In-Home Elder Care: Costs, Planning, & Selecting Care

Roughly 1 in 3 people caring for someone at home (versus a nursing home), said they had hired paid help in the past year, according to a 2015 survey by the AARP Public Policy Institute and National Alliance for Caregiving.

The median cost nationwide for home health aide services is upward of $125 per day (assuming 44 hours of care per week). The median cost for assisted living is comparable to 44 hours of home care a week (though far less than a nursing home), according to the Genworth 2016 Cost Care Study (costs vary by region, number of hours and level of care needed).

The following tips show you how to afford home care—whether you plan ahead for elder care or find yourself in need of help now:

FOR THOSE WHO CAN PLAN AHEAD FOR ELDER CARE

If you’re in your 50s, hooray! You’re in your prime for advance planning to hire a home care worker when the time comes. You can invest; check out long-term care and life insurance policies with in-home care benefits (perhaps through an employer); and explore other products to mitigate the high costs of home care.

The point is that you don’t want to wait until you need it—you want to be proactive about planning. A sign of this trend, the average age for purchasing long-term care insurance has dropped from the 60s to 57.

Policies may include an elimination or waiting period before long-term benefits start, but it’s wise to consider long-term policies. The average claimant on a long-term care policy is 80+. Since you may pay premiums for decades, it’s wise to take time to compare policies and get the benefits you think you’ll need and can afford, long-term.

In the past, most long-term care policies were nursing home only; however, policies are changing to meet current demands, offering more comprehensive solutions in a variety of settings. Ultimately, do your homework to determine if long-term care insurance is right for you. Some people, for example, those with a pre-existing condition, are not able to qualify for, or afford lomg-term care insurance.

IF YOU NEED HELP NOW

If you’re older and need help paying for in-home care sooner rather than later, you can start with searching for services by location on the federal site: eldercare.gov. Other great resources include benefits.gov and the National Council on Aging’s BenefitsCheckup.org, where you can determine which programs you qualify for.

You can also search for services by location using the Eldercare Locator on eldercare.gov.

Homemaker services cover help with such tasks as eating and bathing, cooking and cleaning, and running errands. Home health aides provide a range of both non-skilled and skilled medical services, from checking vital signs to nutrition therapy and wound care.

Medicare pays for medically necessary home health care, on a limited basis (but not for homemaker services). Furthermore, Medicare supplemental plans and health insurance through an employer generally do not cover home care.

Medicaid, the joint federal-state program for low-income individuals (or in some cases those with high costs), does pay for in-home care, some residential and assisted living care, and nursing home care. It is important to remember, however, that each state runs its programs differently and eligibility and benefits vary.

Eligible veterans may qualify for several Department of Veterans Affairs programs , including Aid and Attendance, Housebound, Home and Community Based services, which help to pay for in-home elder care.

Finally, seniors should look into the Program of All-Inclusive Care for the Elderly (PACE), a small but growing Medicare and Medicaid program aimed at keeping frail seniors out of nursing homes. It covers in-home care, checkups, dental and doctor care, hospital and nursing home stays, prescriptions, and even some transportation.

To be eligible, someone must be 55+, be certified by their respective state as “in need of nursing home-level care,” and live in an area with a PACE organization. People with Medicare or Medicaid, or both, can qualify; however, some may be charged a monthly premium. Those not covered by Medicare or Medicaid can pay privately.

Although PACE has been around for decades, only 40,000 people were enrolled as of Jan. 1, 2016. More than 110 organizations offered PACE programs in 32 states as of March 2016.

Individual or group life insurance policies may have cash value the owner can use toward qualified home care expenses. With an accelerated death benefit, the company pays actual charges for long-term care up to a certain amount per day or month. It’s typically capped at 50 % of the death benefit.

A reverse mortgage could provide cash for home care; however, the homeowner remains responsible for taxes, upkeep, and other bills. Experts also warn that individuals can run out of equity in their home and still need care. It’s important to research reverse mortgages to see if they are right for you and take advantage of revere mortgage counseling.

The majority of people who have home care are private pay. People cobble together a budget from savings, long-term care, life insurance and annuities, reverse mortgages, or home equity loans.

If you’re hiring and paying for home care for medical reasons or because the recipient is in the early stages of Alzheimer’s or dementia, you may qualify for federal tax deduction, just as if the loved one were in a nursing home. An adult child may get a tax break if the parent can be claimed as a dependent. (The adult child must meet certain criteria, including that the family caregiver must be providing over half of the care recipient’s financial report.).

THE VALUE OF COMMUNITY SUPPORT

Community resources can prove exceptionally valuable. Don’t overlook churches, synagogues, the United Way, the local Area Agency on Aging office, or senior centers.

These organizations can help with obtaining adult day care, meal delivery programs, and grants for home modification, weatherization, and assistance with heating bills. Such assistance may be enough for you or your loved one to remain independent and at home.

If you’re the family caregiver, you may be eligible for a voucher to pay a neighbor or friend to help out.

Respite care vouchers are funded by the federal government as well as by private organizations, including Easter Seals, the Alzheimer’s Association, and the ALS Association.

CHOOSING AN ELDER CARE PROVIDER

Choosing an elder care provider is an important decision. The following steps can jumpstart the process of trying to find the right care:

  • Create a list of care needs. Before contacting prospective providers, create a list of care needs and how you expect those needs to be met.
  • Call first. Before scheduling face-to-face meetings, call and screen home care providers. Determine the scope of services they offer and if it meets your specific needs find out what kind of help they offer and if it meets your specific needs.
  • Interview at home. Meet with prospective home care agencies or providers in your home. Prepare a list of questions beforehand. Consider asking a third person to join you so that after interviewing prospective agencies, you can compare and discuss your impressions together.
  • Check references. While some agencies conduct criminal background checks on their employees, it is still a good idea to speak with others who have used the provider’s services.
  • Share information. The more care providers know about the individual they are caring for, the better care they can deliver. Organize and share information about your loved one’s personal preferences and background.