Paying for In Home Senior Care in San Bernadino County and Surrounding Communities, California
According to the AARP, 96% of adults in the US prefer to age-in-place at home as opposed to spending their golden years in a nursing home or assisted living community. Seniors with dementia and other medical conditions or age-related declining abilities typically need help with activities of daily living such as bathing, dressing and mobility. How do seniors and their families pay for the personal care services and supervision they need to safely and comfortably age-in-place at home? This page explores financial options, financial assistance programs and other ways of paying for personal home care in San Bernardino County and surrounding communities.
Government Insurance
Medicare
Medicare is a federal health insurance program for people aged 65 and over and certain younger people with disabilities. Medicare parts A and/or B will typically pay for physician ordered medically necessary in-home services in the short term. If your loved one needs only non-medical services (assistance with daily routines e.g., bathing etc.), they will NOT qualify under Medicare for these services.
Medi-Cal
Medi-Cal (California’s Medicaid) is a jointly funded federal/state insurance program that covers low-income people and includes long term care benefits and personal care services. Regular Medi-Cal provides limited coverage for non-medical in-home and personal care services through programs such as the In-Home Supportive Services (IHSS) program. The IHSS program helps pay for services provided to you so you can remain in your home. Services authorized through IHSS include bathing, meal preparation and assistance with other activities of daily living. To be eligible you must be over 65 years of age or disabled or blind. Disabled children can also potentially qualify for IHSS. Qualified applicants can hire any caregiver of their choosing, including family members. The caregivers are paid directly by the IHSS program. Contact us (909-652-0076; [email protected]) for a no obligation free consultation to discuss how the IHSS program can be included to your overall home care funding strategy.
Medi-Cal Waivers
Medi-Cal waivers are programs that provide additional services to specific groups of individuals, limit services to specific geographic areas of the state, and provide medical coverage to individuals who may not otherwise be eligible under traditional Medi-Cal rules.
Home and Community Based Services (HCBS) Waiver
HCBS waiver allows Medi-Cal to develop creative alternatives to keep people away from hospitals and nursing homes. Medi-Cal has arrangements with the Federal government that allows the provision of waiver services to participants in their homes or in the community. Cost of waiver services must be equal to or less than comparable cost of institutional care. Waiver participants must have full scope Medi-Cal eligibility and services must be provided by a licensed HCBS waiver provider. Services authorized through HCBS Waiver include personal care services and respite care. Participants can receive care for as long as it is medically necessary, cost neutral and participants continue to meet the nursing facility or hospital level of care. The HCBS Waiver is not an entitlement program. This means there are enrollment caps for program participation, and if the cap has been reached, a wait list for services is established. You or your loved one may qualify to receive in-home non-medical personal care services through the HCBS Waiver. Contact us (909-652-0076; [email protected]) for more information and a no obligation free consultation to discuss how this waiver can be included as part of your overall home care funding strategy.
Home and Community Based Alternative (HCBA) Waiver
The HCBA is an HCBS Waiver Program. This program targets physically disabled seniors. Priority is given to seniors who are at risk of being admitted into nursing homes or intermediate care facilities. Applicants must require a nursing home or hospital level of care to qualify. Qualified seniors already in nursing homes for rehabilitation after hospitalization (who want to return home) are also prioritized for funding. Applicants must have the ability to safely receive their care at home. The waiver program provides services designed to allow participants to return home and pays for home modifications, home assistance technology, home health care and personal care services. Participants are allowed to hire any caregiver including family members and friends and the caregiver gets paid directly by the waiver program. Contact us (909-652-0076; [email protected]) for a no obligation free consultation to discuss how this waiver can be included as part of your overall home care funding strategy.
Multi-Purpose Senior Services Program Waiver
The primary objective of the multi-purpose Senior Services Program (MSSP) Waiver is to encourage seniors to stay at home and avoid or delay placement of seniors in institutionalized care settings such as nursing homes. MSSP provides services such as basic housekeeping chores, personal hygiene, personal health care chores, grocery shopping, and transportation to non-emergency medical appointments. Certain eligibility criteria must be met in order to receive services. Eligibility for the program is addressed first at screening and confirmed throughout participation in the program. The eligibility criteria are:
- Certifiable for placement in an Intermediate Care Facility (ICF) or a Skilled Nursing Facility (SNF).
- Age 65 or older.
- Reside within the designated catchment area of the County of San Bernardino.
- Receive Medi-Cal under an appropriate aid code.
- Appropriate for case management services.
You or your loved one may qualify to receive in-home care services through MSSP Waiver. Contact us (909-652-0076; [email protected]) for more information and no obligation free consultation to discuss how this waiver can be included as part of your overall home care funding strategy
Private Insurance
Private health insurance plans may be used to pay for certain senior care services. Most forms of private insurance will not pay for long term non-medical home care services, and in-home skilled care is rarely covered at 100 percent.
Long-term care insurance is a type of insurance purchased from private companies to cover the costs of nursing home care, assisted living and home health care. Benefits vary depending on the plan, so it is important to clarify the services covered by the policy at the time of purchase. Keep in mind that assistance with the costs of personal home care may only be provided if the plan includes an allowance for non-medical services.
It is important to plan prudently when it comes to purchasing a long-term care insurance policy. Premiums are lowest for healthy individuals in their fifties or sixties. Older seniors and those with chronic illnesses or serious medical conditions are unlikely to qualify for coverage. According to the American Association for Long-Term Care Insurance, more than half (53.6 percent) of applicants aged 75 and older were declined for traditional policies in 2020.
Ways to use Life Insurance to Pay for Home Care Services
The life settlement industry is emerging as a popular option for seniors to receive cash payments through the sale of existing life insurance policies to third parties, who assume future premium payments and collect the death benefits upon maturity. Seniors can then use this lump sum however they choose—often to cover long-term personal care costs.
There are a few ways that seniors who have life insurance policies can use them to pay for home care.
Accelerated Death Benefit
Seniors can take a loan from their life insurance policy’s cash value or surrender the policy entirely in exchange for the cash value. Policies that feature an “accelerated death benefit” rider offer a cash advance that is subtracted from the death benefit amount the beneficiary receives upon the death of the policy holder. The owner of the policy must be terminally ill with a limited life expectancy or be deemed unable to perform basic activities of daily living (ADLs). The policy is not surrendered at the time of the cash advance, so the policy holder must continue to pay the premiums to guarantee the beneficiary receives what remains of the original death benefit. The insurance company will require physicians’ statements and medical records attesting to the illness or loss of function before they will pay out any early benefits.
Life Insurance Conversion
Instead of receiving a lump sum from the sale of a life insurance policy, the original owner receives a specific dollar amount worth of senior care services in the form of a “long-term care” benefit account. This account must be used to pay for the provision of services like home care directly. The third party who buys the life insurance policy assumes the premium payments and subsequently collects the death benefit when the original policyholder dies. Unlike settlements, life insurance conversions will generally not affect a senior’s Medicaid eligibility.
Veterans Administration (VA) Benefits
The Veterans Health Administration (VHA) Standard Medical Benefits Package may be used to provide various levels of home care services as an alternative to nursing home care and as a way of delivering respite care for veterans and their family caregivers. The VA’s Skilled Home Health Care Services (SHHC), Homemaker and Home Health Aide Services (H/HHA), and Home-Based Primary Care programs are available to all veterans who meet eligibility requirements for standard benefits, although some additional conditions may apply.
VA Pension Benefits (Aid & Attendance)
VA pensions are a source of funding that can help cover the costs of home care for veterans and their surviving spouses. In addition to the basic Veterans Pension, “improved” pensions (categorized as Aid & Attendance or Housebound) increase the monetary benefits available to veterans and surviving spouses whose needs require a higher level of care.
Eligibility for VA Pensions can be complex, but the basic requirements include 90 days of active-duty service (including at least one day during a recognized wartime period) and any character of discharge other than dishonorable. Since pensions are need-based, applicants must meet certain income and asset limits as well. Contact us (909-652-0076; [email protected]) to discuss how VA benefits may be used to help you pay for your personal care needs.
Private Options for Funding In-Home Care
Personal Savings and Retirement Accounts
Most families pay out of pocket for in-home care services. Possible sources used to cover private pay home care expenses might include individual retirement accounts (IRAs), health savings accounts (HSAs), pensions, investments, annuities, real estate and Social Security benefits. Although seniors may be hesitant to use their hard-earned savings or liquidate assets, it is important to consider that properly “spending down” almost all assets is required to qualify for Medicaid. By and large, senior care needs grow over time and higher levels of long-term care are increasingly expensive. Unless an aging loved one has amassed significant savings, when creating a long-term financial plan, it is important to consider the possibility that they may outlive their funds and need to apply for Medicaid at some point.
Using a Reverse Mortgage to Pay for Home Care
A reverse mortgage loan allows senior homeowners with substantial home equity to receive cash by borrowing against the value of their homes. The proceeds can be used to pay for home care, fund home modifications for aging in place, and even purchase long-term care insurance. Reverse mortgages become due when the borrower sells the home, moves from the home or passes away.
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