Paying for In-Home Care Services
As families make complex decisions around senior care, many opt to keep their elderly parent in their own home for as long as possible. There are strong benefits to this option, like maintaining more control over their environment and the comfort of familiarity (their neighbors, grocery store, church, etc.). The question becomes how to broach the subject of home care, and then, how to pay for home care services.
Types of Care
In-home senior care costs vary by location around the US and by type of services.
Home health services are planned around (often chronic) health conditions and usually involve medical staff visits to administer medications, check vitals, provide wound care, and similar services. Home health is commonly prescribed after hospitalization and/or when the senior has limited ability to leave their home. While their visiting healthcare professional might also provide some companionship and safety check-ins, their services are medically focused.
Home care services or non-medical home care is less specialized and offers help with the activities of daily living (ADLs) such as bathing, dressing, and eating meals. Companion care services can include help with chores, such as laundry and cleaning the house, and helping the senior get some exercise. A home care provider might play cards with their senior client, remind them to take medications (but not manage them), and alert their family to any developments such as home repairs needed. Home care is used by many families when a family caregiver is overstretched with the other demands of life, like work and children. It is also a good option when family members live far away from their aging parent. Home care visits can be tailored in frequency and length.
Because the US population has been aging rapidly, with an AARP projection of 73 million seniors by 2030, there is a growing demand for home care services and a shortfall in some areas of senior care assistance agencies. For seniors who are generally healthy and safe living independently, “smart home” solutions can help families keep in close touch while offering features like medication reminders and voice-activated calls for emergency services. Devices like SmartCompanion can be placed around the senior’s home for them to easily make and receive social and wellness calls.
Other types of care are available to fill in gaps where family members cannot be present all the time, or for providing them respite (which is very important to prevent compassion fatigue). These options include adult daycare, which can be found as independent centers or as services at assisted living communities.
Consultation and Consideration
There is a wide range in care options, and in the cost of in-home care. As such, it is advisable to take stock of what your elderly loved one needs in their care plan and speak to relevant experts to make the best decisions.
Besides taking your senior’s input on what is needed and what is comfortable, it is a good idea to speak with their primary care physician or geriatrician to discuss current and future health considerations. Eyesight, hearing, memory, and mobility are examples of factors to consider in making a short- and long-term care plan.
Elder law attorneys are specialists in planning for long term care for elderly clients. This includes expertise in taxes, Medicare and Medicaid, implications around insurance and private pay options, and more. The National Academy of Elder Law Attorneys has an attorney search tool here.
In addition, Area Agencies on Aging (AAA) and Aging and Disability Resource Centers (ADRC) can provide information on services at the local level (more info here and here).
It is also vital to consult an accountant or financial advisor on how to pay for in-home care, paying for long term care if/when needed, private pay for home care, and related financial questions. The National Association of Personal Financial Advisors has an advisor search tool here.
A trusted insurance agent can further give guidance on what insurance covers in-home care and how to search for quality long term care coverage.
Home Care Costs and Payment Options
The costliest care option tends to be home health, as it requires the services of a nurse or other healthcare professional. The range in US home health cost is about $21-$38/hour for home health aides and about $50-$130/hour for nurses. Non-medical home care services cost less, at a US range of about $21-$35/hour.
Resources such as adult daycare and technology solutions tend to cost less, but are less likely to be covered by insurance
There are several options for paying for care at home:
Medicare
A good starting point, Original Medicare covers certain in-home health services when deemed medically necessary, but will not cover non-medical home care. Many seniors opt to enroll in a Medicare Advantage plan to add coverage for these kinds of services. Benefits vary by plan.
Medicaid
Seniors who qualify for Medicaid can often access in-home services, including non-medical ones. This includes the 1915(c) waiver program, administered at the state level, to pay for in-home elder care. A newer program, the Community First Choice Option (CFCO), is also administered at the state level and is currently available in California, Connecticut, Maryland, Montana, New York, Oregon, Texas, and Washington.
PACE
The Program of All-Inclusive Care for the Elderly, or PACE, is a comprehensive program that works with both Medicare and Medicaid to help seniors access needed care in their own homes and communities. While enrollment is required, there are few disqualifiers and many services offered (more information here). Note that this same program is known as LIFE (Living Independence for the Elderly) in Pennsylvania.
Veterans’ Benefits (Aid and Attendance)
Veterans and their spouses (including surviving spouses) may be eligible for the VA’s Aid and Attendance benefit, which reimburses for in-home care on a monthly basis. Read more about Aid and Attendance here.
Long Term Care Insurance
Long term care insurance is a product available from private insurers and covers services such as in-home caregivers. As with other insurance products, this option is best discussed with a trusted insurance agent to clarify qualifications, coverage, and premiums.
Private Pay Options
Private pay merits a conversation with a financial planner, accountant, and/or elder law attorney. Options here include life insurance policy conversions, reverse mortgages, loans, liquidating assets, and others, each with their own risks and benefits.
Paying for in-home care warrants careful research and consultation, but with ample preparation and patient conversation with your elderly loved one, it can make a huge difference in their safety and quality of life. If your loved one needs home care, our VetAssist mission is to make home care easily and quickly accessible for those who qualify through the VA Pension with Aid and Attendance benefit. Veterans Home Care can help you determine whether you or your loved one will be eligible to receive the benefit, which can cover some or all of the cost of home care, and we make it easy to apply. Chat with us via our website, or call us at (888) 314-6075.
