FAQs

This is much confusion between “home care” and “home health care”. Notice some of the main distinctions between the two.

Home Care
Home Care involves care that is provided by persons who are not nurses, doctors or other licensed medical personnel. Home care aims to make it possible for people to remain at home rather than use residential, long-term, or institutional-based nursing care. Home care providers render services in the client’s own home.

Life assistance services include help with daily tasks such as meal preparation, medication reminders, laundry, light housekeeping, errands, shopping, transportation, and companionship. Home care is often an integral component of the post-hospitalization recovery process, especially during the initial weeks after discharge when the patient still requires some level of regular physical assistance.

Home care services are usually paid for directly by the client and his or her family or in some cases are covered under a long-term care policy or the Veterans Administration’s Aid and Attendance Program.

Home Health Care
Health care services provided by licensed individuals such as nurses, doctors, physical therapists, social workers, occupational therapists, speech and language pathologists and dieticians. These licensed individuals are often assisted by home care aides who are trained to provide non-medical care, such as helping with meal preparation, dressing, bathing, getting in and out of bed, and using the toilet.

Home Health care is usually covered by some form of insurance program like Medicare, Medicaid, or a private insurance program. There are strict qualifications to receive home health care services under such programs. Medicare sets the standard for who qualifies for this coverage and many private insurance companies will follow Medicare’s guidelines. To be sure though, check your insurance coverage.

Who’s eligible?

If you have Medicare, you can use your home health benefits if you meet all the following conditions:

1. You must be under the care of a doctor, and you must be getting services under a plan of care established and reviewed regularly by a doctor.
2. You must need, and a doctor must certify that you need, one or more of the following.
• Intermittent skilled nursing care
• Physical therapy
• Speech-language pathology services
• Continued occupational therapy
3. The home health agency caring for you must be approved by Medicare (Medicare-certified).
4. You must be homebound, and a doctor must certify that you’re homebound.
To be homebound means the following:
• Leaving your home isn’t recommended because of your condition.
• Your condition keeps you from leaving home without help (such as using a wheelchair or walker, needing special transportation, or getting help from another person).
• Leaving home takes a considerable and taxing effort.

A person may leave home for medical treatment or short, infrequent absences for non-medical reasons, such as attending religious services. You can still get home health care if you attend adult day care, but you would get the home care services in your home.

Eligibility is also based on the amount of services you need

If you meet the conditions above, Medicare pays for your covered home health services for as long as you’re eligible and your doctor certifies you need them. If you need more than part-time or “intermittent” skilled nursing care, you aren’t eligible for the home health benefit.

To decide whether you’re eligible for home health care, Medicare defines part-time or “intermittent” as skilled nursing care that’s needed or given on fewer than 7 days each week or less than 8 hours each day over a period of 21 days (or less) with some exceptions in special circumstances.

Hour and day limits may be extended in exceptional circumstances when your doctor can predict when your need for care will end.

Below are some examples of what Medicare doesn’t pay for:

• 24-hour-a-day care at home.
• Meals delivered to your home.
• Homemaker services like shopping, cleaning, and laundry when this is the only care you need, and when these services aren’t related to your plan of care.
• Personal care given by home health aides like bathing, dressing, and using the bathroom when this is the only care you need.

Here are the current averages for the Houston area:

In-Home Care – Range between $17 to $28 per hour, with respect to the volume of care services required and from $190 to $300 per day for live-in caregiving services.

Nursing Homes – Range from $120 to $281 per day for a single room and $115 to $268 per day for a double room.

Assisted Living Facility – Average $4000 a month. This would be the amount a senior should have readily available for all month-to-month expenditures while moving into a good Assisted Living facility in order to pay for food items, activities, hair salon visits, house cleaning, part-time caregiving companies along with other incidentals beyond the month to month rent.

Continuing Care Retirement Community – $250,000 down payment on average + $4,000 monthly rental fee (possibility of partial down-payment refund depending on length of stay and care needs).

Medicare: Reimbursement for up to 100 days in a nursing home per stay
Medicare does not pay for long-term care needs, only short-term care for rehabilitation and recovery in a nursing home. Stays are preapproved by a medical doctor. (Please see question #2 for eligibility requirements)

Private-pay: If you have money saved to pay for care yourself, you will be able to privately pay for care services in your home or in a senior care community. Consider your capability to privately pay out month to month income (such as pensions + SSI) or other resources (such as savings, contributions from other family members, reverse mortgage options, etc).

Long-term Care Insurance: You may purchase a long-term care insurance policy which does provide payment for care services in a senior’s home or in a nursing facility. Long-term care can be purchased at any age, with pricing connected to your age and health.
Click here for an overview of long-term care insurance.

Reverse Mortgage: If you own your home, you may qualify for a reverse mortgage where you will receive a monthly payment which you may use for care services. If your home has significantly increased in value, this may be an option. Reverse mortgages are highly regulated by the government and always include an end date.
Click here for an overview of reverse mortgages.

Veteran’s Aid & Attendance Benefit: U.S.A. Veteran’s of a war will qualify for the Veteran’s Aid & Attendance benefit which will provide for a private caregiver to assist with care needs in the home.
Click here for an overview of Veteran’s Aid & Attendance benefit and an application.

Medicaid: Low-income seniors with few assets (usually around $2,000.00), qualify for Medicaid insurance (this kicks in for Medicare – some refer to it as “welfare for seniors). This program is administered by each state and because of this the qualifications and benefits vary by state.
Click here to view Medicaid qualifications and benefits in your state.