What Are the Options for In-Home Care?

For most families helping older adults, it will be an out-of-pocket expense

Part of the Transforming Life as We Age Special Report

(This article appeared previously on the website of the PBS Newshour.)

Editor’s Note: Journalist Philip Moeller provides answers to questions on aging and retirement. His weekly PBS Newshour column, “Ask Phil,” aims to help older Americans and their families by answering their health care and financial questions. Moeller is the author of the new book, Get What’s Yours for Medicare and co-author of Get What’s Yours: The Revised Secrets to Maxing Out Your Social Security.

Rachel – Montana:  My mom is 83 and can no longer walk. She has not left her home for months. My dad is 86 and has taken on caring for her. She has all her faculties and still has a sense of humor, but has a lot of pain. She sits in her lift chair all day and sleeps in it. She has a potty chair that she keeps beside her, and she can get up from her lift chair to use the potty chair, but it’s very painful for her to do so, and she can be left in tears from the exertion. She has arthritis in her legs, knees and feet. She also suffers from lymphedema in her legs.

My dad says as long as he can take care of her, she’ll stay in their home, and she is adamant about staying in her home as well. But my dad has diabetes, his feet have pain and he has slowed way down physically as well. They are on Medicare, and I’d love to find some in-home care for them, especially my mom. My dad is able to get around, still drives, shops for groceries and does some cooking.

Medicare does not cover so-called custodial care in the home. Medicaid does cover such help, but a person must spend down nearly all assets to qualify.

What are some options for them to bring a CNA [certified nursing assistant] into the home to help them? This is new territory for all of us. My youngest son (26 years old) lives in an apartment next door to them, has been their main help for six years and has loved doing so. But things are definitely not the same as they were when he first moved there, and they need someone trained in home health care. I have no idea where to start. I live 300 miles away from them, and I worry constantly.

Phil Moeller: My heart goes out to Rachel and to the millions of other families facing similar challenges. She has poignantly described what will become a major, if not the major, aging-related challenge of our time. This is an issue that our Washington leaders should be tackling aggressively.

Medicare does not cover so-called custodial care in the home. Medicaid does cover such help, but a person must spend down nearly all of their assets to qualify for Medicaid.

Practically speaking, this leaves millions of families with no good option. As the number of Americans in their 80s and 90s continues to soar, the shortage of in-home care solutions will only become worse. If proposals to tightly limit immigrants take effect, the already short supply of caregivers will turn into its own full-fledged crisis. And if Republican plans to sharply reduce Medicare and Medicaid benefits become law, things will move from stressful to awful to catastrophic.

If either parent needed in-home care to treat a medical condition, their doctor could prescribe this care and Medicare would cover it, but only for a short period and then only for a limited time each week. Here’s an explanation from Medicare of the in-home health services it covers. However, as I recently wrote, it can be very difficult for people to even find the in-home care that Medicare is supposed to cover.

A practical solution may be to find a private-pay, qualified home caregiver whom you would pay out of your own pocket to stop in during the day to help your mom and perhaps your dad. Whether you need a nurse or not, I don’t know. Sometimes, a trained caregiver who is not authorized to provide medical care can be the best solution. They can do much of what your parents need and also potentially help out with domestic duties. They also will cost you less than a nurse.

The key here is finding a local agency that is trusted and can provide someone on a reliable basis. This means, in all likelihood, that different people might show up from time to time. This can create friction and adjustment issues, but is often preferable to dealing with a single individual at risk of car troubles, family scheduling issues of their own and other reasons why they might not be able to show up when you need them.

For the in-home medical benefits that Medicare does cover, the program requires enrollees to use only home-care providers that are approved by Medicare and meet the agency’s performance and qualify requirements. Medicare provides an online tool to review these agencies. This is one place to start, but as the recent column I mentioned earlier noted, it can be very hard to find agencies willing to staff these short-term assignments.

I’d also recommend contacting a local office of the National Association of Area Agencies on Aging. Ask for recommendations or leads on trusted in-home caregivers.

All the best to Rachel and all the other families facing similar challenges in helping loved ones to age with dignity and comfort.

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By Philip Moeller
Philip Moeller is author of Get What's Yours for Medicare and co-author of Get What's Yours: The Revised Secrets to Maxing Out Your Social Security. Moeller writes about retirement for Money, the PBS website Making Sen$e and others and is a research fellow at the Sloan Center on Aging & Work at Boston College. Email him at [email protected].

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