Paying for Home Care
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by Carepathways & Homecarefiles
Skilled Care and Supportive or Custodial are the two main types of home care services. Skilled care as a rule is provided by certified Home Health Agencies and focuses more on medical aspects of care. Medicare, Medicaid and private insurances usually reimburse for skilled care. Custodial or supportive care ranging from personal care to companionship needs is provided by Home Care Agencies and is not deemed medically necessary. Unskilled or custodial supportive care is not reimbursed by Medicare and private insurances but instead usually paid with private funds.by Carepathways & Homecarefiles
Nurses and physical therapists along other skilled disciplines provide intermittent services to homebound patients under physician's orders. Medicare, Medicaid and private insurances reimburse for skilled care when provided under an authorized plan of care and the Home Health Agency meets federal guidelines. Home health aide services may also be covered by Medicare and insurances when they are supplemental to skilled care. Aide services include personal care and other assistance for a few hours at a time, specified days per week and within a certain period of time while skilled care is ongoing.
Custodial or supportive care may likewise be provided by home health aides in addition to other certified nurse assistants, personal care aides, homemakers and companions. Private pay services through a Home Care Agency can also include personal care similar to Home Health Care Agencies as well as ambulation assistance, meal preparation, housekeeping and transportation. Privately paid for services are often what are needed most when caring for a loved one at home.
A key distinction between aide services provided by personal Home Care Agencies and aide services provided by certified Home Health Care Agencies is with regard to whether skilled care is required. Simply put when aide services are not supplemental or additional to ongoing skilled care then this care is not eligible for reimbursement. Furthermore reimbursed aide services are only provided intermittently for a certain duration following an authorized plan of care. When skilled nursing is ordered an aide may also make home visits to help with personal care until skilled nursing is no longer required. On other-hand private pay aide services can be arranged for a few hours up to 24/7 without regards to an authorized plan of care.
Many families and older adults are surprised to learn that home care services often are not covered by Medicare or other insurances. The reality is that even when services are reimbursed it is only for short duration with adherence to very strict guidelines. Privately paying for home care when not considered skilled is more then likely however there may be some private resources available. Check with local Area Agency on Aging as they may be able to refer you to home care assistance programs in your area.
Medicaid programs designed for lower income individuals will usually cover skilled home care and often unskilled personal and homemaker services depending on each situation. Medicaid is a joint federal and state managed program causing individual requirements for eligibility and actual home care benefits to vary widely from state to state. Contact your local social services and health departments about home care programs offered in your area through Medicaid or other local funding available. Local chapters of some disease oriented organizations like Multiple Sclerosis society, Alzheimer's association or charities like United Way sometimes assist with home care funding. Furthermore when criteria for Hospice homecare is met then Medicare, Medicaid, and private insurances will usually reimburse for needed services.
Agency rates for nursing aides range nationally from $12.00 to $25.00/hr and even vary within the same locale. Likewise RN and LPN home care rates vary considerably based on geographical area anywhere from $20.00 to $40.00/hr. Therefore it is always wise to call several agencies for quotes in your area and ask if a minimum duration of time (i.e. 2hr or 4 hr blocks) or frequency (i.e.2 or 3 times weekly) required. Some offer per visit rates for specific task such as bathing which may better fit your needs and budget as well.
Privately hiring a caregiver is another option that may be more cost-effective however encompasses additional employer responsibilities. Paying a referral fee for a caregiver through a staffing agency or registry where you then become the actual employer is still another option. The pros and cons of privately hiring a caregiver need to be considered extensively. Weighing these pros and cons against each other is further explored in "Should I Hire In-Home Help Privately or Through an Agency?"
Date added: 03/29/2012
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