Paying for In-Home Care
Medicare and traditional health insurance only pay for “skilled care”, meaning the care must be ordered by a physician, must be medically necessary, and must be monitored by a health care professional. In the case of Medicare, the patient must also be home-bound and unable to run errands, or engage in activity outside of the home. Medicare and traditional health insurance pays for very limited amounts of care, for very brief periods of time. Companion care and non-medical home care are typically not paid for by Medicare or traditional health insurance Click here to learn about other ways to pay for in-home senior care.
In some cases, long-term care insurance will pay for non-medical home care. Look at the care recipient’s policy and call the customer service telephone number or the agent that sold the plan. There is usually (but not always) an elimination period that must be met before long-term care insurance picks up the bill. Claims must be processed per the terms of the policy. Most home care agencies have some experience with filing claims for long-term care insurance, and will be happy to help.
According to the MetLife Cost of Care study for 2011, the national average private-pay hourly rates for home health aides and homemaker/ companion services remain unchanged from 2010 at $21 and $19 respectively. The lowest average hourly rates for home care came from the “Shreveport Area” of Louisiana at $14 for a home health aide and $13 for a homemaker/companion. The highest average hourly rates for home care came from the “Rochester Area” of Minnesota at $34 for a home health aide and $29 for a homemaker/companion. Costs in our area range from $19-$22 per hour.
In-home care services can be paid for in a variety of ways such as- using private funds, using long-term care insurance, using the proceeds from a reverse mortgage, and with funds from the VA Aid and Attendance Pension Benefit. In order to use any of these programs (aside from private funds) there are certain qualifications that must be met.
Private duty home care agencies will pay the caregiver directly. They will take care of taxes and insurance. You and your family will not be responsible for these items. If you use a registry, match-maker service or hire a caregiver privately, you will be responsible for taxes, insurance and other requirements. Make sure you know the laws that apply in your state.
Deciding on Types of Care Services
Here are some of the signs that an aging loved one may need some help at home.
- Lack of housekeeping: Dishes piling up in the kitchen, dirty floors, or large piles of unwashed clothing, general change in housekeeping habits.
- Poor hygiene or change in personal hygiene habits. Wearing the same clothing for several days.
- Bills not being paid.
- Personal finances being neglected, checks bouncing.
- Inappropriate clothing choices (not wearing a coat in cold weather, not wearing shoes, wearing heavy clothing during hot weather)
- Confusion in the kitchen: Not remembering to turn off burners, leaving the oven on, leaving items in the oven and forgetting about them. Food being left out, leaving the water running.
- Changes in behavior: Odd conversations, signs of paranoia, accidentally taking too much medication, phone calls at odd hours, unusual fears and nervousness… all of these things may be signs that your parent needs help.
Home healthcare services are typically medically necessary. They are paid for by Medicare or other health insurance, and have been ordered by a physician. Private duty home care services are typically non-medical, companion care services, including errands, light housekeeping, light meal preparation, medication reminders, light laundry, grocery shopping, transportation to and from MD appointments, taking walks, and getting the mail. Private duty home care services are typically paid for privately or with long-term care insurance, reverse mortgage proceeds, or Veterans Aid and Attendance Pension Benefits, or some combination of these programs.
Look for an agency that has a great track record, references and referrals. Employees should be bonded and insured and thoroughly screened with national and local background checks. The agency should do a great job of matching the caregiver to the care recipient and make sure they have a back-up plan in case a caregiver gets sick, or doesn’t show up for their shift.
In-home care keeps seniors safe in their own homes by providing either hourly or live-in care services. Most seniors would prefer to stay in their own homes for as long as possible. Assisted living facilities are for aging adults who need more care, or need a safer environment. Assisted living facilities are a great option for people who become confused easily, may wander or who need regular medication administration by a med-tech or nurse. Learn more about the differences between in-home care and assisted living.
In-home care keeps seniors safe in their own homes by providing either hourly or live-in care services. Most seniors would prefer to stay in their own homes for as long as possible. Adult day care services allow a senior to stay in their own homes – however, the senior leaves their home for the day and is cared for at an adult day center. This provides the senior with socialization, medication administration, and activities. Some seniors thrive in these types of environments while others may prefer to stay at home in familiar surroundings.
Differences in Home Care Services
Home health aides usually have more training (some are called Certified Nurses Aides or CNAs) and can provide some medical services as well as non-medical services (like bathing, light wound care, or blood pressure monitoring). Personal companions provide non-medical care like light housekeeping, light laundry, errand running, transportation, and light meal preparation.
Live-in care means the caregiver lives in the home most of the week, and may only leave on their days off. They may be replaced by another live-in caregiver on their days off. They have their own bedroom, and sleep at night when the care-receiver is sleeping. All live-in caregivers require a break during the week and will have 2 days off. Most private duty home care agencies can provide live-in services and hourly services. Hourly caregivers do not live in the home. Hourly services may be more appropriate for seniors who need the companion or home health aide to be awake at night.
If my aging loved one needs care 24 hours a day, is there a difference in cost between a live-in caregiver and paying for hourly care?
Typically live-in care is cheaper than paying for 24-hour care at an hourly rate. According to the 2011 Met Life Cost of Care survey the average daily live-in rate for a home health aide is $258 and $255 for a homemaker/companion. Rates in your area may be lower.
Many home care agencies provide more specialized training for their caregivers with regard to Alzheimer’s disease. If your aging loved one suffers from Alzheimer’s disease or dementia, be sure to ask the home care agency if they specialize in dementia, and what kind of training their caregivers are receiving.
Respite care is the provision of short-term, temporary relief to those who are caring for family members. Respite might be for a day, a week, or just a few hours. Most family caregivers need a break from time to time to take care of themselves and enjoy life. All home care agencies provide some form of respite care.
Safety with In-Home Care Services
All agencies should do a criminal background check on their employees. Some also do additional background checks for history of elder abuse or child abuse. Some agencies do background checks at various times during the caregiver’s employment. Ask your home care agency what types of background checks they do and how often.
Caregivers who come into a home to care for an aging adult should be drug-free. Although many states may not require drug screening by law, ask your home care provider if they do pre-employment drug screenings, and if they continuously do random drug screenings during a caregiver’s employment.
Businesses that are “bonded” – typically those that work at your home – do background checks on employees. But bonding provides other protections, including coverage if the job is not completed. If the homeowner has missing or broken items like jewelry or other expensive items, they can make a claim on the bond and be compensated. Insurance, on the other hand, covers liability issues that may arise in the course of someone’s work. If a caregiver is injured in a fall, the agency’s insurance would provide compensation, not you or your insurance carrier. When hiring a contractor or business to do work in your home, ask if they are bonded and insured and ask to see documentation that verifies it.
Many states require special licenses to operate a non-medical home care business. For some states this is only for Medicaid providers, while in other states every provider is licensed. Additionally, the level of care that may be provided varies from state to state. Check with your home care provider (or your state) to find out what types of licensing are required in your state and if they carry those licenses.
From time to time caregivers may call in sick, have a flat tire on the way to work, or a family emergency that requires them to take the day off. Ask us what our plan of action is when a caregiver does not show up for their designated shift. Every home care agency should have some sort of plan in place for these situations.