Definitions: Home Care vs. Home Health Care
Prior to a discussion of home care payment options, it is helpful to differentiate between home care and home health care. Home Care Aides provide custodial care; they help seniors with their activities of daily living such as bathing, dressing, housekeeping and transportation. This is also referred to as personal care, attendant care, non-medical care or companion care.
Home Health Aides offer skilled care such as checking patients’ pulses, temperature or respiration. They assist with medications, braces, ventilators and other medical equipment and can provide higher level skilled nursing as well as more basic personal care. Home health aides are also referred to as nurse aides, nursing assistants, certified nursing assistants and geriatric aides.
Costs: Home, Home Health & Alzheimer’s Care
Both home care aides and home health aides bill on an hourly basis (with the exception of live in caregivers who sometime bill flat rates). Home care aides can be retained through a home care agency or by hiring private caregivers. Home health aides experience greater federal regulation and are almost always hired through an agency.
Home care aides typically visit an individual several times a week for periods lasting from 2-8 hours. Nationwide in 2014, the average hourly amount paid for non-medical home care is $19 with the state averages ranging from $14 – $25. It should be noted that these are average costs from home care agencies. Private individuals can be retained to provide most of the same services with fees that are 20% -30% lower. However, these independents are typically uninsured, do not go through background checks and may be unable to provide alternatives in case they are not available to work on short notice.
Home health aides visit the home as much as medically necessary; typically for shorter periods of time than home care aides. In 2014, nationwide, the average hourly fee is $20 and different state averages range from $15 – $26. After a 10% decline from 2012 to 2013, 2014 is seeing a more normal 1.5% increase in hourly rates.
Alzheimer’s care at home can be affordable and relatively low cost when compared to residential care. Typically home care providers do not charge additional fees to care for individuals with Alzheimer’s. This is not the case in senior living residences where Alzheimer’s and dementia care usually costs an additional $1,150 per month.
Financial Assistance Programs for Home Care
Medicare’s Benefits
Home care aides provide personal care rather than medical care and therefore Medicare does not cover the cost of home care. Medicare Supplemental Insurances cover Medicare co-payments and deductible but do not add new areas of coverage, therefore these policies are of no assistance for non-medical home care.
Home health care costs, on the other hand, are considered medically necessary and therefore they are covered, at least in part, by Medicare and other health insurance programs. However, Medicare severely restricts coverage to only those individuals who are not able to leave their homes and Medicare will not pay for personal care during the visits, so the visits tend to be very brief and procedural in nature. The exception to this rule are Medicare PACE programs, however these are available only in limited geographic areas.
Medicaid
Medicaid, an insurance program for low income seniors, does pay for home health, non-medical home care and other in-home supports to help the elderly remain living in their homes. However, Medicaid rules are state-specific and Medicaid covers these services mostly through Home and Community Based Services (HCBS) Waivers. HCBS Waivers are different in every state, they offer different benefits, having varying eligibility requirements and unfortunately are not entitlements. Medicaid HCBS Waivers have enrollment caps and waiting lists may exists. Click here for a state by state guide to which HCBS Waivers cover home care, their eligibility requirements and application processes.
Help for Veterans
There are several forms of assistance from the VA to help senior veterans afford home care, be that direct financial assistance or care services that can reduce a veteran’s overall need. There are three different pension benefits which can be applied towards home care. Individuals who require more care are eligible for higher benefit amounts. These are the Improved Pension, Homebound and Aid and Attendance. Eligibility requirements and benefit amounts are available here.
Veterans can also get care assistance through Veterans-Directed HCBS, a relatively new program that allow for self-direction of services and the VA Respite Care which can reduce the home care hours a veteran requires.
State Non-Medicaid Programs
Most states have in-home assistance programs for low income seniors who are not eligible for Medicaid. These programs are intended to prevent or delay the placement of needy individuals in nursing homes and are loosely referred to as “nursing home diversion programs”. Eligibility, benefits and even sources of funding varies with each program and some states even have more than one program. As an example of the diversity, some of these programs provide cash assistance, others provide care services and respite and still others provide non-care based, in-home support such as assistance with chores, meals and transportation. Assistance with adult day care and assistance for home modifications to enable aging in place are two other approaches the states use to help. The common thread amongst all of these programs is that they help seniors remain living at home or help families to care seniors in their homes.