When Cindy's Aunt Irene turned 88, she started needing help getting in and out of the shower and getting dressed in the morning. Her son called me, worried. "Bob, Mom's on Medicare. That'll pay for someone to come in every morning, right?"
I wish I could have told him yes. But I'd learned the hard way with my own father. Medicare generally doesn't pay for an aide who comes every day to help with bathing, dressing, and meals. That kind of everyday help is called custodial care, and most families are surprised to find out it isn't covered.
Well, folks, there are other ways to get help. You just have to know where to look, and it's better to look early.
Does Medicare pay for help at home?
Medicare pays for some help at home, but only a certain kind. Medicare's long-term care page explains that it generally doesn't cover custodial care, meaning help with everyday activities like bathing, dressing, eating, and using the bathroom, when that's the only care you need.
What Medicare can cover is home health care for a limited time. That's skilled care, like nursing or physical therapy, ordered by a doctor, for someone who has trouble leaving home. If you qualify for that skilled care, some part-time aide help may be included too. But it's not meant to be ongoing daily help.
What does Medicare cover and not cover for long-term care?
In plain words, Medicare may cover part-time skilled nursing or therapy at home, a short rehab stay in a skilled nursing facility after a qualifying hospital stay, and hospice care. It usually doesn't cover a daily aide for bathing and dressing when that's all someone needs, 24-hour care at home, long nursing home stays, or help with cooking and cleaning.
Some Medicare Advantage plans offer a few extra in-home benefits. They vary a lot, so check the plan's details rather than assuming.
Where else can I find help paying for care at home?
In plain words, there are four good places to ask. Your local Area Agency on Aging, which you can find through the Eldercare Locator at 1-800-677-1116. Your state Medicaid office, which may offer home and community-based services for people who qualify. The PACE program, if it's offered in your area, which combines medical care and daily support. And veterans benefits through the VA, if you or your spouse served.
Medicaid is the biggest payer for long-term care in America, but the rules on income, savings, and care needs vary by state. NCOA's guide to Medicaid for older adults is a good place to start. Your state may also offer a Medicare Savings Program that frees up money for other costs.
What should we do before care is urgent?
Write down the actual tasks your loved one needs help with, like bathing, dressing, meals, medicines, or someone nearby at night. That list makes every phone call easier. Ask the doctor which needs are medical and which are everyday help, because that decides what's covered.
And please don't give away or move money or property to qualify for Medicaid based on something you read online. Those rules are complicated, and mistakes can delay care. Talk to an elder law attorney or a free benefits counselor first.
What happened with Aunt Irene
Irene's son called the Area Agency on Aging, and within a week a caseworker came to the house for an assessment. Irene qualified for her state's Medicaid home care program, which now sends an aide four mornings a week. Her son covers the other mornings with a neighbor he pays. It's not perfect, but Irene is still in the house she's lived in for fifty-one years.
Start the conversation before the crisis, folks. The phone calls are a lot easier when nobody is in a hurry.
Have you had to figure out care at home for someone you love? Tell us in the comments what helped.
