SAVVY SENIOR: There's help with homecare expenses

By Jim Miller

Dear Savvy Senior,

Do you know of any resources that can help with my mother’s home-care bills? Mom is recovering from a stroke and needs in-home care, but I understand Medicare doesn’t cover it, and she doesn’t have long-term care insurance.

Stressed-Out Daughter

Dear Stressed-Out,

Depending on your mom’s circumstances, there are a number of government and not-for-profit programs that can that either subsidize or pay for your mom’s home care or offer aid in other ways. Here’s where to look for help.

Medicare Coverage

If your mom is recovering from a stroke, the first thing you need to know is that Medicare does cover a variety of in-home health care services. To be eligible your mom must be “homebound,” and her doctor will need to approve a “plan of care” confirming that she needs skilled-nursing care or skilled-therapy services from a physical or speech therapist. Her doctor can also request the services of an occupational therapist and a non-medical home aide to assist with activities of daily living like bathing, dressing and using the bathroom.

But, be aware that Medicare will not pay for non-medical home aide services alone, if your mom does not need skilled-nursing or skilled-therapy services too. Homemaker services, such as shopping, meal preparation and cleaning are not covered either.

For more information on how this works, call 1-800-MEDICARE or see Medicare.gov/coverage/home-health-services.html.

Medicaid Options

If you mom’s income is low enough, she may qualify for Medicaid, which offers different programs that can pay for non-medical home care, home health care and other in-home support services. These programs, often referred to as Home and Community Based Services, are state-specific and their eligibility and benefits will vary. To find out if your mom is eligible, contact her state Medicaid agency (see Medicaid.gov).

State Programs

If your mom doesn’t qualify for the Medicare or Medicaid options, check to see if her state offers any state-funded home-care programs. These programs may provide caregivers or vouchers that can help pay for care. To find out about these services, call the Area Agency on Aging near your mom – see ElderCare.gov or call 800-677-1116 for contact information.

Also investigate PACE, which stands for “Programs of All-Inclusive Care for the Elderly.” PACE, which is currently available in 31 states – though not in every community – provides in-home care, including help with activities of daily living, such as meals, dental and medical care, prescriptions, and chaperoned transportation, among other benefits.

Medicaid-eligible patients get PACE for free, but if your mom is not eligible for Medicaid, she may be charged a monthly premium, though far less than she would pay a private service. To see if PACE is available in your mom’s area, see NPAonline.org.

Veterans Benefits

If your mom is a veteran, or a surviving spouse of a veteran, the VA also offers some benefits that can help pay her in-home care. 

One is “Aid and Attendance or Housebound Allowances,” which are supplemental monthly benefits for veterans already receiving a monthly VA pension and requiring healthcare. Veterans and surviving spouses qualify if they have certain disabilities or need help with activities such as dressing, bathing, and feeding, among other criteria. Go to Vets.gov/pension for more information.

Another option is the “Veteran-Directed Care” program. This program, available through VA medical centers in 38 states, as well as in Washington, D.C., and Puerto Rico, provides as much as $2,000 a month that can be used to pay a professional or family member or friend for home care. The program is open to any veteran who meets the criteria, including requiring help with three or more activities of daily living. Visit the “Home and Community Based Services” section at VA.gov/geriatrics for information.

To look for additional programs in your area that can help pay your mom’s home care, go to PayingForSeniorCare.com and use their Eldercare Financial Assistance Locator tool.

Send your senior questions for Jim Miller to Savvy Senior, P.O. Box 5443, Norman, OK 73070, or visit SavvySenior.org. Miller is a contributor to the NBC Today show and author of “The Savvy Senior” book.