As we outlined in our previous post, “Does Medicare Cover Home Health Care?” many of the services required to support aging in place at home are not covered by Medicare or insurance, other than long-term care insurance.  What if your aging parent did not purchase long term care insurance?  What costs can you expect and are there ways to create an affordable home care plan?

Here is what you can expect to pay for in-home care provided by an agency (costs vary by area, for a better idea in your area, visit Genworth’s Cost of Care Comparison Map).

Home Care provided by a licensed home care agency (MetLife Mature Market Institute Study of Long-Term Care Costs, nationwide average):
$21/hour for home health aide (can assist with bathing, dressing, physical assistance)
$19/hour for homemaker/companion (non-hands on care such as errands and housekeeping)

You may be able to find less expensive care by hiring on your own or using a matching service, but it is important to understand your liability and possible concerns about supervision and oversight.  Some of the costs that agencies cover include hiring (and screening/background checks, work history checks), training and supervision, managing the schedule and assisting with backup care, handling payroll taxes, liability insurance and worker’s compensation.  When you consider taking on those costs and responsibilities yourself, you may find that the savings doesn’t compare.  Check your state’s regulations and find out about the type of agency you are dealing with to ensure they cover all these necessary facets.  You may find this article very helpful in understanding true costs and pros and cons of different options, “Affordable, Quality Home Care: Beyond Price per Hour”.

Many people also worry that using an agency will mean they have less control or will have a “revolving door” of different caregivers rather than an established relationship.  This is not necessarily the case, but you should be a good consumer of services and get a good understanding of how the agency handles things so you understand the expectations.  Many agencies will work hard to identify a good match for you/your loved one and that person(s) will stay with you, unless they have an illness or change of plans, in which case the agency has backup caregivers but can again work with you on ensuring it is a good match.

Some tips/resources for affordable home care plans:

You may be able to put together a creative plan, for example using a paid, professional caregiver to help Mom or Dad during key times such as getting up and ready in the morning, bathing, etc. with family and friends providing support and checking in at other times, or attending an adult day program.

Check with your church or other community organizations about assistance.  Volunteers may be available to check in or help with transportation and errands, though likely not any hands-on care.

Supportive community services can help.  For example, a personal emergency response system or in-home monitoring system may provide a safety net for loved ones in between hours of someone being there; meals on wheels can provide warm meals and someone checking in; community groups may offer a phone tree service where they make calls as safety checks.

Consider the value of an assessment by a professional geriatric care manager for assistance.  A care manager can help you identify options, resources and create a care plan based on your preferences and budget.

If your loved one is a Veteran or a widow of a Veteran, look in to the VA’s Compensation and Pension program, which includes a benefit known as “Aid and Attendance” that may offset some long-term care costs.

Talk to your loved one’s financial advisor or seek a consultation with an elder law attorney about options for paying for care.  Your financial advisor should be aware of the potential expenses so that he/she can talk to you about a reasonable budget and potentially reallocate investments to better meet those needs.  An elder law attorney may be able to assist with qualifying for Medicaid and Veterans benefits to assist.  During your care management assessment mentioned above, you can explore what programs may be available in your state to determine additional research and consultations that may be needed.

Explore what home and community based services are available for elders in your area by contacting your local agency via www.eldercare.gov.  Though these programs have often been quite limited, many states are making attempts to reallocate more dollars to such services and there were several provisions within last year’s healthcare legislation to encourage these efforts.

To learn about Paying for Respite Care, read Shannon Martin’s article, Give Me a Break! How to Pay for Respite Care.

Shannon Martin, M.S.W., CMC, is Director of Communications at Aging Wisely, LLC (http://www.agingwisely.com), a professional care management and patient advocacy organization and EasyLiving, Inc. (www.easylivingfl.com), a licensed home care agency, in Clearwater, FL.  Shannon serves as adjunct professor at Eckerd College in St. Petersburg, FL, where she created a course on “Eldercare”.  Prior in her career, Shannon served as social services director and admissions coordinator in an assisted living/skilled nursing facility and worked as a social worker and volunteer coordinator for a large hospice.