Archive for May, 2015

Does Medicare Pay for Long Term Care?

May 26, 2015

Most people think it does.  Most people are wrong.  Medicare is the dominant provider of health insurance for Americans age 65 and better.  When coupled with a Medicare supplement policy or if a Medicare Advantage plan, it does a good job of paying for medical care, but does not pay for long term care (otherwise known as custodial care).  Please do not just take my word for it.  Here is what page 39 of the Medicare & You*, 2015 edition has to say: “Medicare doesn’t cover long-term care or custodial care.”

This may be a good time to restate the distinction between medical care and long term care.  Medical care is treatment by medical professionals that is intended to either help you become well again, or to keep you from becoming worse.  The key element is skilled care provided by medical professionals.

Long term care (sometimes called custodial care) is needed assistance with personal care activities like bathing, eating, dressing and toileting, or close supervision to prevent someone from harming themself or others.  Long term care services are provided by home heath aides, CNAs (Certified Nursing Assistants), homemaker/companion care aides, family members and friends.

Medicare does pay for some nursing home stays provided: 1. You have spent at least three consecutive days (overnights) in a Medicare-approved skilled nursing facility while in an “admitted” status.  Any days/overnights spent in “observation” status do not count, and 2. your nursing home stay must begin within 30 days from your discharge from a hospital, and 3. The care you receive in the nursing home must be related to the reason you were hospitalized, and 4. Your doctor must certify that you require daily skilled care or skilled rehabilitative care.

After successfully jumping through all the eligibility hoops, what is the Medicare nursing home (technically called a “skilled nursing facility”) actual benefit?

a. For the first 20 days in a nursing home, Medicare pays all costs other than personal items like televisions or phones.

b. For days 21-100, you (or your Medicare supplement policy) pay a 2015 deductible of $157.50 per day.  Medicare pays everything above the deductible.  The deductible is indexed for inflation.

c. For days beyond day 100, you pay for everything.  Medicare pays nothing.

There is a home care benefit provided by Medicare, but it is very limited.  Click on  Medicare & Home Health Care  to read about the many restrictions.

Do you still think Medicare pays for long term care?  Do you want to know what does pay for long term care?…please call me so we can discuss.

*Medicare & You is the official U.S. Government Medicare handbook, published annually by the Centers for Medicare & Medicaid Services


Disclaimer: This eNewsletter and all links to other sources should not be construed as tax or legal advice because they are neither. Raymond Smith, The Long Term Care Specialist, does not give legal or tax advice. Consult your attorney or tax advisor for these matters.


© Raymond Smith, The Long Term Care Specialist, 2015


What It’s Like to Have a Stroke

May 25, 2015

(My thanks to Liz Taylor at for her permission to use this article.)

On March 16, 2015, I awoke to a rather peculiar world.  I couldn’t put my finger on why.

After pouring a cup of coffee, I went into my study to answer email.  I read my messages all right, but typing my replies was a disaster.  I couldn’t find the right keys, and when I went to delete the countless mistakes, they came out like this: ///\\rwt, and then -00pp[I.  Hmmm, it was going to be one of “those” days.

I dressed and took my dog for a walk.  The world still seemed peculiar.  A guy on a bike passed and said “hi”.  I said “hi” back, but it came out as: “glmph.”  Oh!  That was strange!

I walked home and put together a bank deposit.  Weird.  My signature looked nothing like it normally did.  I even put an extra letter in my first name.  Repeatedly.

At 10 AM, I went to a meeting and announced, “I think I’ve had a stroke!”  I didn’t really believe I had, but my friends insisted I go to the doctor.  I phoned to say I was coming, but the number eluded me.  I tried 5 or 6 times.  Finally, I got it.  They told me to get in immediately — but not to drive.  I said OK, I’ll walk.  I was three blocks away.

Testing for a stroke…

A nurse gave me the “FAST” test — where you ask a person you suspect of having had a stroke to smile, lift their arms, stick out their tongue, and do a number of other simple exercises.  I passed with flying colors.

The doctor did many more such tests, telling me to push up with my hands, then push down, and so on to test where I was weak.  What time did the stroke occur?  I didn’t know; I’d been asleep.  He said it was too late by then (11 AM) for treatment if a clot caused it, since you have to treat it within three hours.  Understanding the cause is critical to treatment, he wanted me to go to the hospital for testing.  I was having a hard time speaking and finding words, in addition to my goofy typing and handwriting.  He said he thought I’d had a mild stroke in my Broca’s area, in the left hemisphere, which governs speech.  My friend, Ed, agreed to take me to Anacortes Hospital for a brain scan.  A ferry was leaving in an hour.

Types of Stroke:

There are roughly two kinds of strokes: clots and bleeds.  Clots are caused by debris getting loose in your arteries, then getting stuck, depriving your brain of oxygen.  Clots require medicine (tPA) within three hours of a stroke, which is why time is of the essence getting to a doctor.  Bleeds are caused by ruptures of blood vessels that flood your brain.

The brain scan took ten minutes; Ed and I were on the 3 PM ferry home.  The doctor called the next day confirming that my stroke was a bleed.  I started medications immediately.

Six weeks have passed.  Another trip to the hospital showed my carotid artery (which carries blood and oxygen to the brain) was partially obstructed.  It was in a fragile place but not bad enough to require surgery, thank goodness.  I’d been taking my blood pressure at home and found it was sky high (high BP is a major cause of strokes), but at the doctor’s it was normal, and it turns out my machine was broken.  My blood pressure is fine.  Whew.

My Stroke Recovery

My typing is getting better.  My handwriting is almost normal.  I still have trouble speaking, but I find I get better after I’ve “warmed up.”  And people are kind when I have trouble, though I’m trying not to call everything a “thingy.”

It’s been a fascinating experience, though not many people would use that term to describe having a stroke.  I can be casual about it, since it was so mild and non-life changing.  I’ve always wondered what it was like to have a stroke, and now I know.  I know how your mind can work but your body doesn’t.  I know how hard you can try to say something — and can’t.  I know how simple skills can go sideways, suddenly.  I know how important health insurance is.  I’m truly lucky to have such a mild stroke, a wake-up call to prevent another.

  • Strokes are the 5th leading cause of death and a leading cause of disability in the US.

  • Women are more likely to have a stroke than a man.

  • Blacks have more strokes than whites.

*If you’ve had one stroke, you’re more likely to have another.

  • Eighty percent of strokes are preventable.

A book I recommend is “My Stroke of Insight,” by Jill Bolte Taylor, Ph.D., a scientist at Harvard Medical School who specialized in brain research.  At age 37 she had a profoundly unusual and difficult stroke which required eight years of hard work to recover from.  But she did recover — and learned some amazing ways to make her brain become the person she prefers, rather than who she was before.