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How to Pay for Care at Home

When an individual is extremely frail due to aging, or has a chronic or advanced illness, finding and paying for home care and other long-term care services are often a great concern.

How much will we need to spend?

The median rate for homemaker services and home health services in suburban areas of New York City each amount to more than $50,000/year (2016) for a 44-hour week; the median daily rate for a nursing home in outer New York City is $423 amounting to $154,213 annually.  (Source:  Genworth Cost of Care Survey)

Where can we get the funds?

Following are different ways to pay for home health care, either short-term skilled home care or long-term custodial care.

Medicare may pay for home care (at home or in a skilled nursing facility) for brief periods of time. This care is designed to meet the needs of an individual after an acute (short-term) illness or injury. Services are delivered with the expectation that skilled care and rehabilitation therapy will restore the person to the same function as before the acute event; and that the services will end in a reasonable and predictable period of time. The benefit is rarely approved for more than 60 days. Details about Medicare (2016 information).

Medicaid pays for long-term custodial care at home and in a skilled nursing facility but places limits on the amount of income and assets a person may have. The number of hours and use of a Personal Care Assistant (PCA) or a Home Health Aide (HHA) is determined by the doctor’s orders and the evaluation by the Department of Social Service (DSS) Nurse. The PCA or HHA may come from a Certified Home Health Agency (CHHA) or a Long-Term Care Program.  Medicaid eligibility differs from state to state.  Learn More about Medicaid eligibility and coverage in New York State.

If you are aged 21 or older, live in Westchester, and need community (home) based long-term care services for more than 120 days, you will be asked to join a Managed Long-Term Care Plan.  With Medicaid you may also be able to receive financial assistance for food through SNAP and additional light housekeeping through EPIC.

Hospice Benefit (paid for by Medicare, Medicaid, or private insurance) provides a limited number of hours (usually four hours per day) for custodial care in the last six months of life for individuals enrolled in hospice.

Private Pay (out of pocket) can be from  personal savings and income, life insurance, reverse mortgage, or other financial vehicles. If you hire an aide privately, you are responsible for paying taxes and insurance for that person, as required by law. To find reliable aides, you can ask for recommendations from friends, houses of worship, and local aging-in-place organizations. List of Resources for Aides.

Long-Term Care Insurance (LTCI) is a form of insurance specifically designed to pay for custodial care (at home or in a skilled facility). The policy must be purchased and in place before the diagnosis of a chronic or serious illness.  If you have LTCI, contact your agent to discuss what your policy covers (dollars per day, per year, and per lifetime), how to activate the policy, and what your options are. Most LTCI’s require that you hire an HHA from a Licensed Home Care Services Agency (LHCSA).  Details about about long-term care insurance.  Article about whether it may be right for you.

Prescription Drug Assistance is available through RxAssist and Familywize.

Who can help us figure out what is best for us?

You may wish to minimize the impact on your wealth, or you may require public entitlements to finance your care. Consultation with local professionals who know the day-to-day reality of accessing and paying for long-term care services can help you to make the most of what you have and to get you what you need.

A financial planner, who is sensitive to issues unique to a person with ALS, Parkinson’s, Cancer, Alzheimer’s, and other terminal illnesses associated with staggering care costs, can help you avoid making bad financial decisions under emotional duress. An Elderlaw Attorney has expertise in estate and Medicaid planning. A Geriatric Care Manager, or an expert in Medicaid solutions, can help you navigate the long-term care system. Illness-Specific organizations, Aging-in-Place organizations, and  Westchester County services are useful resources for information and referrals, problem solving, care planning, and financial assistance.