Who Pays for Respite Care in a Nursing Home?

Respite care in a nursing home offers temporary institutional care, providing a planned break for primary caregivers. These short-term stays allow caregivers to rest or address personal needs, knowing their loved one is supervised. Respite aims to prevent caregiver burnout and support family care, typically lasting a few days to several weeks.

Private Funding Sources

Individuals often pay for nursing home respite care directly. Daily costs range from $150 to $400, varying by facility, location, care level, and amenities. Out-of-pocket payments offer flexibility, as they are not subject to external eligibility or coverage limits.

Long-term care insurance policies may cover respite care, depending on the specific terms. Policyholders should review their documents for inclusion, waiting periods, and daily benefit limits. Contact the insurance provider directly to confirm coverage and claim processes.

Standard private health insurance plans typically do not cover non-medical respite care for caregiver relief. However, some plans may cover a short-term skilled nursing facility (SNF) stay if medically necessary for skilled nursing or rehabilitation. This requires a doctor’s order and medical necessity criteria. Verify coverage with your provider.

Medicare Coverage for Respite Care

Medicare, for those 65 and older or with certain disabilities, offers very limited coverage for skilled nursing facility (SNF) respite care. General respite care for caregiver relief is not covered by Medicare Part A or Part B.

Medicare Part A covers SNF stays only after a qualifying inpatient hospital stay of at least three days. Admission to a Medicare-certified SNF must occur within 30 days for a condition treated during the hospital stay. A physician must order daily skilled nursing or therapy services for coverage.

The Medicare Hospice Benefit is an exception for respite coverage. If terminally ill and electing hospice, Medicare covers short-term inpatient respite for the primary caregiver. This must be in a Medicare-approved facility, like a nursing home, and is typically limited to five consecutive days. Confirm eligibility with the nursing home and hospice agency before admission.

Medicaid Coverage for Respite Care

Medicaid, a joint federal and state program, funds respite care for low-income individuals and families. Eligibility depends on strict income and asset limits, which vary by state. Generally, income must be below a percentage of the federal poverty level, and countable assets must not exceed a threshold, typically around $2,000.

Many states offer Home and Community-Based Services (HCBS) waiver programs under Medicaid, covering respite care, sometimes in nursing homes. These waivers help individuals remain in their homes or communities who would otherwise need institutional care. However, waivers often have specific eligibility criteria, including functional limitations, and frequently have lengthy waitlists due to limited funding.

To explore Medicaid coverage, contact your state’s Medicaid agency or local Area Agency on Aging (AAA). These agencies provide detailed information on eligibility, waiver programs, and the application process. Applying for Medicaid or waiver programs involves submitting a comprehensive application with financial and medical records. Many nursing homes have financial offices or social workers who can assist with the application process.

Veterans Affairs Benefits

The U.S. Department of Veterans Affairs (VA) offers programs to help eligible veterans with nursing home respite care costs. VA benefits generally require specific service requirements, like minimum active duty and an honorable discharge. These benefits support veterans needing assistance with daily living or medical care.

The Aid and Attendance pension is a VA benefit that helps cover long-term care costs, including nursing home respite, for eligible veterans or surviving spouses. Qualification requires specific medical criteria, such as needing aid for daily activities, and satisfying income and asset limits. This pension supplements income for veterans needing consistent personal care.

The VA also operates its own network of Community Living Centers, which are VA-run nursing homes, where eligible veterans may receive temporary stays. In situations where VA facilities are unavailable, the VA may utilize “purchased care” arrangements, contracting with community nursing homes to provide care, including respite services, for eligible veterans.

Veterans and their families should contact the VA directly, a Veterans Service Officer (VSO), or an accredited representative. They can explain eligibility and the application process, which involves submitting service, medical, and financial information.

State and Community Assistance Programs

Beyond federal programs, state and local initiatives and non-profit organizations may offer financial assistance for nursing home respite care. Some states or local governments provide non-Medicaid programs or grants to help caregivers with respite costs. Program availability and structure vary by geographic area, often targeting specific populations or needs.

Many non-profit organizations and disease-specific foundations support respite care. For example, groups focused on Alzheimer’s or Parkinson’s often offer grants or financial aid for temporary care. Local charities and community groups may also have limited funds or programs, though these resources are often localized with specific eligibility requirements.

Area Agencies on Aging (AAAs) are local resources for aging services, including respite care. They can guide individuals to state-specific programs, local grants, and community resources. To explore these options, contact your local AAA, state department of aging services, or relevant disease-specific foundations. Funding is often limited, and criteria are precise.