Sources for Respite Care Coverage

Respite care is most often paid for out of pocket, though there are some plans, programs, and services that offset or cover the cost.

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Respite Reimbursement

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Some plans, programs, and services completely cover the cost of respite care, and those that do not may at least offset some of the cost.

There are many organizations out there interested in helping caregivers with respite among other things, though they do not advertise it, so it takes seeking them out and having conversations with them.

Original Medicare

Medicare only covers respite care for caregivers of hospice beneficiaries, under the Part A hospice benefit. You can apply for up to 5 days of respite care. At this time, your loved one will be temporarily placed in a Medicare-certified inpatient facility, which is often a nursing home, but hospice providers have arrangements with many 24-hour long-term care facilities that can also provide respite care. Some hospices provide their own inpatient hospice units for occasional respite care. Medicare does not cover respite care in the home.

It's important to understand that the respite care portion of the hospice benefit is not available to any caregiver at any time. Qualifications apply and justification for the relief must be documented. In other words, the caregiver must demonstrate a need for respite care. Likewise, respite care depends on an area Medicare-certified facility having the room available to accommodate your loved one.

Initiating a respite care request requires documentation from a medical provider and then contacting Medicare or the area Medicare Administrative Contractor (MAC) for availability and arrangements. *Your loved one's hospice service may be able to help you navigate a respite care request.

Medicare Advantage (MA)

As of 2019, Medicare Advantage (MA) plans (Part C) can include respite care in their plan designs. The difference in the coverage is that respite is not necessarily limited to hospice, as it is with Original Medicare. Some MA plans will include respite care in the form of adult day care, in-home respite care, as well as short-term respite care in an approved facility.

Note that not every MA plan will have these benefits. Additionally, these benefits must be part of an overall care plan recommended by a medical provider. Each plan will allot a certain dollar amount or number of hours of respite care that will be covered each year.

Initiating a respite care request requires documentation from a medical provider and then contacting the MA plan for availability and arrangements.

Medicaid

Respite care is not a standard benefit with Medicaid. It is covered by Medicaid programs such as waivers or state plans.

*These states have adopted Section 1915(i) - Medicaid State Plan Option for Home and Community-Based Services.

U.S. Department of Veterans Affairs (VA)

Eligible veterans can receive non-institutional respite, outpatient geriatric evaluation and management services, and therapeutically-oriented outpatient daycare. Respite care may be provided in a home or other non-institutional setting, such as a community nursing home. Ordinarily, respite is limited to no more than 30 days per year. The services can be contracted or provided directly by the staff of the Veterans Health Administration (VHA) or by another provider or payor. Contact your loved one's VA liaison to explore your options.

National Family Caregiver Support Program

If you are caring for someone over the age of 60 or someone with Alzheimer's or other dementias, funding may be available through the National Family Caregiver Support Program administered through your local Area Agency on Aging (AAA). Contact your AAA about respite funding options. Find your local AAA by visiting Eldercare.gov or calling (800)-677-1116.

State family caregiver support or respite programs

These are not available in every state. If your state has a state-funded family caregiver support or respite program, you may have respite funding available. Click here for more information about a range of caregiving supports by state.

Lifespan Respite Care Programs

These are not available in every state, but the ones that do often provide respite vouchers, grants, or stipend programs to help families pay for respite through self-directed programs*, especially for those caregivers who do not qualify for other publicly funded programs. See if your state has a Respite Voucher Program and apply.

*Remember that self-directed programs are Medicaid-managed.

Lifespan Respite Care may also advocate for volunteer or faith-based respite services that offer free or low-cost respite care. State Lifespan Respite Care programs may also work in collaboration with a State Respite Coalition. Contact your State Lifespan Respite Care Program or State Respite Coalition for more information.

Private funding sources and faith-based organizations

Check out these sources to get an idea of the programs available. This is not an exhaustive list and you are likely to find more by conducting your own search:

Many faith-based organizations provide a range of home and community-based services, including respite, for disabled people, older adults, and their family caregivers, at no or low cost. Check with your local faith organizations, starting with your loved one's organization (if they are - or were - a member of one).

Average costs

Average costs of different types of respite care according to the 2021 Aging & You Genworth survey:

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RESOURCES

Administration for Community Living (ACL)

Applied Self-Direction

ARCH National Respite Network

Family Caregiver Alliance (FCA)

HelpGuide.org

KFF.org

Medicare.gov - Medicare Hospice Benefits

National Hospice and Palliative Care Organization (NHPCO). (2021, July). Compliance tools and resources: Respite tip sheet. Link

National Institute on Aging

National PACE Association (NPA)

No content in this app, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician.

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