Reducing In-Home Care Costs

In the previous issue “A Priceless Conversation”, we discussed if the help from a family member alone is enough or whether in-home Caregivers or an outside facility might be a consideration. There’s more to providing care than just family agreement that help is needed, there’s also the challenge of how to pay for it. What are the cost’s, who pays for it, can government agency pay for some of the costs, what’s the difference in cost between in-home care and an Assisted Living facility, who knows the answers?



There are two factors to consider; the cost of in-home care or the cost of an avoidable crisis. Once a serious injury or illness occurs, costs can quickly get out of control and even with Medicare, the cost of health care can be paralyzing.


No matter what level of care you’re considering, there is an associated expense. For example an Assisted Living Facility runs about $1,000 per week and up, Board and Care costs less than an Assisted Living Facility and in-home care offers the most cost control since care can range from a few hours a day to round the clock service. An Assisted Living Facility or Board and Care can offer social benefits (seniors around other seniors) but that also means giving up your home and independence or not receiving one-on-one care. Agencies like Senior Helpers and others can provide socialization via transportation to visit friends, relatives, church, go shopping, see doctor’s, allow you to sleep in your own bed and receive many other services as well.


Often in-home care is avoided in an effort to save money but the cost of hospitalization from a simple fall can be sobering and most are unprepared for the impact. I recently sat down with Peggy Rossi, Case Manager (RN, MPA, CCM, CPUR) at Mercy San Juan Hospital in Carmichael and discussed the financial challenges with the cost of health care. “Most families are not familiar with the benefits and limitations of their medical policies.” Medical policies in this case are Long Term Care, Medicare part A and B, Medigap Policies or Veterans benefits.


Did you know that if you are admitted to a hospital for fainting, you might be provided with observation or custodial care versus skilled care and in this circumstance, Medicare will likely deny coverage. Peggy Rossi explains it this way: you are given a hospital bed, get x-rays, lab work, see doctors and nurses, but Medicare doesn’t pay for this level of care! Yikes, did I read this right? You did and you could be on the hook!


If affordability is what’s holding you back from in-home care, there are a number of resources available. If you have a Long Term Care policy, contact a representative to learn if your policy includes in-home care. If you are a Veteran or spouse, you may be eligible for “Aid and Attendance” which may enable you to receive in-home care. You may also qualify for MediCal benefits but you’ll need to understand the application process.


You may be denied or only qualify for limited benefits if your income is considered too high. In this event, you might consider restructuring your assets into a family trust or conservatorship. This may help you qualify for Medi-Cal or Aid and Attendance without spending down all of your assets to do so. There are also new (no cost) bridge loans for Aid and Attendance available through Senior Helpers that will help you during the waiting period.


Senior Helpers often refers clients to discuss these asset strategies with a qualified eldercare attorney. A family trust is helpful if you plan to leave your estate to a family member and you honestly trust them. If this is not the case, you could place your estate in a legal conservatorship.


For more information on Veterans benefits call 916-780-3296, for Medi-Cal questions 800-430-4263, for Medigap insurance visit http://www.medicare.gov/medigap/default.asp.


One cautionary note, if you wait too long to acquire in-home help, end up in the hospital and then try to move assets around to avoid a medical bill through Medi-Cal or Medigap you will likely be too late and your application could get rejected. If you have questions or feel overwhelmed about how to get care or find resources to pay for it, contact Senior Helpers at 916-671-5777, we’re here to help.


There’s more than a 50% chance you could end up in a long term care facility in your life time. Find out what challenges Case Managers face in discharge planning at local skilled nursing and rehabilitation facilities, in the next issue of Senior Magazine.

Overcoming Resistance To Help

As our parents age, we tend to find ourselves helping out more and more. Sometimes our help comes with formidable resistance from Mom or Dad. But how do you know if our help is enough and when to seek assistance from someone more qualified? One thing to ask yourself is how much time are you spending as the primary caregiver for Mom, Dad or a family member? Is your time being consumed at the expense of your personal relationships, career or perhaps even your physical – emotional health?

Did you know that 80% of family caregivers report feeling overwhelmed by the act of being a caregiver and that 50%of adult children report missing work due to caregiving of an aging parent?

Health Care professionals refer to this as “caregiver burden” caused by the stress and challenges of being the primary caregiver. What’s more there’s a hefty toll that can impact the caregivers own health and just as often, adversely affect family relationships too.

The burden gets much worse when it is an aging spouse who provides the care. According to the American Medical Association, there’s 63% increase in the likelihood of suffering a fatal event caused by the stress of being the primary caregiver as an older adult.

One of the biggest challenges is to know the five signs to look for when an aging parent needs help and then, getting Mom or Dad the right kind of help. According to the Mayo Clinic the things to watch out for are (1) weight loss (2) decline in appearance or hygiene (3) home safety including falls (4) difficulty with transportation and (5) reduced physical mobility. There are other factors to take into consideration such as your geographic proximity to your parent’s location or changes in their health that might require closer monitoring. The addition of Dementia or Alzheimer’s may also affect how much time or attention is really required especially as their condition worsens.

If you’ve come to the conclusion that Mom or Dad needs more help than you can or are available to give, then the next hurdle is starting a conversation about what kind of help they might benefit from. But “how exactly” do you get Mom or Dad to accept help? From your parents perspective it might feel like you’re taking away their independence rather than freeing them up from tasks that have become a burden for them or you. Getting started on conversations like this usually begins only after a crisis has already occurred, not before. And with a crisis, the very freedom and independence your parents so fiercely want to retain is taken away from them, often permanently!

Do you remember the old saying “proper planning prevents problems?” It’s not a bad idea to contact your parent’s physician, their church or other organizations who’ve dealt with situations just like yours. When contacting a family physician tell them what’s changed with Mom or Dad and what you think might be needed. Your parents may take the word of a physician or clergyman over you (no disrespect). You may wish to ask for a referral to a Gerontologist in your area who might better understand what your parents may be facing.

There are also a number of non-profit or governmental organizations such as Family Caregiver Support Program (FCSP) that offers support services to family caregivers of persons age 60 and older, or adults of any age with dementia. Learn more by visiting the Eldercare Locator at: www.eldercare.gov .

Consider too, getting the support of folks that Mom or Dad most trust or admire. That means taking the time to discuss with them what you feel is needed and what they can do to help. Along the way, you will want to interview a few in-home assisted living agencies such as Senior Helpers www.seniorhelpers.com to get an idea of the depth of services they provide, their core competencies and availability. If finances are an issue, you may want to read next month’s issue on new, creative ways to pay for in-home care, with little to no money out of your pocket. Veterans and spouses of Veterans will find this article especially helpful.

Time is of the essence, start talking to Mom or Dad today, they may surprise you and agree to accept help. If they’re resistant and you objectively feel they could use help, start a dialog with their physician, clergy or reach out to their friends. Do a little research, 15 minutes a day can add up to hours of knowledge before there’s a major event that requires costly or hasty action.