It’s a common assumption about private duty home care. “Medicare will pay for whatever home care I need. If I’m unable to get out of bed, shower or prepare a meal, it will cover the costs of having someone come in to help.” But the reality can be very different.
When is private care in the home covered by Medicare? Only when Medicare requirements for skilled nursing care or therapy are met and when that care is ordered by a physician. These services are most often provided under the care of a registered nurse, physical therapist, or occupational therapist. In addition, the patient must be homebound, under treatment by the physician with a documented care plan and require intermittent care for a finite amount of time.
Caregiver services, such as those that assist people with activities of daily living such as bathing, dressing, eating or toileting, are not covered by Medicare. Neither are simpler tasks which can be completed by a companion, such as transportation to appointments, meal preparation, light housekeeping or taking care of pets and houseplants while someone is unable to move around the home. Caregiver and companion services, together known as “private duty home care,” are expected to be paid out-of-pocket by the patient or patient’s family. Or, family caregivers may step in to help.
Those who need assistance with daily tasks such as dressing, showering and meal preparation, either on a short-term or a long-term basis, may find themselves in a quandary. How do I pay for the private duty home care that I need?
There are generally four options, depending on financial circumstances, but all of them are paid for out of pocket in some fashion.
1. Rely on family or friends, either paid or unpaid.
For our grandparents and those before them, unpaid care from family or close friends was expected… the norm. If the need for care is long-term, however, it puts a tremendous burden on the family caregiver. Burnout and the impact on their life can be severe. For those with the financial means, other solutions may be preferable.
2. Use an independent caregiver.
Paying someone by the hour can be a very affordable solution for care that isn’t covered by Medicare or other health insurance policies. If you are looking for a live-in or full-time caregiver in lieu of moving into an assisted living facility, be aware the IRS may consider you an employer, with heavy penalties for filing a 1099 instead of a W-2. Also, you will want to carefully vet and check the backgrounds of those whom you allow in your home to care for you or your loved one. For those relying on the family caregiver option, even the occasional support for respite care can be meaningful.
3. Hire a home care or personal care agency.
Some home care agencies offer both skilled and private duty health care, while others provide private duty health care only. Rates for an agency can be 20-30 percent more than an individual caregiver; however, these agencies should assure their caregivers are employed and therefore covered by the agency’s worker’s compensation policy. The agencies should be insured from a general liability standpoint, and licensed if required by the state in which they operate. Agencies can often provides a higher standard of care, thanks to the employee training and experience an agency can provide. Be sure to do your homework about agencies you are considering to make sure they meet your expectations in all of the areas listed above. (Learn about the pros and cons here.)
4. Join a continuing care at home program.
While it’s not a choice for those who need immediate home care, there’s an additional option for someone who is currently independent but looking for a proactive solution for their future care needs. Continuing care at home (CCaH) programs coordinate all necessary care and pay for some or all of it, depending on the plan selected. There’s no waiting periods or maximum coverage limitations.
CCaHs are only available to those able to live independently at the time of enrollment, due to the health and financial criteria required for membership, but are a fabulous alternative to protect one’s financial assets. If a member’s need grows from in-home care to assisted living or memory care, it’s all inclusive.
“We focus on the best quality of care possible, and optimal quality of life while receiving private duty home care services,” says Jermicka Juniel, clinical services manager for Sun Health Supportive Services, provider of Arizona’s only CCaH.
“Whether you need fifteen minutes four times a day or around-the-clock memory care, we can do it for our members. We’re able to be completely flexible and far more attentive with our services than most private duty care agencies can provide.”
Additionally, CCaH plans focus on maintaining health and independence, rather than illness and recovery, which is extremely attractive to those looking for an aging in place solution to remain in their own homes throughout their retirement years.
Sun Health at Home is the first CCaH program in the southwestern United States, and the only one available in Arizona. Learn more about the program and its services at http://sunhealthathome.sunhealthseniorliving.org/ or by attending a no-obligation discovery seminar near you.