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Caregiver Wants To Know About Home Based Medicare
Jan L. Warner & Jan Collins

Question: I am a caregiver for my 84-year-old father, who has lived in my home since my mother died four years ago. All of his resources were spent paying for her care, and he now receives Social Security and a small pension totaling a little over $1,600 monthly. To further complicate matters, I was recently laid off from my information technology job after 27 years and canít help thinking that, in addition to my age, the layoff was caused, in part, by the additional time I have had to spend with my father, whose Parkinsonís Disease has required more and more attention.

Although Iím now unemployed, I am the sole support for myself, and the major contributor toward the support of my father and grown daughter who moved back home late last year. I have been looking for work and simultaneously wondering if there is any financial help available out there for someone in my situation as a caregiver through Medicare or Medicaid?

Answer: As a member of the estimated one in four households in the United States where care is provided for a loved one age 50 or older, you are not alone. According to the U.S. Department of Health and Human Services, informal caregiving is the backbone of our nationís long-term care system with as many as 52 million Americans Ė thatís 31 percent of the adult population Ė acting as informal caregivers. As indispensable as informal caregiving might be, however, folks like you donít receive paychecks from anyone, are subject to burnout from the stress of a most difficult job, and benefits are as scarce as henís teeth.

A 1999 study by Metlife, the National Alliance for Caregiving, and the National Center on Women and Aging found that informal caregivers (who are usually female) may not realize as much as $2,100 annually in eventual Social Security benefits as a result of caregiving instead of working. Considering that the average monthly Social Security benefit in 1999 was $804 for retired workers, and considering that informal caregivers are estimated to lose an average of $550,000 in total wage wealth as a result of providing caregiving, there is an often unexpected economic impact for caregivers at retirement age.

While Medicare covers some very limited home-care benefits for those meeting the eligibility criteria, Medicare does not reimburse family members for providing in-home care. To receive Medicare home health care, your father must meet four prerequisites: 1) a doctor must determine he needs medical care at home and must create a plan for home care. 2) Your father must need intermittent (and not full time) skilled nursing care or physical, speech, or occupational therapy; 3) Your Dad must be generally unable to leave home; and 4) the home health agency must be approved by Medicare.

Depending on where you live, the criteria in your state, and the programs available in the wake of severe budget cuts by state and federal governments, your father may be eligible for some Medicaid services if he meets the level of care and financial requirements. You should contact your local Medicaid office or an elder law attorney NAELA in your area to help you make this determination.

If your father doesnít qualify for Medicaid, a number of states have programs that help seniors pay for prescription drugs. And Medicare legislation passed by the Congress earlier this year -- while controversial and confusing -- contains prescription drug benefits for seniors that might help with your fatherís pharmaceutical costs.

To help you negotiate the bureaucratic maze, we suggest that you call your local Area Agency on Aging and ask for the name of the advocate in your area for The National Family Caregiver Support Program. Authorized by the Older Americans Act of 2000, this program provides a continuum of caregiver services that includes information, assistance, and other services such as counseling, training in caring for the sick elderly, and respite help.

This advocate should be able to answer your questions by phone or in person, and should be able to direct you to the services you need for your Dad. The advocate may also be able to help you craft a long-term care plan for your father in the event you canít continue to take care of him at home.

Another resource that might be helpful is the Eldercare Locater, a nationwide toll-free and Internet-accessible service to help older adults and their caregivers connect to local services. (1-800-677-1116)

Bottom Line: There are no programs we know about that will provide caregivers like you with lost income. Unless you have a good retirement plan or received a decent severance package when you were laid off, youíll probably have to go back to work Ė at least part-time to try to make ends meet.

Taking the NextStep: Because of the increased number of seniors needing care and because of increasing budget cuts by nearsighted and uninformed state and federal governments, informal caregiving will become more important and more costly in terms of human capital than ever before. While there are numerous Websites aimed at caregivers, we believe two of the best are caregiver.org the site of the Family Caregiver Alliance, and nfcacares.org, the site of the National Family Caregivers Association.



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