Considering Home Care? 6 Things to Know

When a loved one needs in-home care, it's important to make an informed decision.

July 31, 2022

If a loved one is struggling with normal daily activities such as bathing and getting dressed, they may need home care. Arranging for home care is complex, especially if the patient is reluctant to accept help. As you begin the process, here are six things to keep in mind:

1. Your loved one's health insurance benefits may not cover home care.

Commercial health insurance plans rarely cover home care services. Medicare only covers temporary home care services, typically after a loved one is discharged from a hospital or rehab center. State Medicaid benefits may provide up to 24/7 homecare for patients who meet financial qualifications, but the enrollment requirements can take 3-4 months. Veterans may be eligible for home care programs through the VA.

Even if the patient has a long-term care plan, there may be a waiting period before it kicks in — and you may be required to pay the agency up front and then seek reimbursement.

2. Using a private home care agency is different from "hiring privately."

A private home care agency is a business that employs caregivers and sends them to patients' homes. Private home care agencies do not typically accept Medicare or commercial insurance plans, although some accept Medicaid plans. Out of pocket costs can range anywhere from $25-$40+ per hour and $300-$550+ per day, with additional fees for nurse assessments and nurse visits. This option is typically more expensive, because the agency handles many of the details. 

“Hiring privately” refers to hiring a helper on your own. This could be a friend, neighbor, or someone you find online. You and the helper will agree on a rate and arrange the schedule. In this situation, you are the helper's employer, so make sure you understand your role when it comes to labor laws, liability, insurance needs, etc.

3. Check when your loved one last saw their primary care physician.

Make sure that they have a primary care physician, and that they've seen this doctor in the past 3-6 months. If you plan to work with a home care agency, you may need a referral from the patient's PCP. The agency can assist you in obtaining the necessary paperwork, but the process will take longer if the patient doesn't have a PCP or hasn't seen them recently.

4. Understand the level of care your loved one needs.

Choosing the right amount of care can be challenging, particularly if your loved one doesn’t want the help. Find ways to balance their wishes with the level of risk involved if no help is available. If your loved one resists having a helper at home, look for less intrusive ways to keep them as safe as possible. Then, continue to watch for signs that it’s time to bring in a helper or increase the level of care.

5. Once you know the costs, you can plan for the future.

As you make decisions about home care, it is essential to have a full understanding of the financial and other resources available to you over the coming months and years. An elder law attorney can help you with financial planning regarding your loved one's care needs. They can also assist with applications for Medicaid if needed.

6. You don't have to figure this all out on your own.

Making informed decisions about home care involves researching your loved one's health insurance coverage, talking to their doctor, identifying the best home care agencies in your area, and making the patient's home as safe as possible. It's a lot to manage, and family dynamics often add another layer of complexity.

For help getting your loved ones the great care they deserve, reach out to an expert health advisor. Health advisors provide concierge services, impartial insights, care coordination, and ongoing support, simplifying the process every step of the way.

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