Medical aids will cover medical care but are not likely to cover frail care costs

Immediate hospital care is often needed following surgery or a major medical incident such as a heart attack or a stroke. But at some point, the patient could be forced to leave the hospital.

The main reason is the cost. Charges can be staggeringly high – with the most expensive type of care being in an intensive care unit. This comes in at R13 000 to R15 000 per day. Even an extended stay in a general ward will amount to quite a bit.

“Depending on the type of medical aid plan in place, a medical aid will cover the bulk of the costs. But it will stop paying once doctors’ reports about the patient indicate that a lesser level of care is needed,” says Elize Porter, Managing Director of Unique Health, which offers a range of services in the health care industry.

So where do patients then go for assistance until they are fully recovered?

The patient’s family may have to take care of them at home or find an alternative way of providing care. Staying with family can be very comforting, but it may be impractical and place the family under pressure. If the family members work, they may need to take leave, and residential homes may need to be fitted with specialist care equipment like grab bars and bath seats.

“Step-down facilities may be the best solution in many cases,” says Arthur Case, Chief Executive Officer of the Evergreen Group, which develops lifestyle village accommodation for the retired community.

“A facility of this sort provides nursing services for people whose condition requires a lower level of care than a hospital provides. This type of care centre may be a stand-alone facility, linked to a hospital, or situated within a retirement home environment, such as at the new Evergreen Lifestyle Care Centre in Muizenberg, Cape Town.”

It’s got the backing of Porter, who emphasises the cost factor with this type of facility. “Whereas hospital care at the most basic level starts at about R2 500 per day, the costs of step-down care are a lot less, generally in the region of about R1 000 or less per day. In many instances, a patient’s medical aid will pay for a stipulated number of days in this kind of care facility because the cost is so much lower than full hospital care.

“During one’s stay in such a facility, the patient will be provided with medical practitioners needed for the particular condition. But once the particular goal of the care has been achieved, the medical aid will withdraw the funding since it will have met its obligation in terms of providing medical care.”

There is another option, though. “Because of the affordability of this type of care, we sometimes see patients choosing to extend their stay beyond what their medical aid will cover and paying for the additional days themselves,” says Case, referring to one patient’s experience at the step-down facility in Evergreen’s Muizenberg village.

It’s also important to make a distinction between medical care, such as that offered in a step-down facility, and frail care.

According to Porter, “Medical aids will cover medical care but are not likely to cover frail care costs. Sometimes a person is given medical care after the occurrence of a particular health issue, but if it becomes clear that the individual’s health has deteriorated permanently as a result of the medical problem and that the person will no longer be able to look after him- or herself, then this becomes a situation in which frail care or assisted living is needed. Medical aids do not cover these type of costs.”

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Source: Care options following a hospital stay

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