How Can I Get Help Paying For Long-Term Care at Home For My Elderly Parents?

Dear Toni,

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I desperately need your help regarding my husband’s parents who are in their late 80s. My mother-in-law has been very sick for the past 3 years, and my father-in-law has been her caretaker. I’ve always heard that the one who becomes the caretaker also becomes one who needs additional medical care. He has never been a sick person, but now he cannot help her. He has lost almost 50+ pounds in the past year and has just been released from the hospital because he was so dehydrated and has lost so much weight so fast. They do not have any long-term care plans. Talking about live-in help or even talking about an assisted living facility is out of the question. They worry that they will outlive their retirement money but also believe they can take care of themselves.

My husband and my worry is that we know they cannot properly take care of themselves and since my father-in-law is still driving, he may have a wreck and kill someone.

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Can you help us explore some options that are out there that can help relieve some of this burden?

Sandy in Sugar Land, TX

Hi Sandy,

Don’t feel like you’re alone. Many Baby Boomers are experiencing just what you’re facing. Elderly parents can be quite trying because they don’t want to lose their independence. It is so difficult when you know they need extra help. Many in this age bracket do not have a long-term care policy and are very conservative when it comes to spending extra money.

My husband and I have experienced this problem. We talked with a home health agency that explained how his parents could maximize their Medicare dollars with home healthcare benefits. Sadly, there is no co-pay or deductible for home health care. Original Medicare will pay 100% for any medical services provided by a home healthcare agency. In fact, Medicare Parts A and B will cover eligible home health care services if the following conditions are met:

• You need part-time or intermittent skilled services.
• You’re homebound, which means:
  • You cannot leave your home without help, such as a cane, crutches, or walker, and need special transportation or help from another person because of illness or an injury.
  • You can’t leave your home because it’s a major effort.
  • Leaving your home isn’t recommended due to your condition.

Those on Original Medicare have patient rights, and they have the right to choose which home healthcare agency they want to use. Those who are enrolled in a Medicare Advantage plan must use network providers and may be limited to how much home healthcare they can receive. Be sure which way your husband’s parents are receiving their Medicare benefits.

How To Receive Home Health Care Services From Medicare

1. It’s medically necessary.

Per the Medicare & Home Health Care handbook, you can receive home health care benefits if: “You’re under the care of a doctor or allowed practitioner (including a nurse practitioner (NP), a clinical nurse
specialist (CNS), and physician assistant (PA)), and you’re getting services as part of a care plan that your doctor or allowed practitioner established and reviews regularly.”

Additionally, your doctor MUST certify that you need one or more of these:

• Intermittent skilled nursing care (other than drawing
• blood)
• Physical therapy
• Speech-language pathology services
• Continued occupational therapy

2. The home health care agency is certified by Medicare.

This simply means that the home health care agency is approved by Medicare and meets all the federal and state health and safety requirements.

To find a Medicare-certified healthcare agency…

• Go Medicare.gov and use their Care Compare database.
• Click “Home health services.”
• Type your address in the “My Location” field.

You can also call 1-800-MEDICARE (1-800-633-4227) for information about home health agencies!

3. You must need skilled care.

This includes skilled nursing care, physical therapy, speech therapy, and occupational therapy.

4. You must be homebound.

First, you can’t declare that you’re homebound. A doctor or practitioner must certify that you’re homebound. To expand on the definition a little, let’s consult the Medicare & Home Health Care handbook again! According to it, to be homebound means:

• You have trouble leaving your home without help (like using a cane, wheelchair, walker, or crutches; special transportation; or help from another person) because of an illness or injury, or leaving your home isn’t recommended because of your condition.
• You’re normally unable to leave your home, but if you do, it requires a major effort.

However, it’s important to note that one can be homebound and still go to the beauty shop, church, the occasional family reunion, etc. In fact, you can still receive in-home health care even if you attend adult day care!

Related: A Definitive Guide To The Cost of Home Care

What Medicare Will Cover For Home Health Care

Once these conditions are met, Original Medicare will cover the types of care listed below:

• Medically necessary part-time or intermittent skilled nursing care, like:
  • Wound care, such as for pressure sores or a surgical wound
  • Patient and caregiver education
  • Intravenous and nutrition therapy
  • Injections
  • Monitoring serious illness and unstable health conditions
• Physical therapy
• Speech therapy
• Occupational therapy
• Durable medical equipment such as a wheelchair, walker, crutches, or a hospital bed
• Injectable osteoporosis drugs for women
• Help with ADLs, like:
  • Mobility assistance
  • Feeding
  • Changing bed linens
  • Bathing
  • Grooming help
• Certain medical supplies such as wound dressing, catheters, and colostomies (but not prescription drugs)
• Disposable negative pressure wound therapy devices
• Medical social workers can help with long-term planning and help find resources.

Consult with your loved one’s primary care physician or specialist if you believe home health care might be right for them. Most generally, your physician, a social worker, a case manager, or a hospital discharge planner can help arrange for Medicare-covered home health care.

Toni Says: Remember, you have PATIENT RIGHTS, and this gives you a say in which home health agency you want to use.

Other Ways to Pay for Long-Term Care

Medicare isn’t your only option when it comes to paying for home health care! You can also consider looking into these options:

• Long-Term Care Insurance: Purchasing a private long-term care insurance policy can help cover care costs. However, you need to consider the premiums and potential benefits!
• Private Pay: While not the most desirable option, you can pay for home health care out of your own pocket. However, this can be costly and even drain your wallet dry unless you’ve set aside money specifically for long-term care.
• Medicaid: Fortunately, Medicaid covers home health care in all 50 states! However, coverage and requirements may vary from state to state! Make sure you check your state’s requirements before you consider this option!
• VA Benefits: Did you know that veterans have access to the Homemaker and Home Health Aide Care? This program is for veterans who need personal care assistance, companionship, or help with the activities of daily living. Services may vary by location.

Other Medicare Resources

Contact Toni: Email the Toni Says® Medicare team at [email protected] or call (832)519-8664 for all your Medicare questions!

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