Of the three leading diseases that kill most Americans, two are well known for being financial nightmares: heart disease and cancer. The cost of drugs, multiple surgeries and hospitalization are widely recognized as presenting huge financial challenges to families, even when there is health insurance. But less known is the high cost of dementia. A study examined Medicare patients with cancer, heart disease and dementia and found that the average total cost of care for a dementia patient over the course of five years was$287,038. The average Medicare cost of care for a heart disease patient was $175,136. For a cancer patient, the average Medicare cost was $175,136. And while Medicare paid almost the same amount for each of these three diseases – around $100,000 – dementia patients had far and away more expenses that were not covered. The average out-of-pocket cost for a dementia patient: $61,522.The dementia patient needs human caregivers to assist them with basic activities of life and supervision, costs that are not covered by Medicare. The out of pocket cost for a dementia patient is more than 80% more than the cost for a patient with heart disease or cancer.
The high cost of caring for a dementia patient will, in many cases, consume a family's entire household wealth, according to a recent article in The New York Times, "Costs for Dementia Care Far Exceeding Other Diseases, Study Finds."
Most families just aren't prepared for the financial burden of dementia. They assume that Medicare cover all of the expenses. Not so. Patients and their families don't realize that isn't the case. Plus, everything gets more complicated when an individual has dementia.
For example, if a dementia patient in a nursing home gets a fever, the staff may say that they aren't equipped to handle it. They call 911. The patient is then admitted to the hospital. This can lead to complications for the patient suffering from dementia. They may get delirious and confused, slip or fall out of bed and sustain injuries, or they choke on their food. This can cause medical costs to sky-rocket.
There are large disparities in out-of-pocket costs for the three diseases. Medicare covers discrete medical services like office visits and acute care, including hospitalization and surgery. These are the types of expenses experienced by cancer patients and heart patients. Those patients usually don't need full-time home or nursing home care until the very end of their life, if at all. As a result, they don't see that continuing cost. On the other hand, dementia patients need constant care for years. In addition, these dementia patients may not be sick enough for a nursing home, but they still will need supervision and care.
When dementia patients are sick enough for a nursing home, the cost is not covered by health insurance. More than half of patients with dementia— with three-quarters of those from racial minorities—spend down, using savings to pay for the nursing home until the money is all gone. After that, Medicaid takes over.
Talk with an experienced elder law attorney about care for the elderly, Medicaid, and dementia. He or she will have ideas on how to best address your family's situation.
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Reference: The New York Times (October 26, 2015) "Costs for Dementia Care Far Exceeding Other Diseases, Study Finds"