U.S. News: Lack of Medicare Coverage Leaves Alzheimer’s Patients With Few Options

About 5 million Americans with Alzheimer’s disease are finding that their needs for care far exceed the scope of Medicare coverage — leaving them with few options, according to U.S. News & World Report.

The disconnect between coverage and needs are “part of the long-term care catastrophe looming for many in the U.S.,” where the current population of elderly is expected to double to an estimated 88 million by 2050, the article states. And for those afflicted with a disease such as Alzheimer’s, the need for long-term care is even more critical. 

This year, costs associated with Alzheimer’s care are expected to reach $214 billion, making it the most expensive condition in the country. The amount needed to provide care for one Alzheimer’s patient ranges from $21 an hour for a home health aide to $239 a day for care in a nursing home.

One possible option to bridge the coverage gap, long-term care insurance, only pays for 12% of those costs nationwide. People without long-term care insurance largely look to Medicare to pick up the costs when Alzheimer’s leaves a loved one unable to take care their daily needs.

But much of the care provided at long-term facilities isn’t covered by Medicare.

If care isn’t deemed “medically necessary,” then Medicare won’t pay for it, Linda Adler, founder and CEO of the patient advocacy group Pathfinders Medical, told U.S. News. 

“The part that people have a challenge with is understanding what constitutes a medical issue and what constitutes assistance or custodial care,” she said.

Adler and others who represent patients are seeing a growing demand as people, like those with Alzheimer’s, are faced with mounting costs, limited resources and often confusing insurance coverage.

Custodial care is often what Alzheimer’s patients need most. The non-medical care – either at home or in a long-term care facility – makes day-to-day life more manageable. However, Medicare doesn’t cover assistance with bathing, dressing, eating and preparing meals, changing bed linens and help using the toilet.

Often, in the case of Alzheimer’s, a patient will become physically ill and require hospitalization for something like pneumonia or a broken hip. After inpatient treatment at the hospital, Medicare will cover some of the costs for a limited period of skilled nursing and custodial care at a nursing or rehabilitation facility. But when this period, usually 100 days, runs out, the patient is no longer covered.

“There was a time when the family could come together and care for elders at home,” Adler says. “But families now are different in many ways, and often when patients are in need of basic care, they are unable to get it from traditionally available sources.”

Read the full U.S. News & World Report article here

Written by Emily Study