Before understanding the basics of Medicare assisted living, let us first try to understand what is meant by assisted living. Assisted living facilities offer housing options for old and infirm people who are incapable of taking complete care of their own well being.
Assisted facilities are meant for people not sick enough to be in a hospital but incapable of living on their own. Assisted living services include many programs keeping in mind the requirements of the clients such as:
- Round the clock supervision
- Meals served in settings akin to a restaurant
- Personalized assistance for grooming, bathing, feeding and dressing
- Transportation facilities
- Laundry and housekeeping services
- Availability of medical emergency and therapeutic services
- Educational, social and cultural activities
- Security and on-call emergency services
- Various kinds of exercise and health care programs
Assisted living facilities are gaining in popularity with the elderly and they come in varying shapes and sizes. Some offer basic services while others offer a wide array of elaborate services and solutions. In most cases, one lives in one’s own home and pays for the services required.
Medicare assisted living, as the name implies is a health care policy that takes care of people living in assisted living facilities. The Medicare program covers home health care and the rules are the same for living at home or in an assisted living facility.
The Medicare program is meant for people who are 65 years or more and in some cases, the policy covers people with some specific disabilities. Medicare program pays for a beneficiary if he/she is considered “homebound”. The definition of a “homebound” beneficiary is based on the logic that unlike a person who is not “home bound”, he/she is not able to travel to a hospital for regular health care requirements. While determining whether a resident is “homebound” or not, the fact that he/she occasionally visits health care providers or goes on educational or cultural trips are not held against the resident.
Medicare assisted living offers the beneficiary with services such as speech therapy, physical therapy and skilled nursing care. Treatment of any wound and administering of an injection would qualify for re-imbursements; while helping a resident to dress or bath does not qualify for Medicare re-imbursements. Medicare re-imbursements can be claimed only when services involve recovery from critical or acute injury or illness.
Therapy services must qualify as “skilled” services in order to be considered for Medicare re-imbursements. The Medicare Home Health Benefit plan may also provide cover for essential medical supplies and medical equipments. Such cases involve provision for catheters and walkers. Medicare Assisted Living does not mean that day to day living expenses are covered by this program; however, the policy takes care of most medical eventualities and grave situations where the beneficiaries require skilled medical assistance.