Care Options for Alzheimer’s Patients

The Alzheimer's Handbook for Caregivers

Planning Ahead

If you are a caregiver, you will be involved in helping to plan for the future legal, financial, and care needs of your loved one with Alzheimer’s. Legal and financial planning should begin soon after a diagnosis has been made. The earlier you explore care alternatives, the more likely you are to find options that you and your loved one prefer.

Planning for the Future

After a diagnosis of Alzheimer’s, you may worry about the impact the disease will have on you and your family. Planning ahead is one way to deal with those fears. By participating in decisions now, you can determine the kind of life you want for the years ahead. In this section, you will find information and tips to help you begin planning.

Choosing Health Care Providers and Facilities

You may be able to live independently and safely for some time on your own or with the help of a family member or hired caregiver. As Alzheimer’s advances, there may come a time when your day-to-day care will require the skills of a full-time health care staff.

To make sure that your needs and preferences for care are understood, talk about the options available to you with a family member or trusted friend. The sooner you do this, the more likely you are to find those options with services you prefer.

Care services tend to fall into three categories: respite care, residential care, and hospice care. The cost for each type of care differs by service and community. Financial assistance may be available through state or federal programs (e.g., Medicaid or the Veterans Administration).

Selecting a Care Provider
There are important questions to ask when deciding on care providers.
Questions to ask in-home caregivers:

  • What is your training and experience in working with people with dementia?
  • What times are you available?
  • Who would substitute if you can’t come?
  • Whom can I talk to at the agency if I have a concern?

Concerns When Choosing a Residential Care Facility

  • Observe how the environment promotes independence of the residents, provides safety and security, and reflects your own preferences for comfort.
  • Ask the care provider if the staff is continually trained on dementia care issues, what kind of programs are offered for people with Alzheimer’s, and how they address an increasing need for care.
  • Ask the provider if residents and family members can participate in creating and reviewing care and service plans.
  • Spend time in a variety of facilities observing what goes on and how people are treated. Talk with residents and visitors about their opinions of the facility and staff. See if the residents look happy, comfortable, relaxed, and involved in activities.
  • Talk with staff working directly with residents to see if they are competent and content in their jobs. Also, meet with the administrator and directors of nursing and social services.
  • Visit a facility more than once before making a decision.

Respite Care

Respite care provides your caregiver temporary relief from tasks associated with caregiving. You benefit from opportunities to socialize with others and live in the community longer. Respite care is mainly offered through community organizations or residential facilities. The most common respite care programs are in-home care and adult day services.

In-home services offer a range of options, including companion services, personal care, household assistance, and skilled care services to meet specific needs. In-home helpers can be employed privately, through an agency, or as part of a government program.

Adult day services provide you with opportunities to interact with others, usually in a community center or facility. Staff lead various activities such as music programs and support groups. Transportation and meals are often provided.

caretaker giving senior tea

Residential Care Facilities for Alzheimer’s Patients

The following are types of facilities that may meet your needs, depending on the level of care you require:

  • Retirement housing generally provides each resident with an apartment or room that includes cooking facilities. This type of housing usually does not have round-the-clock staff on-site. Staff members may have little or no knowledge about dementia. This setting may be appropriate for persons in the early stage of Alzheimer’s who can still care for themselves independently and live alone safely.
  • Assisted living facilities (or board and care homes) bridge the gap between living independently and living in a nursing home. Facilities typically offer a combination of: housing and meals; supportive, personalized assistance; and health care services.
  • Skilled nursing facilities (also known as nursing homes) may be the best choice when a person needs round-the-clock care or ongoing medical treatment. Most nursing homes have services and staff to address issues such as nutrition, care planning, recreation, spirituality and medical care. Many facilities have special care units designed to meet the unique needs of people with dementia.
  • Continuing care retirement communities (CCRC) provide all of the different types of options described above. In these facilities, a person may receive all of the different levels of care on one campus but may need to be moved between buildings to receive different services.

Hospice Care

Hospice programs provide care to persons in the late stages of Alzheimer’s disease. Hospice emphasizes a philosophy of comfort and care at the end of life without using drastic lifesaving measures. This service is available through local hospice organizations and some home care agencies, hospitals and nursing homes.

Insurance Coverage for Alzheimer’s Care

Our national patchwork of insurance programs presents special challenges in reimbursement for dementia care. The Alzheimer’s Association advocates before legislative bodies and in other public forums on the need for more equitable coverage and reimbursement of professional care for Alzheimer’s disease and related disorders. This section contains a brief overview of Medicare and Medicaid, the two publicly funded programs with significant applicability to dementia care.
Other forms of insurance are available to be purchased privately which will provide varying levels of coverage to patients with long term care needs. Some group health insurance policies may include a home health care benefit. Insurance companies have also developed long term care products specifically providing coverage for individuals with these types of needs.

Does Medicare Cover Alzheimer’s Care?

In collaboration with the American Bar Association’s Commission on Legal Problems of the Elderly, the Alzheimer’s Association has initiated a Medicare Advocacy Project to gather information and identify problems encountered by beneficiaries and providers. The project’s director, attorney Leslie Fried, works closely with Alzheimer’s Association public policy staff on the identification of Medicare trends, problems and patterns of recurring issues, and assists with the development of appropriate federal policy positions related to Medicare and health care delivery.

Do Alzheimer’s Care Facilities Accept Medicaid?

Because Medicaid is a federal/state collaboration typically administered by each state’s welfare agency, eligibility and benefits vary from state to state. Medicaid covers all or a portion of nursing home costs for individuals with Alzheimer’s who meet income and asset eligibility guidelines.

Long Term Care Insurance

Insurance companies have designed products that provide benefits to individuals with long term care needs. These types of policies been available for private purchase by individuals since the mid 1980s. Known as Long term Care Insurance, the policies vary substantially in benefit levels but most generally provide a benefit stated in dollars per day. The policies may also include annual and/or lifetime caps on utilization. As you might expect, the cost for the policy is proportional to the level of coverage benefit purchased.

Health Insurance Policies

Individual health insurance policies may provide a benefit for home health care services. The Explanation of Benefits section of the policy will provide information as to whether this coverage is available to the insured policyholder. If offered, the level of this coverage may vary greatly and include exclusions and caps on utilization. Therefore, it is always best to verify the coverage particulars directly with a company representative.

Coding and reimbursement for Alzheimer care: The most appropriate code for diagnosis and management of Alzheimer’s disease is 331, which is reimbursed at the usual Medicare rate of 80 percent. Alzheimer’s can also be billed under diagnostic code 290 (pre-senile dementia), an older category that falls under the mental health classification. Because Medicare, like many private health insurance plans, reimburses mental health care at 50 percent, bills submitted under the 290 code are reimbursed at the lower rate. The 331 code should be used to ensure appropriate reimbursement.

Physical, occupational, and speech therapies: In one of its first significant victories, the Medicare Advocacy Project won reversal of a long-standing policy that automatically denied reimbursement for rehabilitative services for beneficiaries who had been diagnosed with dementia. In the fall of 2001, Medicare issued a program memorandum prohibiting denial of these services based exclusively on a dementia diagnosis. The reversal hinged on the recognition that health care professionals now can often diagnose dementia in its earliest stages, when some individuals can derive significant benefit from rehabilitative services. Payment for medical services and procedures will now be determined on a case-by-case evaluation of an individual’s needs and capabilities rather than solely on a dementia diagnosis.

Psychiatric and mental health services: Medicare often denies mental health claims for beneficiaries with a primary or secondary diagnosis of dementia. These claims should not automatically be rejected, but should be evaluated and reimbursed on a case-by-case basis. Individuals with Alzheimer’s may develop treatable mental illnesses such as depression that should be covered by Medicare. Medicare pays mental health claims at 50 percent rather than the 80 percent rate for other conditions, so allowable mental health services will be reimbursed at 50 percent.

Home health care: Only Medicare beneficiaries who are “homebound” are eligible for Medicare home health care benefits. Medicare’s definition of “homebound” has always been extremely strict, stipulating that leaving the home must involve “considerable and taxing effort.” As of December 2000, the application of the definition was broadened to permit some individuals who attend adult day care to qualify as homebound if their day care program meets certain guidelines.
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