Help at home for an older adult, and who pays for it

Bathing, cooking, medication reminders, someone to check in. This is the kind of help most families need and the kind that's hardest to figure out how to pay for. Here is how it breaks down.

Two kinds of care at home

Home health care is medical: a nurse, a physical therapist, a home health aide working under a nurse's plan, for a limited time after an illness, injury, or hospital stay. Medicare covers this when a doctor orders it and you're homebound.

Home care (also called custodial or personal care) is non-medical help with daily living. Medicare does not cover this, no matter how much you need it. This is the gap that catches most families.

Who does pay for home care

• Medicaid, through home and community-based services (HCBS) waiver programs. Every state has at least one. They can pay for personal care aides, homemaker services, adult day programs, and sometimes home modifications. There are income and asset limits, and often a waitlist. Applying early matters.
• Consumer-directed programs. In many states, Medicaid lets the person receiving care choose their own aide, including a family member or friend, who is then paid by the program. If you're already caring for a spouse or parent and wondering whether you can be paid for it, this is the program to ask about.
• Veterans benefits. The VA has Aid and Attendance, Homemaker and Home Health Aide services, and its own caregiver support program.
• Long-term care insurance, if you bought a policy years ago. Read it; many pay for home care.
• Private pay. Agency rates vary widely by region. Independent aides cost less but you become the employer.

Where to start

Your Area Agency on Aging is a local government-funded office that exists for exactly this. They know the programs in your county, help with applications, and often run services of their own: meals, respite for caregivers, transportation. Find yours through the Eldercare Locator at 1-800-677-1116.

If a hospital discharge is coming

Ask to speak with the discharge planner or social worker before discharge day. Say plainly: "There is no one at home to help. What are the options?" They can order home health, refer to home care agencies, and start a Medicaid application.

What we can do

Text us what's going on and where your family member lives. We'll send you the Area Agency on Aging contact, explain the Medicaid waiver programs in that state, tell you whether it has a program that pays family caregivers, and list home care agencies in the zip code.