As our population ages, the need for homecare services for the elderly becomes increasingly prominent. Conditions such as Alzheimer’s, Parkinsons, COPD, MS, stroke, ALS or simply frailty due to old age can put an individual in need of support to remain living with dignity and safety in their own home. Ensuring our loved ones receive the care they deserve at home is not only a matter of comfort but also a crucial element in maintaining their overall well-being. However, the financial aspects of homecare can be daunting, and families often find themselves navigating a complex landscape of options. In this blog post, we'll explore various avenues to pay for homecare services for the elderly, offering insights into government programs, insurance plans, and private financing.
1. Medicare and Medicare Advantage: A Foundation for Short-Term Care
Medicare, a federally funded health insurance program primarily for individuals aged 65 and older, can be a valuable resource for short-term home health services. To qualify for Medicare-covered home health services, the individual must be homebound and require skilled nursing care or therapy. It's important to note that while Medicare can provide essential support, its coverage is typically limited to short-term, intermittent care and explicitly excludes “custodial care,” i.e., non-medical caregiver services. On the other hand, the up and coming Medicare Advantage plans that are growing in popularity may include limited home health aide services (however, as of 2023, extremely few Medicare Advantage plans do so in California).
2. Medi-Cal: Extensive Coverage for Low-Income Individuals
Medi-Cal, the Medicaid program in California, is a joint federal and state program that offers health coverage for low-income individuals, provides a more comprehensive option for covering homecare services. Eligibility and covered services vary by state, and some states offer Home and Community-Based Services (HCBS) waivers that allow Medi-Cal to cover homecare. Medicaid can be an essential lifeline for those with limited financial resources. These services are usually provided via In Home Supportive Services (IHSS), which are administered by the counties.
3. Long-Term Care Insurance: Planning for Extended Care
Long-term care insurance (LTCi) is specifically designed to cover the costs of services that assist with daily living activities, including homecare in many plans. These policies vary, so it's crucial to review the terms, conditions, and any limitations before purchasing long-term care insurance. While premiums can be high, having a long-term care insurance policy can offer peace of mind and financial support when extended care is necessary. These plans usually have a deductible, called an elimination period, and offer coverage for services hours up to a maximum per period. Coverage is not available immediately, so it is a good idea to start processing a claim with ample time to avoid out of pocket expenses. The elimination period may be waived in some cases such as for claimant under hospice care. BrightStar Care specializes in advising clients on the optimization of their LTCi policy. Our experience goes back over 15 years and included over 30 different long-term insurance companies. Most LTCi companies require support of a homecare caregiver with 2 activities of daily living (aka ADLs) such as dressing, feeding, incontinence care and assistance with ambulation.
4. Veterans Benefits: Honoring Those Who Served
Veterans and their surviving spouses may be eligible for homecare benefits through the U.S. Department of Veterans Affairs (VA). In the Sacramento area, claims are administered by TriWest and managed at the various local VA facilities including Mather, Auburn and McClellan. The Aid and Attendance program, for instance, provides additional financial assistance for veterans requiring assistance with daily living activities. Community Care Network offers services to veterans as well as prescribed by their VA physician. Services include medical and non-medical care in the home. BrightStar Care is a proud provider Exploring these benefits is an acknowledgment of the service and sacrifice of our veterans.
5. Reverse Mortgage: Tapping into Home Equity
For elderly homeowners aged 62 and older, a reverse mortgage allows them to convert a portion of their home equity into funds that can be used to pay for homecare services. Given that government and non-profit support for homecare services is very limited for many, utilizing retirement savings is the primary option for those with assets. And for many, their primary asset may be the equity in their home as they may not have other liquid assets to utilize to pay for caregiver services. While this option can provide financial flexibility, it has implications for home equity and inheritance, so there are important considerations to take into account. On the other hand, what is the point of owning a home (or equity in the home) if you are not able to live (safely) in it? Individuals considering a reverse mortgage should carefully weigh the benefits and drawbacks.
6. Private Pay: Flexibility at a Cost
Private pay is a straightforward option where individuals or their families cover the costs of homecare services out of pocket. This option offers flexibility, allowing families to tailor care plans, i.e., service hours and frequency, to specific needs in combination with other non-cash resources. However, it may not be sustainable for everyone, depending on financial resources and the longevity of care required. Private pay care can be combined with family provided care or care financially supported by one of the other methods included in this blog.
7. Area Agencies on Aging (AAA): Localized Support
Area Agencies on Aging (AAA) organizations provide information and assistance to seniors regarding available resources, including homecare services. Some AAAs offer programs that can help subsidize or provide low-cost homecare based on income and need. Seeking assistance from these agencies can be an essential step in accessing localized support.
8. PACE (Programs of All-Inclusive Care for the Elderly): Comprehensive Healthcare Solutions
PACE is a Medicaid-funded program that provides comprehensive medical and social services for individuals over 55 who require a nursing home level of care but wish to remain living at home. PACE may cover homecare services and other healthcare needs, offering a holistic approach to elderly care. Homecare may consist of a caregiver a few hours a day, several day a week, to support with activities of daily living like food preparation, mobility, or dressing; or, it may include home health such as nursing and physical therapy to help with wound care or medication management. BrightStar Care is contracted the InnovAge PACE program in Sacramento.
9. Family Caregiver Support Programs: Acknowledging Family Contributions
Some states offer Family Caregiver Support Programs that provide financial assistance or respite care for family members caring for elderly individuals at home. These programs recognize the invaluable contributions of family caregivers and aim to alleviate the financial burden on those providing care. In the Sacramento area, you may want to learn about Del Oro Caregiver Resource center and their caregiver respite program offering funds to support family caregivers.
10. Community-Based Programs and Nonprofits: Localized Care Initiatives
Several community-based programs and nonprofit organizations offer assistance with homecare services. These services may include or subsidized care based on financial need or grants. Exploring community-based initiatives can reveal valuable local resources for elderly individuals and their families. Two organizations offering grants in the Sacramento are they Alzheimer’s Association and the ALS Association.
When exploring these options, it's crucial to consider the specific needs of the elderly individual, the level of care required, and the financial resources available. Seeking guidance from financial advisors, elder law attorneys, and healthcare professionals can help individuals and families make informed decisions about paying for homecare services.
In conclusion, the financial landscape of homecare services for the elderly is diverse and dynamic. Understanding the available options and leveraging multiple resources can help families navigate the financial aspects of providing quality homecare for their loved ones. As we strive to ensure the well-being of our aging population, it's essential to explore these options thoughtfully and plan for the evolving needs of our elderly loved ones. Providing quality homecare is not just about physical assistance; it's a testament to the love and respect we have for those who have shaped our lives.
