For anyone that’s explored home care, one question always rises to the top: How on earth do we pay for this?
Luckily, families have several options to explore that can help get loved ones the care they need to stay in their homes. This week, we are discussing the 6 most common types of payor sources we handle on a day-to-day basis. Since our experience largely lies on serving families in Montana, be sure to verify this information with an expert in your state to see if the rules and programs are similarly run. Generally speaking, this article is a good starting point and will give you the ability to ask the right questions to the right people.
Medicaid – Community First Choice Program
This program is the most popular program we work with, as we have people call nearly every day asking about their coverage under Medicaid. Simply put, this is a great program for those that are eligible for the Standard Medicaid coverage. Once someone is covered, they are entitled to the Community First Choice Program. This program will cover Activities of Daily Living (ADLs) on an as need basis.
These ADLs may include:
Bathing
Dressing
Hygiene
Toileting
Transfers
Meal Plan
Exercise
Mobility
Eating
Medication Reminders
In addition to these ADLs, Medicaid also allows for Incidental Activities of Daily Living (IADLs) such as laundry, housekeeping, etc. These are not covered on their own, and are only covered when an individual also needs care for the primary ADLs. Some individuals might also be eligible for a Personal Emergency Response System, an electronic device that can be used to call for help in an emergency.
For more information about the Medicaid Community First Choice Program, visit https://www.medicaid.gov/medicaid/home-community-based-services/home-community-based-services-authorities/community-first-choice-cfc-1915-k/index.html
Medicare
The biggest misconception about home care is that it is covered under Medicare. We answer hundreds of calls a year with people saying they were told they have coverage for home care with their Medicare plan, but sadly this isn’t true. Unfortunately, there are many commercials and advertisements that lead people to believe this, but in all of our research and conversations with Medicare experts, they don’t cover our services.
Here is a list of what is covered under Medicare:
Part-time or intermittent skilled nursing
Physical therapy
Occupational therapyy
Speech and language pathology
Medical Social Services
Part-time and health aide services (only in addition to a skilled care service)
Medicaid also doesn’t cover 24-hour care at home, meal delivery to your home, home maker services (when not needing a skilled service), and custodial/personal care (when not needing a skilled service).
A key distinction we must make is the difference between home care services and home health services. What we offer and frequently reference are non-medical services, meaning we aren’t truly treating anyone for an injury or disease, we are helping them complete tasks in their daily life. Home health care medical professionals on the other hand render treatment to someone with an injury or illness to help them recover. The latter is what is covered under the Medicare program with the only exception that some coverage for home care is allowed if an individual is simultaneously receiving home health services.
For more information about Medicare, visit https://www.medicare.gov/
Veterans Affairs – Home Maker/Home Health Aid Care
We work with many veterans through the VA program. What we love about this program is that the VA puts the veteran in the driver’s seat and allows them to be a part of the decision-making process surrounding when and how the care they need is provided. Other government programs have strict scheduling requirements assigned from case workers, but the VA allows the veteran to schedule in accordance with when they need the most help. Similar to Medicaid, the VA covers the same ADLs and is strictly non-medical.
Examples of ADLs covered under VA (not a comprehensive list):
Eating
Dressing
Grooming
Moving (transfers and mobility)
Transportation to doctor’s appointments
For more information about the VA programs, visit https://www.va.gov/geriatrics/pages/Homemaker_and_Home_Health_Aide_Care.asp
Agency on Aging (AOA)
The Agency on Aging is a great place to start when looking for an introduction to care. They are a government agency that provides ancillary support for seniors who might not need much help with primary ADLs yet, but need some extra support. AOA provides caregivers for home maker services and escort errands for appointments or groceries. They are also available for respite care, which is a great place for a family caregiver to start if they are seeking a break or simply needing additional hours of caregiving for their loved one. AOA also has a program called Meals on Wheels where they will deliver meals to seniors in the comfort of their home. The AOA is a great resource for helping find you other options should you need more care.
For more information on the Agency on Aging, contact your local agency.
Long-Term Care Insurance
Long-Term Care Insurance is a very popular policy, and many already have one they purchased with their life insurance package. We have worked with several providers over the years, and all of them have been cooperative and knowledgeable. Since there are so many providers, there are many different policies out there for people to choose from. Usually, the policy will state what is covered and how much money can be used on a per day or weekly basis. Be sure to check that the policy covers non-medical care, because some polices will only cover home health (much like the Medicare dilemma). But as long as your policy cover non-medical services, you generally the freedom to schedule your caregivers whenever you need them most.
For more information on long-term care insurance, consult with your insurance professional.
Private Pay
This option provides the greatest amount of freedom since there aren’t qualification guidelines in place like there are for VA or Medicaid. Since you are paying out of pocket, you’ll get to decided when and how your loved one receives care. While home care agencies might have limits to what services they can provide, there won’t be limits to how often you can receive care like the government programs and even insurance policies. If you need someone in the home 24/7, those shifts exist and are available to you. While this is certainly a hefty investment, many people prefer the independence of truly being able to choose the care they need, and thus, private pay allows them to do so.
As you can see, there are many options available to allow you to get the care you need. All it takes is some planning and exploring all of your options. Some people even use a combination of these like a long-term care policy and private pay or AOA and VA.
Hopefully this article takes some of the fear out of the process of getting the care you need! If you have any questions, get in touch with us by emailing us at thecaregivenpodcast@gmail.com.