If you’re like the majority of seniors, you want to stay in your home as long as possible. Home care allows you to do this. It’s less expensive than institutional care, such as assisted living and nursing homes. This type of care includes home health care and non-medical care such as assistance with activities of daily living and domestic chores.
Below, you’ll find information on how to pay for elderly home care through Medicare, Medicaid, and other federal, state and local programs.
Elderly Home Care Rising
The market for home care is exploding thanks to the wave of baby boomers reaching their golden years and the need for lower-priced alternatives to institutional care. According to the Bureau of Labor Statistics, the number of home health and care aides will expand to more than 1.3 million by 2020, a 70% increase from 2010.
Home health care employees are typically RNs, LPNs, physical therapists, home care aides, occupational therapists and social workers. Home care aides help with activities of daily living (ADLs) such as bathing, dressing, toileting, and grooming. And they assist with instrumental ADLs such as housekeeping, meal prep, laundry and transportation.
Elderly Home Care Costs
It’s no wonder seniors choose home health care over stays in a hospital if they are able to. The average daily cost of a hospital stay is $6,200, while the average cost of home health care is just $135 per visit.
The national average for a one-bedroom in an assisted living facility is $3,450 a month, according to Genworth Financial’s Cost of Care Survey. A semi-private room in a nursing home on average costs $207 a day.
On average, a home health aide costs about $19 an hour.
How We Pay for Home Health Care
The following is how recipients of home health care pay for services, according to the Centers for Medicare and Medicaid Services:
- Medicare 41%
- Medicaid 24%
- State/local governments 15%
- Out-of-pocket 10%
- Private insurance 8%
- Other 2%
Qualifying for Medicare Home Health Care
If you are enrolled in Original Medicare, you may be eligible for home health benefits. All of the following conditions must be met:
- You must be under the care of a doctor and getting services under a plan of care established and reviewed regularly by your doctor
- Your doctor must certify that you need one or more of the following: skilled nursing care, physical therapy, speech-language pathology, and/or occupational therapy
- The home health agency must be Medicare-certified
- A doctor must certify that you are homebound, i.e. your condition keeps you from leaving home without help (wheelchair, walker, help from another person), leaving home takes a “considerable and taxing effort”
In addition, you can only receive benefits for a part-time skilled nurse, which is defined as providing care on fewer than 7 days/week or less than 8 hours each day over a period of 21 days or less. Those needing full-time care (beyond the above)
What Medicare Covers
- Skilled nursing care provided by a registered nurse (RN) or licensed practical nurse (LPN). Skilled nursing includes services such as shots, tube feedings, giving IV drugs, changing dressings, prescription drug and diabetes care teaching, etc.
- Physical therapy, occupational therapy, and speech-language services
- Medical social services including counseling and help finding community services
- Medical supplies used in your care. Can also include durable medical equipment
What Medicare Does Not Cover
- Personal care (home health aides) such as bathing, dressing, and other activities of daily living.
- Homemaker services such as cleaning, laundry, shopping and preparing meals
- 24-hour-a-day care
- Home-delivered meals
- Medical alert devices
Medicaid and Home Care
Because Medicaid administration falls under individual states, the coverage and eligibility will vary. According to federal Medicaid guidelines, home health coverage must include part-time nursing, medical supplies and HCA services. Other services may include physical, occupational and speech therapies.
Home Care for Veterans
Veterans may be eligible for the Housebound benefits if:
- The Veteran has a single permanent disability evaluated as 100-percent disabling AND due to such disability, he/she is permanently and substantially confined to his/her immediate premises, OR,
- The Veteran has a single permanent disability evaluated as 100-percent disabling AND, another disability, or disabilities evaluated as 60 percent or more disabling.
In addition, your income must be less than $14,978 without dependents or $18,773 with dependents.
Another Veteran’s benefit is the Homemaker and Home Health Aide Care. These are services such as case management, assistance with activities of daily living, and other home-related care services.
This is part of the VA Standard Medical Benefits Package for enrolled Veterans who meet the clinical needs for the service.
Other Veterans benefits include Skilled Home Health Care (nursing, physical/occupational/speech therapy, social work), Telehealth Care (phone/video care to track blood pressure, blood sugar, pulse, blood oxygen levels, heart/lung sounds), and Home Based Primary Care.
To apply for any of these Veterans benefits, contact your VA social worker/case manager and complete the Application for Extended Care Benefits (VA Form 10-10EC). You can also call VA toll-free at 877-222-VETS (8387).
Program of All-inclusive Care for the Elderly (PACE)
PACE is a Medicare and Medicaid program that provides care to seniors in the home. The program provides services such as home care, counseling, meals, transportation, and many other care services.
To be eligible, you must be:
- 55 or older
- live in the service area of PACE
- need nursing home-level of care
- be able to live safely in the community with help from PACE
If you have Medicaid, there is no monthly premium for the long-term care portion of the benefit. If you have Medicare, you’ll pay a monthly premium to cover the long-term care benefit and a premium for Medicare Part D drugs. There is no deductible or copay for drugs, service or care provided by your PACE team. For more information, go to Medicare’s PACE page.
State and Local Services
In addition to the above federal resources, each state has an elder affairs/aging department with programs to support seniors, including home health and home care. For example, New Hampshire’s ServiceLink is a comprehensive community-based resource for seniors who are looking for home care, housing, financial support, food assistance and many more services.
To find home health and home care in your area, click on your state’s link below.
Alabama – Department of Senior Services