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“Assisted Living” at Home
Nearly one out of every four U.S. households (23 percent, or 22.4 million) provides care to a relative or friend aged 50 or older. The majority of these caregivers are baby boomers. In the twenty-first century the demands placed on family and other informal caregivers are likely to escalate, affecting nearly every American family. Since most persons prefer to stay in their own homes and live independently for as long as possible, this column addresses questions and concerns regarding these issues.
Question
After suffering a stroke my mother was briefly hospitalized and then transferred to a rehab facility. Luckily, she is doing fairly well, but is still having a hard time walking steadily and using her right arm and leg. She is now being told that she will be discharged in a day or two. The social worker at the facility has arranged for a few weeks of physical therapy visits at home and perhaps someone to stop a couple times a week to help her bathe. She says that this is all of the in-home care that is covered. Since her needs are mainly for basic help with personal care, meals and housekeeping, she is not sick enough to qualify for more. We are upset since she is covered by Medicare and a supplemental insurance policy, and concerned that my mother will not be able to get along on her own.
Many people assume that private health insurance or Medicare will cover the cost of in-home help for basic personal care. In reality, the basic assistance and personal care that many people need is not covered by either of those sources. What may be covered will depend on the circumstances and insurance company policies.
Sources that may cover in-home basic personal care are long term care insurance, and a variety of programs offered through the Medicaid program or the local Area Agency on Aging. Private pay services are also available and can be combined with covered services.
Though it would generally cost less than care in residential or nursing care facilities; coverage of long term care and services in a home or community-based setting is very limited. Since most persons prefer to stay in their own homes and live independently for as long as they can, there is a great need for sources that will cover care and services in that setting.
The following lists some sources that you can call or email for information. Note that this is general information and coverage will always depend on an individual’s arrangements with the payment source.
Private Health Insurance
· Including MediGap policies, Managed Care Plans (HMOs), Group Plans through employers, American Association of Retired Persons (AARP), etc.
· Some home health services, when prescribed by a physician may be covered. Generally basic personal care, custodial care and home chore services are NOT covered.
For more information call the Pennsylvania Department of Insurance toll-free Consumer Hotline at 1-877-881-6388, or e-mail consumer@ins.state.pa.us or visit www.insurance.state.pa.us/html/instypes.html.
Medicare
· Covers those age 65 and older and those who have been receiving Social Security disability benefits for at least two years
· Coverage is limited to a number of short (usually 1 hour or less) visits per week for a period of time prescribed by a physician.
For more information about Medicare visit http://www.medicare.gov/.
· Purchased privately or may be through employer.
· Coverage for in-home basic personal care and/or a stay in a long term care facility. Per day maximums and time limits may apply. Check the policy or the insurance company that issued the policy to find out what is actually covered.
For more information call the Pennsylvania Department of Insurance toll-free Consumer Hotline at 1-877-881-6388, e-mail consumer@ins.state.pa.us or visit http://www.insurance.state.pa.us/html/longtermcare.html.
Local Area Agency on Aging
· Federal and state government agencies have collaborated to develop a variety of special programs that will arrange for extended care and services to be provided in home and community-based settings. Whether or not you are eligible for these programs will depend on your income and resources; your need for care; and the availability of funds. A new cost sharing program is also available.
For more information contact your local Area Agency on Aging, visit www.aging.state.pa.us/aging/cwp/view.asp?a=275&Q=177124 or call the Department of Public Welfare Information Helpline at 1-800-692-7462.
Medicaid
· For persons with low to moderate income and limited resources.
· Coverage for a limited amount of care and services in the home if prescribed by a physician and approved by the Department of Public Welfare as an alternative to residential or nursing home care
For more information about Medicaid, visit www.dpw.state.pa.us/omap/recinf/omapapply.asp, the County Assistance Office website of www.dpw.state.pa.us/general/dpwcao.asp or call the Department of Public Welfare Information Helpline at 1-800-692-7462.
Private Pay (Also Referred To As Patient Pay or Out-Of-Pocket)
· Any individual or family member may contract services to be paid out-of-pocket without requirements such as doctor prescription or financial qualifications. Care to supplement covered services can also be arranged.
· Companion/Nurse Aide, LPN, or RN level services can be contracted through private duty nursing services. Light housekeeping, laundry, and meal prep as well as basic personal care and medical services are usually offered.
· Some services may also be providers for your covered sources, such as insurances or the local Area Agency on Aging, making it easy to combine service or to continue with the same caregiver on a private pay basis when coverage runs out.
Cheryl Nemanic, CCM, is the General Manager of Private Duty Services for Liken Health Care, Inc., a private duty nursing service in the Pittsburgh area since 1974. If you have a question, Cheryl can be reached by phone at (412) 816-0113, by email at cnemanic@likenhealthcare, or visit the website at www.likenhealthcare.com.
