for.
What is Custodial Care?
If you must go into a nursing home or if you need long term care at home, there are different reasons why you might need that care and support. For example, a person who temporarily moves into a nursing home facility for rehab for a broken hip is not in the same situation as a person who will be living in a nursing home for the rest of his or her life due to dementia or due to any condition that makes routine daily living impossible without help.
When the help that you need is just routine assistance with daily activities of living, then the care which you need is called custodial care. Medicare has a page on its website explaining what custodial care means. It is defined as “non-skilled personal care,” with examples provided of non-skilled personal care that are considered custodial care.
Some examples of custodial care listed by Medicare included help getting dressed, moving in and out of a bed or chair, eating, and showering. If a person cannot do most or any of these basic life skills on his or her own then he may have no choice but to go into a nursing home or get a visiting nurse to come and provide custodial care.
Since the care that the person receives would not be considered skilled if someone went to a nursing home just because he couldn’t shower or eat on his own, Medicare would not pay for it and it would be the responsibility of the family and private insurers to pay for the unskilled custodial care. Medicare only pays for a skilled nursing facility, such as in circumstances where.a person who has had an operation will need to have bandages changed several times daily by a qualified professional.
Medicare also defines custodial care to include basic kinds of medical services most people do at home without help, such as putting in their eye drops if they have an eye irritation.
Why Does the Definition of Custodial Care Matter?
The definition of custodial care matters a lot, because it can make or break your future financial security.
Medicare makes clear it provides no coverage at all for custodial care. Medigap policies and Medicare Advantage policies do not provide coverage at all for custodial care. Most private insurers have no coverage for custodial care in a nursing home or other care environment either. This means that Medicaid could be your only option for getting custodial care covered.
Medicaid is means-tested and need-based, though, which means that you could be forced to impoverish yourself before getting covered — unless you make a plan to ensure this does not happen.
Getting Help from A Sharonville Nursing Home Lawyer
A Sharonville nursing home lawyer at Zimmer Law Firm can offer assistance and advice on getting custodial care covered and can otherwise help you to understand coverage rules. Medicare actually provides much less coverage than most people think it does, so work with our legal team to help make sure you can the care you need without having to spend your entire life savings just to pay for help and support.
To find out more about how we can help you, you should consider joining us for a free seminar. You can also give us a call at 513.721.1513 at any time to get help finding out your rights as a nursing home resident.