Paying for Home Care Services- What You Should Know

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posted by Ryan Whittington on February 09, 2011

In Home Care Services, some agencies provide one, some or all of the possible services available. Home Care Services fall into 5 general categories.

  • Homemaker Services
  • Personal Care Services
  • Meal Services
  • Home Health Care Services
  • Skilled Health Care Services

Home care services can be paid for directly by the patient and his or her family members or through a variety of public and private sources.

Paying for Home Care services can be one of the most confusing and frustrating parts of the care.  While public options are available, most home care services are paid for privately; out of pocket by the elders or their families.  Establishing home care as an alternative to going into a nursing home can become a major expense.  For this reason, everyone should consider long term financial planning.

Public Third-Party Payers

Public third-party payers include Medicare, Medicaid, the Older Americans Act, the Veterans Administration and Social Services programs. Some community organizations such as local chapters of the American Cancer Society, the Alzheimer's Association, and the National Easter Seal Society, also provide funding to help pay for home care services.

The two most popular in this group are Medicare and Medicaid.


As defined by the US Department of Health and Human Services, Medicare is a Health Insurance Program for:

  • People age 65 or older
  • People under the age of 65 with certain disabilities
  • People of all ages with End Stage Renal  Disease

Elders which require short-term skilled care or various therapies (physical, ocupational, respratory, etc.) following an acute stay in a hospital or rehabilitation facility are eligible for Medicare regardless of income level.

Hospice care is generaly provided regardless of the patient's and/or family's ability to pay. This is normally covered under the Medicare services.


Medicaid is a program for low income elders who choose home care as an alternative to a nursing home.  Income levels are a determinate to qualify for the Medicaid program.  For more information on Medicaid click here.

Veterans Benefits

There is a benefit offered through the Veterans Administration called the Aid and Attendance benefit. This benefit is available to veterans and/or their surviving spouses who served during certain wartime periods.  To know more about these services, contact us and we will connect you with an appropriate VA representative.  Several of our clients have received this benefit and have commented that it has extended abilities to remain in their home.

Amounts vary, but a veteran can expect to receive on average (and tax free), $12,000 - $20,000 each year.

Private Pay

Home care services that fail to meet the criteria of third-party payers must be paid for "out of pocket" by the client or other party. The client and home care provider negotiate the fees.

This area of services is growing rapidly.  There are very limited funding sources that pay for care as a person ages normally.  If you are an older individual and need assistance with getting to and from the doctor, going up and down the stairs or completing many regular day to day tasks such as shaving, bathing or toileting you must pay privately. Traditional Medicare does not pay for this.

Home Care Rates

When searching for home care agencies, most times rates are a consideration.  It is a good idea to know how rates at agencies compare to each other.  While the company you choose may be based on the rate you can afford, you should not be paying considerably less than the average hourly rate in your area.  For St. Louis, many families choose to use the Alzheimers Association List when interviewing home care companies.

When considering home care rates, there are countless ways to evaluate a company.

Here are a couple of items that should matter to you as the consumer:

  1. Who Owns the Company?
  2. Are there nurses on staff?
  3. How much does the company pay their employees?
  4. How does the company choose your Caregiver(s)?
  5. What is the training and expertise of the caregivers?

No matter which type of home care you require or choose to use, the goal of home care is to allow elders to remain in their home, safely, for as long as possible.  Many statistics show that not only do most seniors prefer to remain at home, but that they actually do better and have less hospital admissions when they remain at home with appropriate care.

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Advocacy and Education and Case Management
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