Realizing that someone you love is not functioning as well at home as they used to can come as a shock; discovering what in-home care costs can be even more surprising, particularly since many people believe that Medicare or traditional health insurance will pay for all types of assistance.
If your loved one needs only non-medical care such as light housekeeping, help with bathing or other personal care or simply someone to stay with them during the day or night, they are not “sick” and therefore, Medicare and health insurance do not cover these services. That’s why this care is frequently called “private pay”, “private duty” or “personal care.”
Many seniors have been “saving for a rainy day” for much of their adult lives...but they hesitate to use this money for their own care, preferring to preserve their nest eggs as an inheritance for their children or grandchildren. If your elders want to live in their own home for as long as possible--and assets are available to enable them to do so--it is important to help them understand what Medicare and traditional insurance will and will not cover...and encourage them to use the resources they have to keep them living safely and independently in the environment they treasure most. In other words, let them know that “it’s raining now!”
However, if your loved one does not have the means to pay privately for non-medical care, there are other resources and options to help meet both needs and budgets. Following are the most common methods for paying for non-medical home care:
Long-Term Care Insurance
If your loved one has a policy specific for long-term care, it may cover care in the home, in a
facility or both, depending on how the policy is written. Like other types of insurance, premiums, benefits and exclusions vary greatly; it’s crucial to know details such as what must happen to “trigger” benefits; what kinds of services are allowed; what is the maximum daily benefit for covered services; if there is a waiting period during which you must be eligible for services before they become payable; if there is a cap (limit) on benefits; what paperwork must be filed and to whom it should be sent; and more.
Many personal services agencies expect that their fee for services be paid to the agency, then the client or family can seek reimbursement from the insurance company. The agency will assist in providing whatever documentation the insurance company requires to help clients access the benefits of their long-term care policies.
The Veteran Aid & Attendance Pension program is another option for paying for non-medical care for qualifying service members and their spouses. There are a number of physical and financial requirements and the application process can be complicated and lengthy; you can learn more about VA benefits at http://www.va.gov/ or contact your local Veterans Services officer (you can access a list of officers for all counties in Indiana at http://www.in.gov/dva/2370.htm.) Be aware that home care agencies are generally not accredited to assist veterans with completing required paperwork or advising veterans about specific claims or benefits (even if they offer to do it free of charge.) Only specific, VA-accredited representatives may legally assist with the filing of an application and the claims process.
Government Funded Care
Although the federal Medicare program will not pay for non-medical care, there are other federal and state funded programs that cover a certain number of hours of care per month (provided through approved agencies) to keep low-income elders living in the community rather than going to a nursing home.
Your local Area Agency on Aging (SWIRCA & More in southern Indiana) can explain the types of available programs, verify income eligibility and assist with the application process; once approved, recipients can then choose which home care agency they want to provide services.
It’s critical to apply early for these services since there may be waiting lists; plus, Area Agency on Aging staff can provide information about other available community resources such as home-delivered meals, handyman services for home repairs or safety improvements, and more.
Seniors can often remain in their homes with a network of support from family members, friends, volunteers from a church or other organizations...supplemented by paid care from a home care agency. A reputable agency can help you evaluate your loved one’s needs, refer you to additional resources within your community and develop a care plan that provides only the service that your loved one needs when they need it (rather than paying for a “package” of services, some of which may not be necessary.)
A Word of Warning
If you decide to use an independent caregiver that is not employed by a licensed agency, you become that person’s employer; and as such, you are responsible for background checks, hiring, firing, payroll, required taxes and compensation coverage if they are injured on the job (your homeowner’s insurance does not automatically cover these claims.)
Independent care may seem less expensive, but can end up costing more in terms of time, potential tax consequences and the risk of not having readily-available back-up care.
To learn more—or to arrange services for yourself or a loved one—please contact the Deaconess VNA Plus Personal Care department at 812-425-3561 or toll free, 800-326-4862.