An 86-year-old woman lives home alone. Her husband died 2 years ago; since then her self-care has deteriorated. She has lost weight and has become increasingly frail. She has fallen on several occasions and appears bewildered when faced with simple household decisions. Physical examination shows no focal neurological deficits and a Folstein Mini-Mental Status score of 19 (out of possible 30). A workup for reversible causes of dementia is negative, and treatment in a balance disorder clinic is not helpful because the patient cannot remember her instructions. The patient appears in your office, accompanied by her daughter, who is concerned about her mother’s safety. She inquires about nursing home placement but is worried about the financial implications of this decision.
Which of the following statements is true?
A. Medicare will pay 80% of the costs associated with nursing home careMedicare is a federally sponsored health insurance program for the elderly (age > 65). Medicare part A provides for acute hospitalization and some subacute and transitional services. Medicare part B, which requires a monthly premium, pays the fees of doctors and certain other health providers. Medicare part D covers some prescription drug costs. Although Medicare covers some groups of nonelderly patients (eg, chronic dialysis patients, disabled patients), it does not pay for long-term custodial care even in the elderly. Medicare will provide payment for hospice care if the patient has an estimated life expectancy of less than 6 months.
Medicaid is a welfare program to provide health care monies to the indigent. Whereas Medicare is administered by the federal government, Medicaid is administered by the states (often, however, using pass-through funds from the federal government). The eligibility threshold for Medicaid, therefore, varies from state to state. Generally, adults who qualify for Medicaid must be very poor with few available assets (requirements for coverage of children and pregnant women are somewhat more lenient). Medicaid provides few transitional services, but does pay for chronic nursing home care. The decision to place a frail parent in assisted living, nursing home, or Alzheimer unit is a difficult one for many families. Still, 30% of frail elderly are in chronic nursing facilities, often at a monthly cost of $3000 to $6000. Over 50% of patients above age 90 are unable to care for themselves at home.