Hiring a homemaker and home health aide service makes it possible for a senior to live in his or her own home or to stay with children without fearing that he or she has become a burden. It is usually a less expensive alternative to residing in an assisted living facility.
Homemaker and home health aide services send workers to the senior’s residence. Homemakers clean, do laundry, prepare meals, and take care of other tasks that seniors are no longer able to accomplish on their own. Home health aides assist seniors with activities of daily living, such as eating and bathing.
The cost of homemaker and home health aide services depends upon a number of factors, including the nature and number of services that a senior requires, the amount of time it will take to provide them, and the part of the country in which the senior lives.
According to a 2014 survey by Genworth, the nationwide median cost of homemaker services for seniors is $19 per hour. The nationwide median cost of home health aide services is $20 per hour. Those figures are consistent with cost estimates provided by MetLife in a 2012 survey.
Median costs do not reflect the wide variance in fees that are charged in different parts of the country. Even within the same community, costs may vary. Here are some examples (taken from the Genworth survey) of hourly rates that services charge for home health aides in different states:
The Genworth survey focused on services that were not Medicare-certified. The rates that are charged to patients who are able to make payment through Medicare are limited by federal law. Services that accept Medicare often have a private-pay division that charges a higher rate to seniors who are using Medicare benefits to pay for their services.
Some agencies charge a set fee per visit (such as a bath visit) regardless of the time the visit will take. Agencies might also charge according to the number of services that will be required during a visit.
Tip: Since fees and fee structures vary from agency to agency, it makes sense to obtain fee schedules from a number of different agencies. A careful comparison will help you choose the service that best meets your needs at the most affordable cost.
Since homemaker and home health aide services are classified as nonmedical, they are not typically covered by private health insurance. Most of the time, seniors or their family members pay for the services out of their own pockets. As we discuss below, other sources of payment may be available under some circumstances.
Long-Term Care Insurance
Seniors who have long-term care insurance may be able to use insurance proceeds to cover the cost of home health aides. In addition, most states participate in the Long Term Care Insurance Partnership Program. When seniors purchase a “partnership qualified” long-term care insurance policy, they are able to keep more of their assets and still qualify for state Medicaid coverage.
Older Americans Act
Federal funds are available to states to help seniors live independently. Those funds typically cover homemaker and home health aide services. The programs are means-tested, meaning they are only available to seniors with limited financial resources. Area Agencies on Aging serve as the contract point to assist seniors in learning about their eligibility for funding.
As a general rule, Medicare does not pay for homemaker or home health aide services if those are the only services a senior needs. Assistance that helps seniors cope with the limitations that are natural part of aging is not covered by Medicare.
Medicare might pay for home health aide services if they are part of a care plan that a doctor has recommended to maximize recovery from a health condition. To qualify for Medicare payment of home health aide services, the senior’s physician must certify that:
- The senior needs “intermittent” (part-time) skilled nursing, physical therapy, or speech therapy that will be provided within a home as part of a care plan
- The senior is homebound (leaving home to seek treatment is medically inadvisable)
- The home health aide’s services are provided as part of a doctor’s continuing care plan to help a senior recover from a health condition
If a doctor certifies that a senior needs intermittent nursing, physical therapy, or speech therapy that must be provided within the home, Medicare may also pay for home health aide services. If the senior needs full-time nursing care, Medicare will not pay for the nursing or home health aide services to be provided within the home.
To obtain Medicare coverage, the agency that supplies the home health aide services must be Medicare-certified. The senior should work with the home health agency to apply for Medicare coverage. The agency should provide a breakdown of services for which Medicare will pay (typically related to help with the activities of daily living) and those which Medicare will not pay (typically homemaker services such as cleaning and meal preparation).
Alert: If you think Medicare might cover the cost of home health aide services, make sure that the home healthcare agency you hire to provide the services is Medicare-certified.
States typically offer assistance, funded via Medicaid waiver programs, for homemaker and home health aide services. Unlike Medicare, the state funding does not depend upon a doctor’s certification that the services are medically necessary. The waiver programs are intended to help seniors avoid moving to a nursing home for as long as possible.
Eligibility and benefits depend upon each state’s program. Benefits are generally limited to seniors who have a strong need for the services, particularly those who would reside in nursing homes if they did not utilize homemaker and home health aide services. Benefits are also limited to seniors who can demonstrate financial need. In other words, seniors who can pay for the services from their own resources will not usually be eligible. The degree to which seniors must “spend down” their own assets before they qualify for a Medicaid waiver program varies from state to state.
Seniors who are military veterans and who are at least 50 percent disabled due to a service-related condition may be eligible for Veterans Administration benefits that cover home health aide services. Eligibility requirements tend to mirror those of Medicare.