By Gregory Solometo
In the March issue of WestView, I discussed the roles of home care professionals who are essential to comprehensive elder care. This month, I discuss the financing options available for home care services.
Aside from the few services which Medicare covers, the unfortunate reality is that much of home care comes down to budget. Quality of life gets trimmed back based on the ability to pay and the family’s perception of value. General popular opinion has no real understanding of what services ‘we’ are entitled to and which are paid for by government resources. Medicare is nothing more than a temporary bandage for people recovering from an episodic short-term hospital stay. If you qualify, you will receive short-term custodial care for a few hours a day, for a few weeks, from a home attendant that is paid $9 to $10 per hour. These workers usually visit multiple patients each day in a time-pressured rotation. Continuity of care is often not possible (i.e., a different person shows up at your door each day) which is frustrating to the elderly who don’t like change and are going through a tumultuous time. Nursing visits may be included for complicated medication management or wound care, all of course on a temporary basis until you recover.
If you don’t quickly recover and have long-term care needs, there are three main methods of funding care:
1. Medicaid: This program is meant to support the medical needs of the impoverished if they demonstrate limited assets and annual income. There are two types of Medicaid—Community and Institutional. The Community option enables you to live in your home with Medicaid-covered resources. The Institutional option covers a Medicaid-approved living facility (not somewhere that would pass the Grandma Rule®). An elder care attorney would guide you through this difficult process. If you qualify, you can apply through a Managed Long-Term Care (MLTC) agency, which would assess your needs and provide care. Keep in mind that this care involves hourly shift workers with little to no supervision. There will be a nurse overseeing the case (which is the law in NYS) but s/he will visit infrequently and will not be easily accessible off-site. The quality of these providers is often suspect and inconsistent. The industry gets its less-than-stellar reputation from many of these agencies whose workers don’t show up, show up late, or provide sub-standard levels of care.
2. Long Term Care (LTC) Insurance: This insurance vehicle is specifically designed for supporting long-term care needs late in life. To qualify, you need to lose the ability to manage two of the following six basic life needs: (a) bathing, (b) eating, (c) toileting, (d) dressing yourself, (e) continence, and (f) basic mobility. But not all policies are created equal. Most have exemption periods where you pay privately before payout commences and most have daily caps and lifetime maximums. We as a company use a third-party provider that specializes in this area. About 30% of our clients pay us partially or fully through their LTC insurance. Due to people living longer, some insurance companies have limited the payouts or stopped writing policies altogether. LTC insurance is a luxury item but one well worth considering. If you are in your 40s, 50s, and 60s, I strongly suggest you speak to a financial expert about obtaining a policy.
3. Private Funding: This is the final option for your home care. 70% of our clients pay us privately for the care they receive. A healthy and The Grandma Rule®-approved home care world really only comes from a private-paying environment. This is my humble opinion, of course, but I’ve lived through it directly and manage it daily on a professional level. Until government and other larger organizations in the care continuum change their stance on the value of preventative and long-term healthcare in the home, this will continue to be the case.
There is no fourth option. When it comes to home care and the latter stages of life, we are on our own. Traditional medical benefits from United, Aetna, Oxford, etc. do not cover long-term home care. Belief that their private medical benefits cover home care is a commonly-held misconception. The second most common invalid belief is that Medicare will pick up all home care-related costs. We are living longer and the last few years of the aging process are expensive. Someone must pay for this care, whether through government or private sources. Private solutions will always achieve the strongest result.
Gregory Solometo started Alliance Homecare after caring for his ailing grandmother for five years. He created The Grandma Rule® hiring philosophy to provide all clients with an elite and highly qualified team of healthcare professionals. Prior to Alliance Homecare, Gregory worked primarily in the financial services industry. He graduated from Emory University in 1995.