Not every older American ends up in a nursing home or a retirement community. In fact, most older individuals continue to live at home, many with the assistance of some type of in-home care. In-home care can help you remain independent, and delay the need to enter a nursing home or an assisted-living facility.
In-home care is a broad term that covers in-home health care (nursing or health aide services), household help (homemaker services) and personal care (companion or caretaker services).
If you have a medical condition that requires nursing care, daily monitoring, or therapy, you may need to hire a nurse or an aide to help take care of you at home. You can hire health care personnel through nursing registries or home health agencies (HHAs). Nursing registries match you with a suitable nurse for your condition, but they don’t necessarily supervise or train nurses. HHAs, on the other hand, match you with a nurse or nurse’s aide who is supervised and trained by the agency. HHAs are usually licensed by the state and may be accredited by a national association such as the National Association for Home Care. Most have Medicare certification as well, meaning that they have met minimum federal standards and accept Medicare.
You may need to hire household help if you can live somewhat independently, but you need someone to help you with cooking, laundry, cleaning, or shopping. You can find household help through some home care organizations or through the help wanted section of your newspaper. Some state and local governments also have programs set up to assist the elderly. These programs are either free or low-cost. They may include providing personal assistance services (such as bill paying, house cleaning, repairs, and shopping), as well as companionship services (such as telephone reassurance or visits). To find out what programs are available in your area, search the Internet or check phone listings under the following titles: Department of Social Services, Department of Human Services, Health Department, or the Council (or Office) on Aging.
You may need personal care if you have trouble bathing, dressing, walking, or feeding yourself. People that provide personal care services sometimes perform household tasks as well. Some home care agencies or HHAs can find you a suitable aide, or you can find one through the newspaper. Remember, though, that if you hire your own aide, you may have to pay Social Security taxes and withhold income tax from his or her salary.
Although in-home care usually doesn’t cost as much as nursing home care, it can still be quite expensive. The cost depends primarily upon the type of services you need, and how frequently you need them. You may pay $50 a week for housecleaning, or $300 a week or more for personal or part-time nursing care. You may be able to pay for in-home care from your savings or income (many people do), but before you decide to do this, check into care programs offered by your community. You should also determine if you are entitled to any Medicare or Medicaid benefits.
Medicare and Medicaid
In-home health care is covered under Medicare Part A if the care you need is medically necessary skilled care. The care you need must be intermittent or part-time, supervised by a physician, and provided by a skilled nurse who works for a Medicare-certified HHA. If you don’t have Medicare Part A insurance, Medicare Part B covers in-home health care. Medicaid may cover in-home health care if you live in certain states. Unlike Medicare, Medicaid may allow you to hire a family member to provide care (with certain restrictions).
Long-term care insurance
In the past, LTC insurance policies only covered nursing-home care, but now most of these policies cover in-home care as well. However, you may pay more for a policy that covers both types of care. When you consider buying a LTC policy, you have to decide if the extra premium you will pay for in-home care will warrant its cost, and you have to check on what conditions may not be covered at all or covered only after a waiting period.
You may be concerned about letting a stranger come into your home, or you might be afraid that the quality of in-home care you receive will be substandard. Because of the variety of care options, the home health industry is not tightly regulated. However, you can protect yourself by thoroughly checking the credentials of whomever you hire.
Checking the credentials of a home health agency
If a home health agency is certified for Medicare, it is supposed to comply with Medicare standards, and undergo state examinations each year. To check an agency’s Medicare status, call the Medicare Hotline at (800) 633-4227. In addition, HHAs should be licensed by the state, and some may be members of the Better Business Bureau.
Checking the credentials of an individual
Checking the credentials of an individual is very important. Start by asking for several references, including more than one professional reference. Find out if the individual has insurance or is bonded (some individuals who run their own cleaning business, for example, may be) and consider purchasing extra insurance to protect yourself against liability claims or employee theft.
In-home care may be tax deductible
You can deduct medical expenses that exceed 7.5 percent of your adjusted gross income (10 percent if you’re younger than age 65) if you itemize your deductions. For example, you may be able to deduct wages you pay for in-home nursing services, including any services connected with caring for your medical condition, such as changing dressings and bathing. The person you employ does not necessarily have to be a nurse, but the services he or she provides must be medically necessary services. You cannot deduct general household help such as shopping, cooking, and housecleaning. In addition, if you pay medical insurance premiums or need to modify your home to accommodate your medical condition, you may be able to deduct these expenses as well.
Caution: Although the threshold to deduct medical expenses has been raised from 7.5 percent of adjusted gross income to 10 percent (beginning in 2013), this threshold increase will be delayed until 2017 for those age 65 or older.
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