By Mark Harvey

Based on a lot of emails I’ve received from a lot of you, there are a lot of good questions floating around that are really the same questions, coming from different folks dealing with different situations. So let’s see if we can make a few things easier, beginning with:

Medicare: Medicare is health insurance. Yes, it has all of its various “Parts,” but it’s really no different than the health insurance a person may have had when they were employed: It covers medical stuff.

So, if Mom breaks a hip and goes into the hospital for surgery, Medicare covers most of that. (True, Mom may have a Medicare supplement plan that covers more of it, but Medicare is covering the lion’s share.)

Then, Mom goes into a nursing home for “rehab.” That’s still medical stuff, because Mom is “recovering” from the surgery, get it? So, Medicare covers up to 20 days in the facility. (True, under some circumstances, Medicare may cover some of more than that, but let’s leave that alone, for now.)

As long as Mom is discharged within that 20 days, and assuming that she spent the obligatory three nights admitted to the hospital, Medicare pays the freight; and that’s that for that.

But what if Mom was already headed down the dementia/Alzheimer’s path before she fell? Now, with the surgery and whatnot, everything has escalated, and it’s obvious that you just can’t care for her at home anymore, so she’s going to need to move into a facility permanently. Doesn’t Medicare cover that?

No! That brings us to…

Medicaid: Medicaid is health insurance, too. But assuming that Mom qualifies for Medicaid (in terms of need, income and assets), it will pay for long-term care. Medicare never pays for long-term care, so Mom might need to switch from Medicare coverage to Medicaid coverage (assuming she qualifies), even if she’s going to stay in the same facility.

So, what the heck is…

Long-term care: It just means that Mom (or whomever) is going to need a substantial amount of care from other people, for a very long time — often, permanently. Don’t make that too complicated.

Now, what if we have…

Long-term care insurance: Great! I’m glad you were able to afford it, and good for you! Hopefully, back when you realized that Mom was going to need long-term care after the Medicare-paid 20 days, you dug out that long-term care insurance policy and read it — then read it again and contacted the agent with questions, because one thing you probably saw is a “waiting period” that has to occur before the policy starts paying anything. (90 days? 180 days?) So, you had time to think about how this care was going to get paid for until the long-term care policy kicks in.

But, wait a minute: What if you’re going to be able to care for Mom at home after that discharge from the rehab facility? Well, hopefully, while Mom was in the facility (or even before the surgery), you talked to her physician about…

Home health: What the heck is “home health?” Think nurses, physical therapists, speech therapists, occupational therapists, etc. Home health can visit Mom at home, assuming that her getting to a medical clinic is “taxing and difficult,” and provide skilled medical services (nurses!) at home.

Yes, there might also be some other ancillary services that come along with it, like a “bath aide,” but they aren’t going to vacuum or do the dishes; think skilled medical services.

And who pays for this? Medicare — assuming that you’ve engaged (and the doctor ordered) a Medicare-certified home health agency.

Yes, there are licensed, completely legitimate home health agencies out there that are not Medicare-certified. Is it deceptive advertising? No! These are agencies that provide nurses, therapists, etc., to provide valuable in-home, skilled medical services to people who need/want it; they just aren’t going to be paid for by Medicare. They might be paid by other forms of insurance or privately, as in out-of-pocket.

Will they vacuum and do the dishes and whatever else? Well, I’m pretty sure the nurses and therapists won’t, but staff from another part of that same agency might, which forces me to realize that I’m not going to get as far with this today as I’d hoped. So cut this one out and stick it on the fridge with that cute doggie magnet, and we’ll pick it up here next week.

I agree: It is complicated. No, you aren’t stupid. And yes, it can be done.

Mark Harvey is the director of information and assistance for the Olympic Area Agency on Aging. He can be reached by email at harvemb@dshs.wa.gov; by phone at 360-532-0520 in Aberdeen, 360-942-2177 in Raymond, or 360-642-3634; or through Facebook at Olympic Area Agency on Aging-Information & Assistance.