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.
Nationwide in 2017, the average cost for non-medical home care is $20 per hour with the state averages ranging from $15 – $27 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, independent caregivers 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 2017, nationwide, the average hourly fee is $20.50. Different state averages range from $16 to $27 per hour.
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 $1,200 per month.
There are many misconceptions around Medicare’s benefits for home care. Medicare does not pay for non-medical care, period. Therefore, assistance for non-medical care provided in the home is not covered. Medicare Supplemental Insurances cover Medicare co-payments and deductibles but do not add new areas of coverage. Therefore, these policies are of no assistance for non-medical home care.
Home health care, on the other hand, when considered medically necessary is covered, at least in part, by Medicare and other health insurance programs. However, Medicare severely restricts coverage to only those individuals who are “homebound”. This is defined as persons who require assistance (by human or medical equipment such as wheelchairs) to leave their homes. Alternatively, persons who health may be worsen by leaving their homes are also eligible. During home health care visits, Medicare will not pay for any personal care that is provided during that visit. Visits tend to be brief and procedural in nature.
Medicaid, an insurance program for low income persons, pays for non-medical home care, home health care and other in-home supports to help individuals remain living in their homes. However, Medicaid rules are state-specific and therefore eligibility and benefits change in every state. When Medicaid provides care outside of nursing homes, it is referred to as Home and Community Based Services (HCBS). HCBS can be covered under Regular Medicaid, often called State Plan Medicaid, or under Medicaid Waivers, also called 1915 Waivers or HCBS Waivers. Regular / State Plan Medicaid is an entitlement program, but waivers are not entitlements. A limited number of slots are available and waiting lists are fairly common. Most states cover home care for the elderly (both non-medical and home health) in both their State Plan and their waivers.
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. Viatical settlements 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, life settlements and conversion programs.
Accelerated death benefits and death benefit loans 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.
Loans specifically designed for elder care are an interesting financial product. These loans are intended for short term needs while a family is waiting for other financing to become available. 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 adult children. Finances will become available it is just a matter of when the home will sell.
Families can self-pay for care by using their home as a financial resource. Two options include reverse mortgages and home equity lines of credit. However, depending on one’s marital status, their severity of need and the projected length of need, these options might not necessarily make 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 reverse mortgage is probably not the best option.
Infinity Payment Options
Infinity Healthcare Services works with patients and their families to provide home healthcare services on a private pay or self–pay basis. Sometimes private pay becomes necessary for either skilled medical or non-medical care services that are not covered by insurances, third party payer source, or Medicare and Medicaid.
Infinity Healthcare Services works with wartime veterans and their surviving spouses, 65 years and older, who may be entitled to a tax-free benefit called Aid and Attendance provided by the Department of Veteran Affairs. Part of the Veterans Benefit Program, is designed to provide financial aid to help offset the cost of long-term care for those who need assistance with the daily activities of living such as bathing, dressing, eating, toileting, and transferring.
Infinity Healthcare Services currently accepts Medicaid Waivers which help provide services to people who would otherwise be in a nursing home or hospital to receive long-term care in the community. Although there are waivers for many conditions, our focus is towards waivers for people who have intellectual disabilities, developmental disabilities, and autism.
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 or if permitted to do so, their premiums would be cost prohibitive. For this reason, our discussion of LTC insurance is relevant only to persons doing very long term planning.