What options do we have to pay for home care?

A fellow caregiver asked...

My mother moved in with us at 78, she was a great addition to our family and helped doing little things like dishes and her own laundry, now she is 82 and I make her breakfast, lunch and dinner when I am home. Both my wife and I work and if we cannot make it home for lunch, my mother does not eat. I am working with her doctor to get some weight on her, but she is to the point where I am concerned about leaving her alone. She is on Medicare, financially, we can no afford to bring someone in for 6 hours per day, that would cover our time away, What options are out there for us/her?

Expert Answer

Unfortunately, Medicare's home care coverage is not going to help you in this situation. The kind of care your mother seems to need is called "custodial care" and involves help with the activities of daily living but not medical care. Medicare only provides help in the home when medical care -- skilled nursing and therapy -- is required, and even then only for a limited time.

There are some other options for you to look into. If your mother has only a small income and no more than a few thousand dollars in assets, she might qualify for Medicaid. Medicaid provides medical coverage, but it can also provide long-term care for people like your mother whose needs are not primarily medical. Whether your mother qualifies for Medicaid and if so whether she would qualify for long-term care depends on the rules of the Medicaid program in your state. The specific Medicaid rules in your state would also determine the type of care she could receive, and how much of it, depending on her needs and the kind of care available under the state's Medicaid program. It may even be possible for you or your wife to become paid family caregivers, with an off-shoot of the Medicaid program paying you a small amount to help care for your mother. To find out the Medicaid eligibility rules in your state, and whether they have a family caregiver program, you can go onto your state's Medicaid Web site. Use any Internet search engine and enter "Medicaid" and the name of your state. Or, you can call the Eldercare Locator toll-free at 800-677-1116 and ask for contact information for your state's Medicaid office, then call the main office and ask about the specific rules and programs in your state.

Whether or not your mother qualifies for Medicaid, you might want to find out about adult day care centers in your area. These are places where an elder can spend several hours a day and get assistance with the normal activities of daily life, as well as have supervised recreation and the company of others. Adult day care is sometimes covered by Medicaid. Even if there's no Medicaid coverage, adult day care may be a less expensive option -- and more interesting for your mother -- than hiring a private caregiver to stay at home with your mother while you and your wife are at work. To find out about adult day care centers near you, you can contact your local Area Agency on Aging or the National Adult Day Services Association (NADSA)[nadsa.org] for a list of its local members. You can also look at Caring.com's Local Resource Directory. And don't forget to ask family, friends and neighbors.