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Where To Find In-Home Care Financial Assistance?

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In-home care is powerful, providing support where seniors need it the most – in the comfort of their own homes. This type of support can help seniors to remain independent for longer, while also protecting their health. 

However, in-home care can also be frighteningly expensive, sometimes costing more than $4,000 per month. Even paying for just a few hours of support for a week might be far beyond a senior’s budget, particularly if they are relying on Social Security. 

Financial assistance programs can make a big difference. Some financial assistance programs provide cash support that seniors can direct as they need to, while others provide specific care services. Many of these programs won’t completely pay for all needed home care services, but they’re still powerful, even if they just decrease costs a little. 

 

What are the 2 Types of In-Home Care?

At its heart, home health care includes any professional support that helps people to remain safely at home. 

However, it can be broken down into two main types: 

1. Skilled Medical Care

Medical care involves specialized support from licensed individuals, including nursing assistants, physical therapists, and sometimes registered nurses. 

This type of support is particularly common for seniors who have been recently discharged from the hospital, have had a serious injury, or need to be carefully monitored. Services include working with colostomy bags, catheters, and ventilators, physical or occupational therapy, wound dressing, and pain management. 

Because the work is highly skilled, this type of home care support tends to be expensive. 

2. Personal Care

This is the non-medical aspect of care. Personal Care focuses on the activities of daily living (ADLs) and the instrumental activities of daily living (IADLs). 

ADLs refer to the basic tasks of self-care, like walking, bathing, and eating, while IADLs are the more complex tasks around the home, like managing medications, finances, and shopping. 

Paid caregivers can help in all of these areas. However, the specific services may differ depending on who is hired. 

For example, some home care staff may focus mostly on the IADLs, while others may offer ADL support as well. It may even be necessary to hire different people for different roles. 

How Much Does In-Home Care Cost?

The cost of home care varies dramatically and is influenced by the type of care, the specific services needed, and care frequency.

For example, costs may be relatively low for a loved one needing non-medical home care for a few hours a week, but much higher for someone needing hours of medical care each day. 

Some seniors may also need a combination of both types of support, which influences the cost. 

What are the Government-Focused Financial Assistance programs?

1. Medicare

Medicare provides limited support for home care, generally for homebound seniors. This can include skilled nursing care, occupational therapy, and related support services. Routine medical care may sometimes be provided too, but only in some circumstances and often not in the long term. 

Indeed, Medicare will generally only cover home health care when it is considered a medical necessity. As a result, it’s often difficult to get any coverage for in-home care through Medicare. 

Medicare Advantage

Medicare Advantage (MA) plans provide more flexibility because. These are able to provide supplemental health care benefits, which can sometimes mean that in-home support is provided as well. 

The services vary considerably from one plan to the next, making it crucial to look carefully at what each plan offers. Plus, Medicare Advantage and supplemental health care benefits are relatively new areas, so there may be changes as time goes on. 

Program of All-Inclusive Care for the Elderly (PACE)

These Medicare-based programs are available in some states and require seniors to meet specific requirements. 

In particular, they must be:

      • Aged 55 or above
      • Certified as needing nursing home care by their state
      • Able to live safely in the community when they first enroll
      • Low-income and eligible for Medicare or Medicaid

PACE programs cover a variety of services that support independence, including home health care, social services, respite care, adult day care, and nursing home care when this is needed.

Even seniors with Alzheimer’s disease or other forms of dementia can be eligible for PACE services. 

 

2. Medicaid

Medicaid mostly focuses on short-term care, largely for people who have recently been in a skilled nursing facility, hospital, or similar location. Various services are covered, including both ADLs and IADLs assistance, durable medical equipment, physical therapy, transportation, and adult day care. 

However, there are a variety of limitations and restrictions, such as how traditional Medicaid only supports people with severe medical conditions, particularly those who would normally be eligible for a nursing home stay. 

The funding is also specific to home care agencies certified by Medicaid. This means that Medicaid’s funding can’t be used to hire family caregivers or those from non-Medicaid-certified companies. 

Medicaid rules vary between states, which can result in differences in eligibility, health care services, levels of coverage, and more. 

3. Home & Community-Based Services (HCBS)

These services are also known as Medicaid waiver programs. They’re one of the most common sources of home care financial support, as they go beyond what Medicaid offers. 

Waivers aren’t considered an entitlement program which means that meeting eligibility requirements doesn’t guarantee the services. Instead, there’s a limited number of slots and seniors often need to join a waiting list. 

All states operate at least one Medicaid waiver program type for in-home care, though many states offer multiple programs.

Differences in requirements mean that some seniors may be eligible for one service and not another. Some may also be more useful, depending on how well the support matches what the senior needs.   

4. Veterans Benefits 

The Department of Veterans Affairs (VA) also provides home care support through a few different programs

 
VA Pensions

Veterans can be eligible for non-service connected pensions, where the required care doesn’t need to result from service.

There are multiple tiers, depending on whether the veteran is healthy, if they require some ADL assistance, or if they are completely housebound. 

Details about pension rates and requirements can be found on the va.gov site

Veteran Directed Care Program

There is also a Veteran Directed Care Program, which provides veterans with more control over the care they receive. 

 

5. Non-Medicaid State-Specific Programs

States often have their own assistance programs for low-income seniors, particularly those who don’t meet Medicaid requirements. These programs aim to help seniors remain at home, rather than in nursing homes. 

There are vast differences between the programs, with eligibility, funding sources, and specific benefits varying from one program to the next. How they function varies as well. 

For example, some programs provide cash support, while others provide specific services instead. Those services may be related to ADLs or they may focus on non-care services. Financial support for home modifications might be offered as well. 

State sites and local area agencies on aging (AoAs) can help you to find the programs for your region, along with any requirements. 

 

Personal Approaches to Financial Assistance 

The financial assistance programs we’ve been talking about so far are all helpful, but they won’t be relevant to everyone.

Eligibility is often an issue, especially for seniors who have too much income or assets to be eligible for Medicaid. Seniors may sometimes need to take other approaches. 

Long-Term Care Through Insurance

Some life insurance policies have a long-term rider, allowing seniors to use some of the death benefits for long-term care. It’s also possible to purchase long-term care insurance, which is specifically designed for seniors who may need long-term care. 

Both approaches can be powerful but have their limits too

For one thing, such policies are often much more expensive than regular health insurance and seniors may be paying for them for years before they need long-term care. The premiums could also increase over time, making things even more complicated. 

Even if seniors can afford this type of policy, they may not be eligible. Many people get declined, especially if they have significant health problems. 

Using the Home

Seniors may also use their houses to pay for home health care services. This includes taking out a home equity loan or a reverse mortgage. However, such approaches come with risks. 

Reverse mortgages are challenging because many vendors use them to run scams. They’re also complicated and can be difficult to understand. If you’re considering this approach, it’s important to find a federally approved program and go through educational sessions to understand exactly what is involved.

A home equity loan is helpful only if the senior’s care needs are appropriate for the equity in their home. This is where problems arise, as the senior might need considerably more care or may live longer than expected. Both situations could lead to the home equity running out when the senior still needs care.  

Sibling and Family Agreements

It may also be possible to get family members on board with paying for care. This might involve setting up a joint agreement where people contribute financially every month, then that money can be used to pay for care.  

This approach could be particularly good when no one is available to act as family caregivers, but adult children do have financial resources. 

What Are Other Forms of Support?

While there are plenty of financial assistance programs and other options, these won’t always be enough. The care recipient might struggle to meet eligibility requirements or the money provided may simply not be enough.  

It may be important to turn to other types of support as well, like the following:

  • Getting Family Involved
    Having family caregivers can decrease the amount of paid caregivers needed, which makes a huge difference financially. It may even be possible to focus first on family caregiving and use paid services mostly as a form of respite care.

    A senior could also use some of their supplemental security income (SSI) to pay a family member to care for them, perhaps at a reduced rate than a professional caregiver.

  • Support Programs 
    • Support programs like the supplemental nutrition assistance program (SNAP) or Meals on Wheels. 
    • Support programs like these help to cut down costs and free up more resources for home care.

  • Adult Daycare
    • These programs provide various support services, including meals, social activities, and even some health care services. These can be helpful for giving family caregivers a break and lowering home care costs.  
    • Other community-based services and supports. It’s always worth talking to your local area agency on aging (AoA) to see what is available in your area. The site eldercare.acl.gov is powerful too, helping to connect you with local care programs and even providing contact information. Even if the services can’t help with home care specifically, they could reduce financial strain elsewhere or help support family caregivers. 

Final Take-Aways

There are many financial assistance programs to support seniors at home, including those that help low-income seniors and their family members. However, the availability and eligibility requirements of these programs vary depending on where you live.  

As such, you’ll need to research the options for your state. You could also talk to experts in your local area about what is available and which programs your loved one may be eligible for. 

Getting skilled advice is crucial, as Medicare, Medicaid, and related programs can quickly get confusing. Sometimes care recipients aren’t eligible simply because they applied for the wrong type of coverage

If the costs are high and you’re not finding many options for support, you may need to consider whether home care is the right choice for your loved one. While many seniors want to age at home, doing so can get expensive fast and may not even be the healthiest choice. 

After all, if they need a lot of help from family caregivers and paid support services, it may be time to move to a more specialized environment, like assisted living.

Angelica P. Herrera-Venson

Angelica P. Herrera-Venson, DrPH is a gerontologist, public health and Medicare expert, and published researcher in family caregiving and chronic health conditions. She is the author of The Multicultural Guide to Caregiving and has held prestigious fellowships, including the Health Policy & Aging program and Geriatric Psychiatry fellowship from the National Institute of Mental Health. Angelica was an Associate Director at the National Council on Aging and has worked extensively with Medicare and Medicaid dual-eligible patients. She is currently the owner of Kapok Aging & Caregiver Resources, a hub for caregivers from around the world.

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