paying for home care_ financial options, aid and assistance.pdf
TRANSCRIPT
7/21/2019 Paying For Home Care_ Financial Options, Aid and Assistance.pdf
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A A A(/)
About Us (/about-us.html)
Contact Us (/contact-us.html)
Glossary
(/longtermcare/glossary.html)
Sitemap (/sitemap.html)
Home (/)
Costs of Senior Care
(/longtermcare/costs.html)
Types of Senior Care
(/longtermcare/types.html)
Paying for Senior Care
All Options(/longtermcare/resources
Ass is ted Li ving
(/longtermcare/paying-
for-assisted-living.html)
Home Care
(/longtermcare/paying-
for-home-care.html)
Home Care Supplies
(/home-care-
supplies/financial-
assistance.html)
Home Modifications
(/home-
modifications/how-to-
pay-for-home-
mods.html)
=121:paying-for-home-care-financial-options-aid-and-yout=default&page=)
pe5_vertex&link=bd93926242b06fda8339e6eecfd6c9bf79147a4c)
Home Care Financial Assistance andPayment Options
Page Reviewed / Updated - May 2015
Find Affordable Home Care (/home-care-
assisted-living/find-affordable-elder-
care.html)Financial Assistance for Home Care
(/longtermcare/resources/locator_tool.html)
Learn about Virtual Home Care (/financial-
assistance/companion-care.html)
Home Care vs Assisted Living Calc.(/longtermcare/home-care-vs-assisted-
living.html)
Table of Contents
Home Care vs. Home Health Care
Costs: Home, Home Health & Alzheimer's Care
Financial Assistance for Home Care Medicare's Benefits Medicaid Help for Veterans
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Nursing Homes
(/longtermcare/paying-
for-nursing-
homes.html)
Medical Equipment
(/durable-medical-
equipment/how-to-pay-
home.html)
Prescriptions
(/prescription-
drugs/assistance-for-
the-elderly.html)
Adult Day Care
(/longtermcare/find_adult
Options By State
(/financial-assistance/50-
states.html)
Resource Locator
Tool
(/longtermcare/resources/locator_tool.html)
Compare Benefits &
Care
(/longtermcare/compare_benefits.html)
Help Planning for
Care
Find Affordable Senior
Care (/home-care-
assisted-living/find-
affordable-elder-
care.html)
Lower Your Cost of
Care
Cost Saving
Technologies
(/longtermcare/aging-
in-place-
technology.html)
FAQs and Helpful
Guides (/eldercare-
State Non-Medicaid Programs Other Options
Self-Payment Options for Home Care Reverse Mortgages / HELOCs / Equity Key
Life Ins urance Policy Conversions Home Care Loans Long Term Care Insurance
Finding Affordable Home Care
Developing a Financial Plan for Home Care
State-by-State Home Care Costs
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 and companion care.
Home Health Aides offer skilled care such as checking
patients’ pulses, temperature or respiration. They assist withmedications, 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'sCare
Both home care aides and home health aides bill on an hourly
basis (with the exception of live in caregivers
(/longtermcare/live-in-caregiver.html) 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.
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faqs-and-helpful-
guides.html)
(/longtermcare/resources/locator_tool.html)
Our goal is to help familiesfind the means to pay for seni or care by providingobjective i nformation andinteractive tools on our ad-
free, easy-to-use an dcomprehensive website. Read More (/about-us.html)
Hourly rates for home care vary by asmuch as 50% even in the same state or
town.
Nationwide in 2015, the average cost for non-medical home
care is $20 per hour with the state averages ranging from $15
- $26 per hour. 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.
Independent caregivers typically charge20% - 30% less than home care
agencies.
Home health aides visit the home as much as medically
necessary; typically for shorter periods of time than home
care aides. In 2015, nationwide, the average hourly fee isalso $20, the same as for non-medical home care. However,
when looking at different state averages there is $16 - $27.
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 for Home Care
Medicare's Benefits
Medicare does not pay for home care
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aides and only selectively covers home healthcare.
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.Furthermore, the Centers for Medicare & Medicaid Services
have announced annual 3.5% reduction in home health care
provider reimbursements annually until 2017, which will further
impact seniors.
The exception to the limited home care rule are Medicare
PACE programs
(/longtermcare/resources/pace_medicare.html), 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 andMedicaid 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 (/medicaid-
waivers/home-care.html) for a state by state guide to which
HCBS Waivers cover home care, their eligibility requirements
and application processes.
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Some home care is also offered through Medicaid Personal or
Attendant Care programs. Again these programs are state
specific and can be found at the link above.
Help for Veterans
There are several forms of assistance from the Department of
Veterans Affairs that help veterans afford home care. This
may be direct financial assistance or care services that can
reduce a veteran's overall need.
To start, 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 (/longtermcare/resources/veterans_pension.html).
Veterans can also get care assistance through Veterans-
Directed HCBS (/longtermcare/resources/veterans-directed-
hcbs.html), a relatively new program that allow for self-
direction of services and the VA Respite Care
(/longtermcare/resources/va_respite_care.html) 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.
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Please follows the links below to read about specific programs
in your state.
State Non-
Arizona NMHCBS (/longtermcare/resources/arizona_nmhcbs.
Alaska Senior Benefits (/longtermcare/resources/ak-senior-b
Alaska Senior Access Program (/longtermcare/resources/ak-
Alaska Adult Day Services (/longtermcare/resources/ak-adul
Alaska Alzheimer’s Mini-Grants (/alzheimers/ak-adrd-mini-gra
Alaska Senior In-Home Services (/home-care/ak-senior-in-ho
California Alzheimer's Day Care
(/longtermcare/resources/california_alzheimers_daycare.htm
California In-Home Supportive Services
(/longtermcare/resources/california_inhome_supportive.html
Colorado Old Age Pension (/longtermcare/resources/colorad
Colorado Home Care Allowance (/home-care/co-home-care-
Connecticut CHCPE (/longtermcare/resources/connecticut_h
Connecticut Adult Family Living / Caregiver Homes (/longter
family-living.html)
Connecticut Choices at Home Project (/longtermcare/resourc
Delaware Adult Day Care and Alzheimer's Day Treatment (/a
care.html)
CARE Delaware (/longtermcare/resources/delaware-care-pr
DC's Senior Citizens' Home Repair (http://www.payingforseni
modifications/dc-senior-citizen-home-repair.html)
Florida OSS for Seniors (/longtermcare/resources/florida_os
Florida Project R.E.L.I.E.F. (/longtermcare/resources/florida_
Florida Alzheimer’s Disease Initiative
(/longtermcare/resources/florida_alzheimers_disease_initiati
Florida CCE Program (/longtermcare/resources/florida_cce.h
Florida Home Care for the Elderly
(/longtermcare/resources/florida_homecare_elderly.html)
Florida Local Services Program (/longtermcare/resources/fl-l
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Georgia Home & Community Based Services (/longtermcare/
hcbs.html%20)
Hawaii Kupuna Care (/longtermcare/resources/hawaii_kapun
Hawaii Chore Services Program (/cash-and-counseling/hi-ch
Idaho Senior Respite (/longtermcare/resources/idaho_senior
Idaho Homemaker Services (/longtermcare/resources/id-hom
Illinois Community Care (/longtermcare/resources/illinois_co
Indiana Choice (/longtermcare/resources/indiana_choice.ht
Iowa Able Foundation Loan Program (/home-modifications/io
Iowa Senior Living - Case Management Program (/home-car
program.html)
Kansas Senior Care Act (/longtermcare/resources/kansas_s
Kentucky Hart-Supported Living (/cash-and-counseling/ky-h
Kentucky Personal Care Attendant (/cash-and-counseling/ky
attendant.html)
Kentucky Adult Day Care and Alzheimer's Respite (/longtermalzheimers-day-care.html)
Maine Home-Based Care (/longtermcare/resources/maine_h
Maryland Senior Care Program
(/longtermcare/resources/maryland_seniorcare_program.ht
Maryland In Home-Aide Services (/longtermcare/resources/m
Massachusetts HCP and ECOP Programs
(/longtermcare/resources/massachusetts_hcp_ecop.html)Minnesota Alternative Care Program
(http://www.payingforseniorcare.com/longtermcare/resources
Mississippi In Home Care Services / Homemaker Program
(http://www.payingforseniorcare.com/home-care/ms-in-home
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Other Options
Families should think not just about programs which offer
assistance but also programs targeting seniors that can
reduce other expenses thereby freeing up financial resources
to put be towards the cost of home care. In this categorythere are a variety of tax credits and deductions. For
example, any expense incurred to care for an elderly relative
that enables the family to work is tax deductible. Read about
other tax credits for elderly (/longtermcare/tax-deductions-
credits-for-seniors-and-elderly-2010-2011.html).
Home care and adult day care are, in
most cases, tax deductible expenses.
Energy costs to heat and cool one's home can take up a
significant portion of low income seniors' fixed incomes.
LIHEAP is a program designed to help seniors with their home
energy bills, which can again free up dollars for home care.
The LIHEAP application has specific filing deadlines which
often give preference to lower income seniors. Learn more
here (/longtermcare/resources/liheap_financial_aid.html).
Non-profit organizations sometimes offer financial or care
assistance for individuals with specific conditions. Explore
programs at the following links for individuals with Alzheimer’s
(/longtermcare/resources/alzheimers_respite_care.html) ,
Cancer (/longtermcare/resources/cancer_co-
payment_assistance.html), Diabetes
(/longtermcare/resources/diabetes-assistance-programs.html), Kidney Disease
(/longtermcare/resources/kidney_patient_assistance.html)
and Leukemia
(/longtermcare/resources/leukemia_lymphona_copay_assistance.
Possibly the easiest and most effective way to reduce home
care expenses is to find affordable care. The hourly rates for
home care can vary by as much as 50% even in the same
geographic area. Our organization provides a free service
that help families to locate quality-screened, affordable care
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providers. Start here (/home-care-assisted-living/find-
affordable-elder-care.html).
Self-Payment Options for Home Care
Reverse Mortgages / HELOCs / Equity Key
There are several ways families can self-pay for care by using
their home as a financial resource, these include reverse
mortgages, home equity lines of credit and Rex Agreements.
However, depending on marital status, severity of need and
the projected length of need not each of these options
necessarily makes economic sense. For example, if the
person in need of care is single and may need to move into
residential care within a two year period, then a reversemortgage is probably not the best option. The same applies
to Rex Agreements. One can read more about when it is best
to use each of these options and their pros & cons at the
following links: Reverse Mortgages
(/longtermcare/resources/reverse_mortgages.html), Home
Equity Lines of Credit (/longtermcare/resources/heloc.html),
Rex Agreements
(/longtermcare/resources/rex_agreement.html).
Life Insurance Policy Conversions
Life insurances holders have a variety of ways of converting
their policy into cash or home care services prior to the
policyholder's passing. There are three options that allow
individuals to stop making premium payments and receive
immediate payouts on their policies without passing. Viaticalsettlements are designed for individuals with less than 2 year
life expectancy. Life settlements are intended for persons
with longer life expectancies. Life insurance conversions give
consumer the greatest value for their life insurance policy
however the benefit comes in the form of care services
instead of cash. Pros, cons and eligibility information is
available for viaticals
(/longtermcare/resources/viatical_settlements.html), life
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settlements (/longtermcare/resources/life_settlements.html)
and conversion programs (/longtermcare/lifecare-assurance-
benefit-plan.html).
Life insurance policies can beconverted into home care services,
preserving the policyholder's eligibility for Medicaid. Learn more (/longtermcare/lifecare-assurance-benefit-plan.html).
Accelerated death benefits
(/longtermcare/resources/accelerated_death_benefits.html)
and death benefit loans
(/longtermcare/resources/death_benefit_loans.html) are two
other ways individuals can receive cash for the life insurance
in advance of their death. However, with these two options,
the policyholder must continue to make their monthly premium
payments.
Home Care Loans
Loans specifically designed for elder care are a new and
interesting financial product. These loans are intended for
short term needs while a family is waiting for other financing.
For example, a veteran's pension claim approval can take 6-
12 month, but once it is approved, it is paid in a retroactive
lump sum back to their claim filing date. A loan is made to
these individuals with the expectation that it will be re-paid for
the lump sum. A similar situation exists for families selling a
home and having the elderly relative move in with the adultchildren. Finances will become available it is just a matter of
when the home will sell. For more information on fees, pros
and cons for home care loans, click here
(/longtermcare/resources/bridge_loans.html).
Long Term Care Insurance
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Individuals with long term care insurance can use the benefits
to pay for home care. For persons without LTC insurance
who have a need for care, they typically are not eligible to
purchase insurance. For this reason our discussion of LTC
insurance (/longtermcare/resources/ltc_insurance.html) is
relevant only to persons doing very long term planning.
Finding Affordable Home Care
There is a great deal of variation in the cost of home care not
just amongst the states but even in the same geographic area
within a state. A recent study found in most areas, there are
care providers who charge as much as 50% below or above
the average hourly rate for that area. This means the choice
of care provider is a major factor in affording long term care athome. It is difficulty and time consuming to contact each care
provider in the area and determine their rates. For this
reason, we've partnered to provide a free service that helps
families find the most affordable home care in their area. Start
here (/home-care-assisted-living/find-affordable-elder-
care.html).
Developing a Financial Plan for Home Care
Since many families pay for home care from their savings,
they are in a state of continuously diminishing resources.
Many assistance programs determine eligibility based on an
individual’s resources. Therefore, the assistance available to
an individual is constantly changing. In other words, the
longer a person requires (or is projected to require) home
care, the more assistance that becomes available to them.
For this reason (and others), it is advantageous to develop a
long term financial plan when considering home care. Doing
so has the dual benefit of ensuring a comfortable and
consistent aging process for your loved one while at the same
time preserving your family’s assets and resources.
The creation of a financial plan for home care is a
complicated process and must accommodate various health
scenarios. Fortunately, there are resources available to help
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families with financial planning for home care. A complete
exploration of one's care planning option is available here
(/longtermcare/find_provider.html) and summary follows
below. Each option has its pros and cons.
Public Benefits Counselors – local Area Agencies on
Aging (AAA) and Aging and Disability Resource Centers
(ADRC) have benefits counselors on staff that can help
with financial planning. While they typically do not charge
for their assistance, they may be under-staffed and
unable to provide adequate long term planning. They also
tend to be highly knowledgeable about local programs but
have less larger financial planning experience. Find your
local AAA or ADRC
(/longtermcare/find_aging_agencies_adrc_aaa.html).
Geriatric Care Managers – GCMs help families create
and implement long term care plans and, as a part of that,
some will help with financial planning. Since GCMs are
typically paid for out-of-pocket, one can expect a higher level of attention than one might receive from a public
benefits counselor. Families tend to contact GCMs only
after the need for care has become apparent and
therefore GCMs are not in the best position to do long
term planning. Often GCMs come from nursing or public
health backgrounds and do not have extension financial
experience. Find a Geriatric Care Manager
(/longtermcare/find_geriatric_care_managers.html).
Eldercare Resource Planners - ERPs are specialists in
developing financial plans for home care. They differ
from Care Managers in that they typically come from a
financial background instead of healthcare background.
They are paid out-of-pocket but can often pay for
themselves in the financial assistance resources they
discover for their clients. They are significantly less
expensive than Elderlaw attorneys, but cannot perform
some of the legal procedures which only attorneys can.
Learn more
(/longtermcare/find_eldercare_resources_planners.html).Elderlaw Attorneys - the most expensive and most
thorough option. An elderlaw attorney and their staff can
provide a one-stop shop for home care financial planning
but their hourly rate may prove cost-prohibitive for some
families. One can search the National Academy of Elder
Law Attorney database here
(https://www.naela.org/Public/About/For_More_Information/Fin
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State-by-State Home Care Costs and Affordability Index
This table contains the average hourly cost of home care
aides for all 50 states and D.C. In addition, it contains our
experimental home care affordability index* which considers
the cost of home care in a state relative to its median
household income. The state’s ranking out of 50 states andWashington D.C. is contained in the final column.
2015 Home Care Costs and
State Home Care Hourly Rate Home Care
Lower #s are
United States $20
Alabama $16
Alaska $26
Arizona $20
Arkansas $17
California $23
Colorado $22
Connecticut $20
Delaware $20
District of
Columbia
$20
Florida $18
Georgia $18
Hawaii $24
Idaho $19
Illinois $21
Indiana $19
Iowa $22
Kansas $19
Kentucky $19
Louisiana $15
Maine $22
Maryland $20
Massachusetts $24
Michigan $20
Minnesota $24
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Copyright © 2015. All rights reserved. Use or replication of this content by other web sites or commercial
Mississippi $16
Missouri $19
Montana $23
Nebraska $22
Nevada $21
New Hampshire $23
New Jersey $20
New Mexico $19
New York $21
North Carolina $18
North Dakota $26
Ohio $19
Oklahoma $19
Oregon $22
Pennsylvania $20
Rhode Island $24
South Carolina $18
South Dakota $22
Tennessee $18
Texas $19
Utah $21
Vermont $21
Virginia $18
Washington $24
West Virginia $16
Wisconsin $21
Wyoming $20
*Data provided by Genworth Financial, Inc. (NYSE:GNW) and the US Census
Bureau
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