Who pays for respite care? What you need to know

It can be both emotionally and financially challenging to see a loved one’s health decline with age. You’ll likely have to ask difficult questions like when might it be time for a move into a long-term care facility? Or perhaps you’ll need to hire home care. But in many cases, family caregivers step in.

Should you decide that your older loved one will age in place under the care of a loved one, whether for economic or emotional reasons, it’s unrealistic to assume that the family caregiver will always be able to provide the constant care that they need. That’s why planning for respite care is essential both for the senior as well as their primary caregiver. Also essential: Figuring out who pays for respite care and how much they cover.

What is respite care?

Respite care is short-term relief — or a respite — for family members taking care of a loved one. It’s a way of giving primary caregivers a break or allowing them to go away for a short period of time. Typically, this temporary coverage for a set amount of days, not a few hours, and is usually for one to four weeks. 

Care might be provided in-home by a professional caregiver from an agency or the loved one might go to an assisted living or memory care community — sometimes as a trial for a future admission, explains Glenn Lane, founder of Westchester Family Care in Mamaroneck, New York. You might also consider an adult day care. 

Whether provided at home or another location, respite care provides personal time and backup support for the senior’s primary caretaker. This is essential for their mental and emotional health as well as the well-being of the senior. “Caregivers need a break because caregiving is physically and emotionally demanding,” says Marguerita Cheng, a certified financial planner and chief executive officer of Blue Ocean Global Wealth in Gaithersburg, Maryland.   

How much does respite care cost?

According to the latest Genworth Cost of Care Survey, the national median hourly cost of homemaker services is $30 and a home health aide is $33. The national median daily rate for adult day health care is $95 and an assisted living facility $176. 

The most affordable option: Depending on an older adult’s needs, daily respite services outside the home, like a day program, are typically the most affordable option and tend to cost $10 to $20 per hour, notes Elle Billman, program coordinator of Colorado Respite Coalition.

The second most affordable option: In-home respite care might be the next most budget-friendly choice. Because it involves a trained professional coming to the senior’s location to provide one-on-one care, home care typically costs more at $20-35 per hour, says Billman.

The most expensive option: This would involve temporarily moving a senior into an overnight facility. Lane explains that although costs vary depending on the region where the care is provided or the facility is located, he estimates a short-term stay in an assisted living facility would be 10-20% more than the normal costs for a long-term resident in that region. This fee covers the room or apartment, housekeeping and meals in addition to assistance with activities of living and companionship for the agreed upon amount of time.

Who pays for respite care?

Whether your respite care has an hourly or daily rate, the costs are likely to add up quickly. That’s why many family caregivers and older adults turn to insurance for help. However, not all insurance even partially covers this type of care, let alone fully. 

Here’s what you need to know about each type of policy.

Health insurance. This type of insurance simply doesn’t cover respite care, explains Cheng.

Medicare. This federal government health insurance program provides medical benefits for qualifying individuals as well as those over 65. But according to Brad Baune, a wealth management advisor at Northwestern Mutual in Mendota Heights, Minnesota, Medicare generally only covers short-term overnight stays at a hospital or skilled nursing facility after a qualifying hospitalization up to five days. “Medicare can help if you qualify, but often you will not be able to choose your facility,” says Baune.

However, for respite care for a hospice patient, coverage is much more substantial. Medicare-certified hospice care, including medical, nursing, social, aide and homemaker services are all covered. For inpatient respite care, you may have to pay 5% of the Medicare-approved amount.

Medicaid. Although funded by the federal government, this is a state-run program for qualifying lower-income individuals so exact benefits are dependent upon where you live. Some states provide some respite care assistance under Medicaid’s Home & Community-Based Care Services waiver program.

Long-term care insurance. Depending on the existing plan, LTC insurance will provide coverage for custodial care in a nursing home, home health care or adult daycare, explains Price.

Veterans benefits. For qualifying veterans and survivors who are housebound or need help with daily activities, monthly respite care assistance is offered through the VA Aid and Attendance benefit. Additional respite care support may be available depending on where you live, including nursing home respite care for up to 30 days per year. 

Other helpful respite care resources

Cheng recommends the following for those looking for additional respite care assistance:

• The ARCH National Respite Locator Service for help finding local services in your community.
• The Well Spouse Association provides support for loved ones of chronically ill or disabled people along with information on local support groups.

Despite the cost of respite care, Cheng hopes that primary caregivers realize that this temporary respite from caregiving can be priceless. “Caregivers experience emotional, mental, physical and financial stress — plus, they can also feel overwhelmed and isolated,” she says. “Don’t be afraid or feel guilty about asking for help.”