SILVERcare

Paying for necessary home care is a major crisis facing our society. Below are some of the possible options and their respective limitations. For a more in-depth discussion of funding sources, please contact us under the “How may we help you” menu selection.

Medicare – the Myth –

The “Myth” many have as to Medicare paying for long-term care is that it will cover most of their health care needs. However, contrary to what many people think, Medicare only pays for limited skilled care, where the patient is in a recuperating mode, such as after surgery or a trauma event. Medicare does not cover the extended disability needs, nor does it cover the custodial and routine care usually required by the elderly. Home care is very limited (skilled nursing or physical therapy, etc visits only) and nursing home care is non-existent beyond the initial 100 days of a stay – if that stay follows a 3 day hospitalization period. Once rehabilitation or skilled needs are met following a surgery or trauma, Medicare, as a provider of long-term care, is out of the picture.

Medicaid-

Medicaid is Federally and State funded program to provide health care to qualifying individuals with little or no assets and very limited income. Recipients must be certified as eligible by the County Department of Social Services. Medicaid allowance for services are under strict limits and providers are paid only a stipulated amount for defined services, including home care and institutional care. Services may be arranged with approved providers only, under the auspices of the State.

Community Alternative Program-

Also under the Medicaid guidelines, this program allows for limited home care services to recipients with some limited income. These services are to allow a patient to remain at home in lieu of nursing home placement. Qualifying individuals are assigned a County case manager with the Department of Social Services, who oversee the care provided by approved agencies, such as SILVERcare.

Long-term Care Insurance – Most long-term care policies define the “trigger” for coverage to begin. Often it is a physician’s determination that the insured will need help with at least two activities of daily living. See “Our Services” for a listing of these. After a required waiting period for services, coverage will begin under the daily limits for the specific class of services covered by the policy. The plan of care, (prepared by our nurses), often defines the necessary levels and types of care needed. Reimbursement is usually obtained by submitting proof of the services being rendered. Our staff will be happy to review your policy for specific determinations.
Disability and Workman’s Compensation coverage – Injuries or disabilities resulting from coverage under these policies may enable reimbursement of some home care costs. Each case is treated independently and home care allowances may be limited. We will be happy to refer you to professionals who may assist in investigating any potential coverage.

Private Pay – Unfortunately, a great deal of home care, outside the Medicaid arena, is funded by the private funds of individuals and family members. Because of the severe limitations and restrictions of the government and private insurer sources, much of the in-home care is not covered. As a result, creative planning and efficient implementation of care options is essential. SILVERcare is committed to helping obtain the optimum care in the most cost-effective manner and maintains the flexibility and commitment to accomplish the desired end result.