PROFESSIONAL IN-HOME CARE
Step 4: Understand the costs.
Note: This particular section of this resource primarily pertains to people residing in the United States. If you live outside of the U. S., coverage and cost of in-home care may be different and it will be helpful to explore the specific options available in your area.
If I am paying out-of-pocket for in-home care, how much does it cost?
The large majority of non-medical in-home care is paid for privately, out-of-pocket. How much this costs varies greatly depending on where you live, as well as what kinds of services they are providing— for example, companionship and home helper services versus personal care; care during the day versus overnight. Another factor is whether you are hiring a caregiving agency versus a private duty / independent( not through an agency) caregiver. It can be $ 15- $ 40 per hour. Or more or less! Again, it varies greatly. Generally and unfortunately, the cost of professional care has been increasing in recent years.
Will my insurance cover in-home care?
• Medicare and private health insurance: Medicare and most private health insurance typically do not cover in-home care.
Medicare and private health insurance will, however, cover“ Home Health.” Home Health includes skilled nursing services and rehabilitation( physical, occupational, speech therapy) in the home. Home Health requires a referral from a doctor or advanced practice provider( physician assistant, nurse practitioner). Someone may be referred to Home Health while recovering from a hospitalization, illness or injury. It is also common to refer to Home Health if a person would benefit from rehabilitation therapies but would have too much difficulty getting to an outpatient clinic and is in need of therapies in the home. To qualify, the person must be felt to be“ homebound,” meaning that it takes considerable effort and special assistance to leave the house. While someone is getting Home Health, they may also qualify for an in-home aide, but this is often only for personal care( bathing a couple of times per week), and they will usually not be able to offer respite or home helper services. This is temporary, until the person is discharged from Home Health.
There is a tendency to hear the terms“ home health” and“ in-home care” used interchangeably, which leads to the frequent misconception that insurance covers home care. It is also common to hear people refer to in-home care as a“ nurse” or“ nursing service,” when most in-home care is not skilled nursing care. Unfortunately, insurance representatives are also sometimes not clear on the differences in terms and may mistakenly tell someone that their insurance covers in-home care, when they are in fact referring to Home Health.
• Medicaid:
Medicaid can often cover in-home care. This can include such programs as Personal Care Services( PCS), CAP in-home, or Special Assistance. Talk to your Medicaid worker about what programs are available in your area and what you may be eligible for. If you do not have Medicaid, contact your county’ s Department of Social Services to see if you may be eligible and how to apply.
• Long-term care insurance:
Long-term care insurance does cover in-home care services. If you have paid into long-term care insurance, how much care will be covered and for how long will depend on your individual plan. You will have to contact your long-term care insurance company / agent to inquire about how and when to activate services and what your coverage will look like.
Are there other programs that cover or offer in-home care?
• Hospice:
For people under the care of hospice, the hospice agency can often offer a nursing assistant for baths a few times each week. They may also have a volunteer program where a volunteer can sit with someone and provide companionship for a couple of hours. Many families will still hire in-home care services when under hospice care.