What Does Home Care Cost?

Many families would prefer to keep aging relatives at home instead of arranging for them to stay in a nursing home or assisted living facility. Even great nursing homes can seem a little stiff and impersonal – and they are often very expensive. But caring for the elderly at home can also be expensive. The do-it-yourself approach is the preferred method for many people and there are financial aid options and tax cuts available for those who choose to take this path. Here’s some more in-depth info on home care cost.

Home Care Cost Average

While home care cost will differ significantly depending on where you live, the best way to get an estimate is to figure out how many hours you will need per week. A senior who has significant health needs or can’t be left alone will obviously need more care than someone who is still in relatively good health. The national average cost of home care per hour is $20 per hour – that will vary based on where you live but you can at least get a sense of what the cost will be. It can range from $13 to $30 per hour depending on the state.

By comparison, the average resident at an assisted living community pays $3,628 per month and nursing homes can cost up to $253 per day. These costs are significantly higher than at-home care in most cases, unless you need live-in, round-the-clock care. Alzheimer’s and dementia care cost approximately $1,150 additional per month.

Home Care Versus Health Care

Home health care is actual medical care provided by a registered nurse, occupational therapist or another type of medical professional. Home health care can include therapy and nursing services, administration of medications, medical tests, general monitoring, and wound care. Home health is medical care and is often covered by medical insurance. Medicare will cover it when it is prescribed by a physician. Medicaid will cover it for qualified individuals. If it’s not prescribed, it is often paid for out of pocket. (see our article: what is home care?)

Home care is provided by caregivers who help seniors with daily living and companionship. It is not classified as medical care and is usually paid for privately. It is a helpful solution when a senior isn’t able to drive and needs transportation, lives alone and is isolated, or needs assistance with daily living activities like meal preparation, house cleaning, etc. Home care cost for private duty agencies and caregivers is less than for medical home care.

Who Pays for Homecare?

Homecare services can be paid for in a variety of ways. The patient or family can pay for the care themselves or they can rely on other resources. Generally, home health care, involving medical care, is more likely to be covered by public and private resources. Home care that isn’t prescribed and doesn’t include medical treatment is most often paid for by the patient or family. Here is some more info about the different resources seniors can look to for help in paying for home care cost and home health care cost.

Medicare

Most Americans older than 65 are eligible for the federal Medicare program. If an individual is homebound under a physician’s care and requires medically necessary skilled nursing or therapy services, he or she may be eligible for services provided by a Medicare-certified home health agency. Depending on the patient’s condition, Medicare may pay for intermittent skilled nursing; physical, occupational and speech therapies; medical social work; home health aide services; and medical equipment and supplies. The referring physician must authorize and periodically review the patient’s plan of care.

Medicaid

Medicaid is a healthcare program for low-income individuals. Patients will have to apply and meet the eligibility requirements of their individual state. Typically, home health services are only provided to patients who get federal assistance, like Social Security Income, or patients who are needy, such as aged, blind or disabled patients. Many seniors qualify for Medicaid, but because it’s up to the states to decide who receives it, individuals should look into the qualification requirements for their home state.

Older Americans Act (OAA)

Enacted by Congress in 1965, the OAA provides federal funds for state and local social service programs that enable frail and disabled older individuals to remain independent in their communities. This funding covers HCA, personal care, chore, escort, meal delivery and shopping services for individuals with the greatest social and financial need who are 60 years of age and older.

Veterans Administration

Veterans who are at least 50 percent disabled due to a service-related condition are eligible for home health care coverage provided by the Veterans Administration (VA). A physician must authorize these services, which must be delivered through the VA’s network of hospital-based home care units. The VA does not cover non-medical services provided by home health aides.

Social Services Block Grant Programs

Each year, states receive federal social services block grants for state-identified service needs. The government allocates these funds on the basis of the state’s population and within a federal limit. Portions of the funding often are directed into programs providing home health aide and homemaker or chore worker services.

Commercial Health Insurance Companies

Commercial health insurance policies typically cover some homecare services for acute needs, but benefits for long-term services vary from plan to plan. Commercial insurers, including Blue Cross and Blue Shield and others, generally pay for skilled professional home care services with a cost-sharing provision. Such policies occasionally cover personal care services.

Most commercial and private insurance plans will cover comprehensive hospice services, including nursing, social work, therapies, personal care, medications, and medical supplies and equipment. Cost-sharing varies with individual policies, but often is not required. Individuals sometimes find it necessary to purchase Medigap insurance or long-term care insurance policies, for additional home care coverage.

Medigap insurance is designed to bridge some of the gaps in Medicare coverage. Some Medigap policies offer at-home recovery benefits, which pay for some personal care services when the policyholder is receiving Medicare-covered skilled home health services. The policyholder’s physician must order this personal care in conjunction with the skilled services. Home care coverage in Medigap policies is not designed to cover extended long-term care. This type of coverage is most helpful to individuals recovering from acute illness, injuries, or surgery.

Long-term care insurance primarily was intended to protect individuals from the catastrophic expense of a lengthy stay in a nursing home. However, as the public need and preference for home care has grown, private long-term care insurance policies have expanded their coverage of personal care, companionship, and other in-home services.

Considerable care should be taken in selecting a long-term care insurance policy, as home care benefits vary greatly among plans. Consumers should be aware of limitations on coverage, such as prior hospitalization requirements, and pre-existing condition exclusions. Some policies may only pay for services that are already covered by Medicare.

CHAMPUS

On a cost-shared basis the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS) covers skilled nursing care and other professional medical home care services for dependents of active military personnel and military retirees and their dependents and survivors. CHAMPUS offers a comprehensive hospice benefit to its terminally ill beneficiaries, which covers nursing, social work and counseling services, therapies, personal care, medications, and medical supplies and equipment.

Workers’ Compensation

Any individual requiring medically necessary home care services as a result of injury on the job is eligible to receive coverage through workers’ compensation.

Individuals should contact their state health departments and local offices on aging for additional information on home care cost and means to pay for it.