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In my years working in Hospital Administration, I routinely had staff telling me about patients or families caught in a medical crisis caused by a fall or major surgery or simple aging. They were “surprised” to find that when they were told they could no longer live safely in their home, that Medicare was not going to pay for their needed long term care living arrangements.
I’m assuming that this information will not be a surprise to Humble Dollar readers. But I found this post on Linked In from a Senior Care Educator and Advocate named Katie Monahan Brooks, CDP, DCS. I don’t know her and I don’t know the Humble Dollar policy about reposting what she posted on Linked In. But she has expressed this more clearly and bluntly than I could have. And, it is apparent from her writing that she wants this message broadcast far and wide. My hope is that Humble Dollar readers can be part of this education process. Here is what Ms. Brooks wrote, unedited by me:
“I’m done pretending this confusion is acceptable.
If I have to explain one more time that Medicare does NOT pay for senior living, I might actually lose what’s left of my sanity.
Let’s be painfully clear:
And yet—every. single. week.—I sit across from families who are shocked. Angry. Betrayed.
And that’s exactly the problem.
This isn’t just a misunderstanding.
This is a massive, nationwide education failure that leaves families blindsided in the middle of a crisis—when emotions, guilt, fear, and urgency are already exploding.
People work their whole lives believing:
And then reality hits them like a brick wall when Mom falls. When Dad declines. When safety disappears overnight.
And I’m the one who has to say: “No… Medicare doesn’t pay for that.”
Over. And over. And over again.
And yes—I’m angry about it. Not at families. Not at seniors.
I’m angry that we failed to educate an entire generation before they needed the information.
We advertise to people how to pick a Medicare Advantage plan… But not how they’ll actually pay for care when they can no longer live safely alone.
That’s unacceptable.
So, here’s my challenge to every professional in healthcare, aging services, finance, and insurance:
If this post made you uncomfortable—good. That means it’s overdue.
And if you or someone you love is starting to ask: “What happens when home is no longer safe?” That’s a conversation I’m always willing to have—before crisis hits.”
This is Howard again: If you are on Linked In, you can find Ms. Brooks’ post and repost it yourself. And, please be creative in finding other ways to broadcast this message. It’s important.
You can copy these into your browser and get some valuable information.
I can also email you a point paper I have created called:
Medicare (Doesn’t Equal) Long-Term Care (One-Page Family Guide). Just email me at racelens@gmail.com and all the links will be in the pdf file I’ll send you.
• Medicare: Long-term care coverage (what’s not covered)
• Medicare: Skilled nursing facility care (SNF) overview
• Medicare: Home health services (what Medicare doesn’t pay for)
• Medicaid: Long-Term Services & Supports (LTSS) overview
• Medicaid: Home & Community-Based Services (HCBS)
• PACE overview (Medicare/Medicaid program in some areas)
• VA: Aid & Attendance / Housebound (adds to VA pension if eligible)
• Eldercare Locator (find your local Area Agency on Aging)
Prepared
People looking into CCRCs need to be aware that while Medicare and Medicaid will never pay for Assisted Living (although a Long Term Care insurance plan may), they will only pay for Skilled Nursing if the facility is both certified and will accept payment. My CCRC takes both Medicare and Medicaid, but that doesn’t seem to always be the case.
Howard, I agree with you, but I believe we as consumers of health care services have a responsibility to learn what services will be available to us and those we will have to pay for. It is a two way responsibility.
Interesting, is this situation a lack of education or can we accept some fault for not listening. We live in a very busy and noisy world.
Thanks for this, Howard. Part of the problem is the confusion between Medicare, for the elderly and disabled, vs. Medicaid, for the poor. Some savvy people manage to deplete their own assets or those of a loved one so that the elderly person qualifies for Medicaid. Former NYS Governor Pataki was disparaged because his mother was found to be living on the taxpayer’s Medicaid dollars in a Skilled Nursing Facility. Legal, but unethical imho.
People in crisis need support, and I wonder how often families are told about PACE (Program of All-inclusive Care for the Elderly)? All Senior Care Educators should know! It is a combined Federal and State program to provide qualified frail seniors with comprehensive medical and social services to maintain community living. Comprehensive services include coordination of care from primary care, dental care, hearing aids, vision care to specialist care, drug coverage and med administration, home care, transportation to appointments, home safety survey, drug and even meal delivery, occupational and physical therapy as needed, social work assistance, family respite care, and hospice care at the end. Medicare and Medicaid pay the whole cost at a capitation rate to the PACE organizations. PACE organization takes over ALL obligations of Medicare and Medicaid. It often covers long-term custodial nursing home care. (Medicaid is not a requirement, but pro-rated share costs apply).
I believe this “lack of education” must somehow be related to why we now have “contents are hot” and other similar warnings. When did common sense and/or the ability to read go away? C’mon, Medicare and You isn’t that difficult to read and understand!
Well said. Thanks for sharing Howard.