By Laura Herman, Dementia and Eldercare Professional
Hospice services include just about everything a person needs to handle the last chapter of their life with comfort and dignity. Medicare covers hospice services for those with a life expectancy of six months or less who have chosen to stop trying to cure their illness, instead choosing to focus on comfort and quality of life.
But does Medicare cover caregiving? There’s a lot of confusion about this topic. Let’s clear it up. We’ve compiled some of the most frequently asked questions about Medicare and hospice. Here are the answers.
1. Does Medicare Pay for a Family Caregiver?
Sadly, Medicare will not pay a family member to care for their loved one, even if they’re on hospice.
2. What Qualifications or Specific Certifications Are Required of a Caregiver? Who Qualifies as a Caregiver Under Medicare Rules?
Medicare will only pay for home care provided by qualified and certified Home Health Aides or Home Hospice Aides who work for Medicare-approved home health agencies or hospice programs.
Home hospice aides (HHAs) are certified nursing assistants who have received special training in caring for patients and have been certified by their state board of nursing. HHAs also receive additional training in matters of grief, death, and dying. Many hospice agencies require aides to have experience with direct patient care before they’re hired.
3. Does Medicare Pay for In-home Care? How Do I Get Medicare Home Care for Elderly Hospice Patients?
More often than not, Medicare won’t pay for in-home care. However, Medicare will pay for home care for hospice patients (regardless of their age) – provided by certified and trained Home Hospice Aides – if they need it. The hospice team will determine how much and what kind of care is needed based on their observations and input from you.
These aides can assist with personal care – such as bathing, dressing, and grooming – as long as it’s been written in your care plan by your hospice nurse. Hospice aides can also help keep areas of the home you use clean, comfortable, safe, and sanitary by assisting with light housekeeping tasks.
Home hospice aides typically visit one to three days per week. In many cases, the same HHA comes from week to week, which can contribute to a special, trusting relationship between the aide, you, and your caregivers or family members.
Ask your hospice team about Home Hospice Aide assistance.
4. What Caregiving Tasks Are Not Covered by Medicare?
Medicare will generally cover all caregiving tasks that are considered necessary by the hospice team.
Home Hospice Aides are not nurses, so they can’t handle nursing-level care like wound care or catheter insertion. Home Hospice Aides must follow the care plan written by your hospice nurse.
5. What Other Programs Are Available to Support Caregivers Outside of Medicare?
If you don’t have Medicare, fret not, as there’s still plenty of opportunity for support and assistance. Not only is hospice covered by Medicare, but it’s also covered by most private health insurance, as well as Medicaid in many states. If you are curious, you can refer to your policy or contact your insurance agent with questions.
Many hospice providers have charity programs available to help cover costs for patients who do not have private insurance or Medicare but are eligible for hospice care.
Learn more about different ways to pay for hospice care.
Additionally, hospice volunteers may be available through your hospice provider to support you in various ways. For example, they could provide:
- Social visits
- Pet therapy
- Help with writing letters
- Respite care
- Help with shopping
- Pet care
- Light housekeeping
- Home maintenance
Some volunteers even bring special skills or interests, such as haircutting services, aromatherapy, music, or massage.
Contact your hospice team to find out what kind of volunteer support is currently available.
Family caregivers also have several options for finding all kinds of support and assistance outside of Medicare.
- Contact your local Area Agency on Aging
- Ask your employer which family leave or caregiver benefits they may offer
- Visit the Eldercare Locator’s Caregiver Corner
- Dial 2-1-1 to locate help and resources near you
- Talk to your hospice team about your needs
6. How Much Does Medicare Cover?
Medicare pays for a wide array of services – essentially everything you’ll need to manage your terminal illness, its symptoms, and any pain or discomfort as you near the end of life. Medicare pays for most of these benefits completely, but in some cases, there may be a very small co-payment required.
Hospice benefits include
- Doctor and nursing care, with doctors and nurses on-call 24 hours per day, 7 days per week
- Hospice aide for bathing, hands-on care or homemaker services
- Medical equipment and supplies
- Medications for comfort or symptom control
- Social work services, and more
7. What are the Levels of Hospice Care?
There are four levels of care that hospice agencies provide. Your hospice agency will adjust your level of care based on your particular needs.
Routine Home Care - Members of the hospice team visit you at home (or in a facility, if that’s where you live).
Continuous Home Care - In a crisis, your hospice team can stay with you for eight or more hours a day. The majority of these hours are provided by a nurse – not an aide – to address severe pain, nausea, breathing problems, or anxiety. Continuous home care may also be able to help in emergency situations in which your usual caregiver or family support system is suddenly unavailable. It’s not available for routine or ongoing care.
General Inpatient Care - If your symptoms are too severe to handle at home, you may need round-the-clock care in a skilled nursing home, hospital, or freestanding hospice facility.
Inpatient Respite Care - If your family member or primary caregiver needs a break, respite care can cover a 5 five-day stay in a freestanding hospice facility.
Supporting a Hospice Family Caregiver
There is no doubt that Medicare is a boon when it comes to covering hospice. It covers almost anything a patient needs to manage their terminal condition. Ultimately, when Medicare covers hospice fully, patients can focus on living their best life during whatever time they have left.
Hospice benefits do include home caregivers to a very limited extent, but unfortunately, they won’t pay a family member to care for a loved one. They won’t cover caregiving over extended hours in your home. That said if you are a caregiver and in need of help, Medicare can pay for extended care in a freestanding hospice facility.
Resources exist for caregiver support, but they often vary by locale. Talk to your hospice team about your needs. They’re here to support you and your family through this tough time.
- “Hospice Care Coverage.” Medicare.gov, undated, www.medicare.gov/coverage/hospice-care.
- “Hospice.” CMS.gov, 14 March 2022, www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/Hospice.
- “How and Where Is Hospice Care Provided and How Is It Paid For?” American Cancer Society, 10 May 2019, www.cancer.org/treatment/end-of-life-care/hospice-care/who-provides-hospice-care.html.
- “How Hospice Works.” Medicare.gov, undated, www.medicare.gov/what-medicare-covers/what-part-a-covers/how-hospice-works.
- Morrow, Angela. “Levels of Hospice Care as Defined by Medicare.” Very Well Health, 03 October 2021, www.verywellhealth.com/levels-of-hospice-care-1132297.
- “Hospice Benefits.” Medicaid.gov, undated, www.medicaid.gov/medicaid/benefits/hospice-benefits/index.html.
- “Hospice.” Center for Medicare Advocacy, undated, medicareadvocacy.org/medicare-info/medicare-hospice-benefit/.
- Morrow, Angela. “The Duties of a Hospice Home Health Aide.” Very Well Health, 25 February 2020, www.verywellhealth.com/the-home-health-aide-1132610.
- “Become a Volunteer.” Hospice Foundation of America, undated, hospicefoundation.org/Volunteer.
- “Paying for Hospice Care.” Hospice Foundation of America, undated, hospicefoundation.org/Hospice-Care/Paying-for-Care.