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HOW TO PAY FOR CARE AT HOME
HOW TO PAY FOR CARE AT HOME

How will I afford all this?

When an individual is extremely frail due to aging, or has a chronic or advanced illness, finding and paying for home care and other long-term care services are often of great concern.

How much will we need to spend?

The median rate for homemaker services and home health services in suburban areas of New York City each amount to more than $50,000/year (2016) for a 44-hour week; the median daily rate for a nursing home in outer New York City is $423 amounting to $154,213 annually. (Source: Genworth Cost of Care Survey)
Where can we get the funds?
The following are different ways to pay for home health care, either short-term skilled home care or long-term custodial care.

Medicaid pays for long-term custodial care at home and in a skilled nursing facility but places limits on the amount of income and assets a person may have. The number of hours and use of a Personal Care Assistant (PCA) or a Home Health Aide (HHA) is determined by the doctor’s orders and the evaluation by the Department of Social Service (DSS) Nurse. The PCA or HHA may come from a Certified Home Health Agency (CHHA) or a Long-Term Care Program. Medicaid eligibility differs from state to state. Learn More about Medicaid eligibility and coverage in New York State.

If you are aged 21 or older, live in Westchester, and need community (home) based long-term care services for more than 120 days, you will be asked to join a Managed Long-Term Care Plan. With Medicaid you may also be able to receive financial assistance for food through SNAP and additional light housekeeping through EPIC.

Hospice Benefit (paid for by Medicare, Medicaid, or private insurance) provides a limited number of hours (usually four hours per day) for custodial care in the last six months of life for individuals enrolled in hospice.

Private Pay (out of pocket) can be from personal savings and income, life insurance, reverse mortgage, or other financial vehicles. If you hire an aide privately, you are responsible for paying taxes and insurance for that person, as required by law. To find reliable aides, you can ask for recommendations from friends, houses of worship, and local aging-in-place organizations. 

Long-Term Care Insurance (LTCI) is a form of insurance specifically designed to pay for custodial care (at home or in a skilled facility). The policy must be purchased and in place before the diagnosis of a chronic or serious illness. If you have LTCI, contact your agent to discuss what your policy covers (dollars per day, per year, and per lifetime), how to activate the policy, and what your options are. Most LTCIs require that you hire an HHA from a Licensed Home Care Services Agency (LHCSA).
Details about long-term care insurance.
Article about whether it may be right for you.

Prescription Drug Assistance is available through RxAssist and FamilyWize.
Medicare – Home Health Care Benefit
Medicare may pay for home care (at home or in a skilled nursing facility) for brief periods of time. This care is designed to meet the needs of an individual after an acute (short-term) illness or injury. Services are delivered with the expectation that skilled care and rehabilitation therapy will restore the person to the same function as before the acute event, and that the services will end in a reasonable and predictable period of time. The benefit is rarely approved for more than 60 days. 

The Bad News
Medicare does not provide coverage for homemaker services such as shopping, cleaning, or laundry, nor does it pay for help with personal care such as bathing, dressing, or toileting when this is the only care that you need.

Assistance with activities of daily living and housekeeping are custodial care services, and Medicare does not pay for custodial care.

Worth Repeating
Medicare Home Health Care Benefit Coverage is only available if you also require skilled care. Services that could be safely done by a non-medical person, or by yourself, without the supervision of a nurse, are not considered skilled care.

If You Need Skilled Care, the Good News
Medicare covers skilled care to maintain the functional status of persons with chronic conditions. Coverage does not depend on a beneficiary’s potential for improvement, independent self-care, or return to prior level of functioning.

Medicare pays for skilled nursing and therapy services to prevent or slow the deterioration of an individual’s condition. You can continue to receive home health care services for as long as you continue to qualify.

Medicare pays for the full cost of home health care except for the 20% co-payment for durable medical equipment.

Medicare Part A covers the first 100 days of home health care after an inpatient hospitalization of at least 3 days, or a skilled nursing facility stay after a hospital stay. Additional days are covered under Part B. There is no prior hospital stay requirement for Medicare Part B coverage of home health care.

Home health care services covered by Medicare
  • Skilled nursing care – Examples of skilled nursing care include tube feedings, injections, wound care, observation & assessment of condition, and management of care plan.
  • Home health aide services if you require skilled nursing and therapy services.
  • Skilled therapy services for maintenance or rehabilitation purposes. Examples of skilled therapies include physical, occupational, and speech/language therapy.
  • Medical social services
  • Medical supplies and durable medical equipment
Qualifying for Medicare Home Health Care

You must be home bound:
  • You require assistance of equipment (walker, wheelchair, crutches) or another person to leave home.
  • It is difficult for you to leave your home and you do not routinely do so.
  • Your doctor determines that leaving your home would be harmful to your health.
You require intermittent skilled care:
  • Skilled care refers to nursing care or rehabilitation therapy.
  • Intermittent care means skilled services once every 60 days to once daily for three weeks (or longer for a finite and predictable period).
A physician must certify that:
  • You are homebound and require intermittent skilled care.
  • A plan of care has been made and is regularly reviewed.
  • A face-to-face encounter has confirmed that you qualify for home health care.
You must receive care from a Medicare Certified Home Health Agency (CHAA).

Duration and Frequency of Medicare Home Health Care Services
  • Medicare beneficiaries typically receive four to ten hours per week combined of nursing, therapy, and home health aide services.
  • Your doctor must approve a new plan of care every 60 days for you to continue to qualify for Medicare home health care.
  • Medicare will pay for up to 28 or 35 hours per week of home health care services based upon your need.
NOTE: If you are advised that your maintenance or rehabilitation services are to be discontinued, request written notice. The notice should state the reason for termination and the appeal process. Ask your doctor to write in support of necessary care.

Additional Information about Medicare
For information about the Medicare home health care benefit and appeals, we recommend the following links:

Medicare Rights Center (MedicareInteractive.org)
800-333-4114

Medicare (Medicare.gov)
800-633-4227

Center for Medicare Advocacy (MedicareAdvocacy.org)
860-456-7790

877-574-8529
Who can help us figure out what is best for us?
You may wish to minimize the impact on your wealth, or you may require public entitlements to finance your care. Consultation with local professionals who know the day-to-day reality of accessing and paying for long-term care services can help you to make the most of what you have and to get you what you need.

A financial planner who is sensitive to issues unique to a person with ALS, Parkinson’s, Cancer, Alzheimer’s, and other terminal illnesses associated with staggering care costs can help you avoid making bad financial decisions under emotional duress. An Elder Law Attorney has expertise in estate and Medicaid planning. A Geriatric Care Manager, or an expert in Medicaid solutions, can help you navigate the long-term care system. Illness-Specific organizations, Aging-in-Place organizations, and Westchester County services are useful resources for information and referrals, problem solving, care planning, and financial assistance.
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