WSJ: When to Consider In-Home Care
By Jaklitsch Law Group of Jaklitsch Law Group on Sunday, September 15, 2013.
It might be easier than you think for you, or a loved one, to stay at home as you age.
Long-term care becomes necessary when people start struggling with tasks like bathing, dressing, getting around and taking medications-or with memory loss. Sometimes, food shopping becomes difficult, so older people don’t eat right, and the problem spirals into a hospital visit should they become weak and contract a disease such as pneumonia.
“When is the ‘Aha’ moment? Is it after Mom leaves the stove on and the pot burns?” says Bob Bua, president of Genworth Financial‘s GNW -0.81% CareScout, a provider of support services for insurers and families.
Nine out of 10 Americans say they want to grow old at home and keep living in their communities as long as possible, according to AARP. Home-health providers are rushing in to meet the demand.
But there are things to consider when looking into care at home-including the number of limitations a person is struggling with, whether they have supports in the community and whether the home itself is suitable. New advances in home care are allowing more people to remain in their homes because of telehealth and apps designed to keep track of an elder person’s medication compliance and comings and goings, says Steve Landers, chief executive of VNA Health Group, which provides home-health services.
Meanwhile, there are different types of at-home options to draw on. Maybe you need to see a doctor or nurse regularly, and these professionals do pay house calls. Personal-care assistants can help with nonmedical tasks like bathing. Assistance shopping, cooking or cleaning are also options.
One resource to help you get started is the National Association for Home Care and Hospice (nahc.org). Local resources vary and it can be helpful to also look into your area agency on aging.
The costs of home care are typically lower than in institutions such as nursing homes or assisted-living facilities. A private room in a nursing home averages $230 a day, or $82,800 a year, according to an annual survey of long-term care costs by insurer Genworth Financial. Average monthly rates in an assisted-living facility are $3,450, or $41,400 a year. A home-health aide costs an average of $19 an hour, or $30,326 based on a 30-hour week.
For many people, these prices will come out of pocket, however. Medicare typically pays for nursing and home care only when it’s medically necessary and that doesn’t tend to include personal care or round-the-clock services. Patients who are needing extra support at home or who are considering assisted living often look to long-term-care insurance to cover costs or pay privately. Medicaid, the state and federally run programs for the poor, more often covers nursing home and home-health assistance but it is important to check your state and individual eligibility.
Because of some of the economic realities, managed-care companies that contract with states to work with Medicaid patients are increasingly pushing patients toward home care. Programs include going into aging patients’ homes and evaluating their condition, and contracting with home-health services and adult day care, according to the industry group America’s Health Insurance Plans.
Health insurance company WellPoint, for instance, runs Medicaid long-term-care programs in seven states, and finds in general that for every individual it can care for in a nursing home, it can pay for three people to stay in their communities. It sends care coordinators and case workers into beneficiaries’ homes for health assessments and asks them over 300 questions about their functioning. If the beneficiaries need it, the company can connect them with services they need to avoid admission to a nursing home. In some states, the company pays family members to provide the care.
Another managed-care provider, Molina Healthcare, has a new program in Florida to divert patients from nursing homes. “It’s almost like a social call,” says chief executive Mario Molina. “We notice the fridge light is out and we triage things.”
But there are also risks and downsides to staying at home. Communities for older adults and nursing homes provide socialization that many in the geriatric community need. Older people home alone run the risk of a problem like slipping and falling-worsening their functioning rather than improving it.
What’s more. the toll on adult-children caregivers when aging parents stay home is high. One study found that replacing unpaid care given by adult children would cost $450 billion a year, AARP says. If those caregivers aren’t properly trained, the older person’s health could be at risk.