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Opting for Home Care

While some retirees choose to transition to retirement communities when the time comes, many prefer to stay at home. Many people who choose this route rely on family for caregiving at first, but often reach a point where more advanced, frequent, or medically trained care is needed.

Retirees who prefer to stay in their homes can get at-home help at a variety of levels. Here’s an overview of your options for senior in-home care.

Types of Home Care

  • Non-Certified Aides. A non-certified aide provides non-medical personal care services that may include meal preparation, companionship, light housekeeping, laundry services, and so on. Some non-certified aides may perform heavier chores such as yard work and window-washing. Usually, non-certified aides do not provide personal care such as assistance with bathing, dressing, and bathroom activities. The skills and job duties of non-certified aides can vary widely depending on your agency and your state.
  • Certified Nurses’ Aides (CNA’s) and Home Health Aides (HHA’s). CNA’s and HHA’s undergo a similar certification process, although the process and requirements vary by state. Generally, they receive training in home care—although CNA’s may have slightly broader healthcare training. They provide assistance with activities of daily living, which may include personal care, health monitoring, nutritional help, medication assistance, bathroom activities, and light housekeeping in some cases. CNA’s and HHA’s usually work under the supervision of a doctor and comply with a formalized medical care plan.
  • Licensed Practical Nurses (LPN’s) or Registered Nurses (RN’s). These are the most medically qualified home care providers. Both LPN’s and RN’s must pass stringent state curriculum requirements as well as a standardized national certification process after completing a college degree in nursing. These professionals are able to provide advanced skilled nursing care, and RN’s are also able to oversee members of health care teams.

What’s Covered by Medicare

Medicare will cover home health care under certain circumstances. To receive coverage, your situation must meet all of the following criteria:

  • Your doctor decides that you require at-home medical care and creates a plan for this care.
  • You need skilled nursing care or physical therapy, on at least an intermittent basis.
  • The home health agency providing the staff to care for you must be Medicare-certified.
  • You usually cannot leave your home without help or considerable effort. You still fall under this definition if you leave home to receive medical treatment or adult day care, or for brief, occasional non-medical excursions.

If all the above criteria are met, Medicare will pay for:

 

  • Part-time or intermittent care from an RN or LPN.
  • Part-time or intermittent Home Health Aide (HHA) services under the supervision of an RN or doctor.
  • Physical therapy, occupational therapy, or speech-language therapy.
  • Medical-social services including counseling and resource assistance.
  • Some medical supplies, including wound dressings and durable medical equipment.

Currently, Medicare does not cover:

 

  • Most medications, except, in some cases, FDA-approved injectable osteoporosis drugs.
  • 24-hour at-home care.
  • Meal delivery.
  • Housekeeping services such as cleaning, laundry, and grocery shopping.
  • Personal care services from HHA’s if there is no RN or doctor supervision and this is the only care needed.

Other Sources of Funding

Medicare leaves gaps in senior home care coverage that can be significant for those whose needs don’t fall within its requirement boundaries. There are, however, a few other options for funding of home health care.

  • Older Americans Act (OAA). This program provides federal funding to state and local social service organizations that assist older individuals in maintaining their independence at home. Services covered include personal care services, chore assistance, mobility assistance, meal delivery, and shopping assistance. Usually you must demonstrate social and financial need and meet an age requirement of 60 or older. In some cases, you may be asked to contribute a percentage of your income toward the services. To find out about the OAA options in your area, check with your local Area Agency on Aging.
  • Community organizations. Some local organizations, as well as state and local governments, provide eligible people with assistance in paying for home health care. What’s covered varies from organization to organization, and may pay for some or all needed services. Most people find out about the options in their community by consulting with social workers, local aging offices, or hospital discharge planners.
  • Health insurance. Health insurance policies vary on how much in-home care they will pay for. Typical health insurance policies cover temporary home health care for acute needs, but long-term care may have to be purchased as a separate policy or rider. Some commercial providers will share costs on skilled professional home care and personal care services. Here are a few options for health insurance coverage.
  • Medigap. Medigap insurance fills some of the gaps left by Medicare coverage, including some personal care services if ordered by a physician in conjunction with skilled nursing. Generally, this type of coverage is better suited to those who need temporary care to recover from illness or injury, rather than long-term care.
  • Long-term care insurance. There are long-term care plans available that will cover personal care, companionship, around-the-house help, and other services. These plans vary greatly and may have coverage limits, and some only pay for what’s already covered by Medicare—so be sure to read the fine print when choosing a plan.
  • Managed Care Organizations (MCO's). These are group health insurance plans and they may sometimes provide home care coverage. If your MCO contracts with Medicare, it must offer all Medicare-covered home health options in your area.

At-home care can be the ideal solution for those who wish to live out their retirement at home. If you’re considering senior home care for yourself or a loved one, look into local paid agencies or your local government-run center on aging for resources. You can also speak with hospital discharge planners and social workers who specialize in elder care issues. The more time you can take to research the options, the better chance you’ll have of finding a solution that works for your budget—and your needs.

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