As a registered nurse, can I get Mom's insurance company to pay me for her home care?

1 answer | Last updated: Oct 11, 2016
A fellow caregiver asked...

As a registered nurse, am I able to legally care for my 92 year-old mother at home and receive insurance reimbursement? She is post-stroke 1 year this month and has dementia. I currently have a sitter with her at home during work hours that I pay out-of-pocket.

Expert Answers

Whether you can be paid, by private insurance, to care for your mother at home depends entirely on the terms of the insurance policy. The fact that you are an RN may make it more likely that you can be paid under some policies. The fact that you are the insured's daughter may make it less likely. (By the way, in case you're thinking about Medicare coverage, I'm afraid you'll have to give up that idea because Medicare does not cover long-term "custodial" -- meaning non-medical -- home care.)

If the insurance you're referring to is some kind of private health insurance (that your mother has in addition to Medicare), your mother might be covered under the home health care provisions of the policy. But such a health care policy is not likely to provide the kind of long-term custodial care -- now provided by a "sitter" -- that you're talking about. But if it does provide some amount of home health care that your mother qualifies for, whether you could be paid for providing it would depend on the terms of the policy. Most health care policies require that home health care be provided by a state-licensed home health care agency. Some, however, pay for care by a licensed RN, which might allow you to qualify. You've got to check the specific terms of the policy to find out whether you might be permitted to provide the care -- assuming that your mother qualifies for coverage at all.

The other type of private health insurance that might provide the type of care you're talking about is a long-term care -- LTC -- insurance policy. If your mother has such insurance and if she qualifies for home care coverage under the policy (which it certainly sounds like she would), then the question is the terms the policy sets for payment of the home care benefit. Some LTC policies pay a set daily amount directly to the insured person (your mother) who qualifies for home care, and that person can spend the money however she wants, including paying a family member. Other policies only directly pay a certified home care worker, either through an agency or to an independent but state-certified worker. Whether you as an RN would qualify for payment under such a policy would depend on the exact wording of the policy and on who is certified to provide home care in your state. Finally, some LTC insurance policies specifically prohibit payment to an immediate family member. Again, whether this is the case with your mother's insurance policy depends on the specific terms of the policy itself.