Hourly Rates
Throughout the United States there is a wide spectrum of fees based on cost of living, and the availability of caregivers. With the low level of unemployment, it is currently difficult to find quality caregivers.
Hourly fees for in-home caregivers can range between $14-27 per hour. Agencies usually have a minimum time requirement for care: 4 hours minimum is the industry norm. At times, one may find agencies that will allow a lower minimum time but with an increase in the hourly rate.
Examples of tasks and rates: An example of an industry pricing arrangement would be a 2-hour bathing service costing $50. Another would be a client requiring 4 hours of care three times a week to assist with bathing, laundry, companionship, and preparing meals for a later time. Assuming costs of $16.00 per hour, one would be paying $192 per week or $825 per month. If a client is dying at home and is bed-bound, 24-hour care is usually needed so that comfort measures including turning the client to avoid bedsores, can be performed around the clock. At $16.00 per hour, this type of care would cost $384 per day, $2,688 per week, or $11,520 per month.
Some agencies have a travel charge to compensate caregivers for transport to the clients home. A common cost is .41 per mile. If the caregiver is expected to transport the client, a transportation fee based on mileage will be charged as well. Other charges will include necessary supplies such as gloves or incontinent briefs. Agencies usually provide or help families obtain these items.
Some agencies have Care Management services, which include ordering medication from the pharmacy, shopping, facilitating physician appointments, bill paying, or numerous other items to allow a client to stay independent. Costs can range from $40-120 per hr.
Special Issues for 24 hour live-in care:
If a client's care is for safety and assistance; as an example due to dementia
or agitation at night, 24 hour live-in care may be required. The client may or may not sleep through the night but the
in-home care agency will need to insure that the caregiver be given adequate uninterrupted time to sleep. Agencies need
to comply with labor laws in these cases, while doing their utmost to insure client safety.
There will always be two employees on a live-in assignment. One employee will be on duty for 3-4 days, and then be
relieved by the other caregiver. The cost of this type of service will range between $170-240 per day again depend
ending on location. At $180 per day, a week of this service will cost $1,260, a month $5,400.
Cost of In-Home Care versus the alternatives
Choosing an in-home care alternative means incurring certain costs while foregoing other expenses.
In the case of a client and a family with light to moderate needs requiring intermittent respite care, the cost of
an in-home care aide is an economical financial decision.
The aide comes to the home, no transportation is required, placement into an institutional setting can be delayed, an
agency can provide supervision, and handle all of the administrative tasks of hiring and retaining good caregivers.
It is a flexible choice allowing the level of care to be increased or eliminated without making long-term decisions.
On the other hand, if intensive, round the clock care is required, staying at home with an in-home caregiver can be
the most expensive way to procure care. This is not surprising since the client receives one-on-one attention in the
privacy of his or her own home, there is no wait to have one's needs met, and the caregiver comes to you.
Individuals and families, who are well to do, often choose this type of care because of the individual attention
afforded the client. While it is more expensive than living in an assisted living center or retirement home, this type
of care avoids institutional placement.
Possibilities for third party reimbursement
While people are increasingly discovering the need for and value of retaining in-home health care workers in the
home, with a few exceptions, the health insurance industry and the Federal Government have not developed insurance
programs that cover this service. With limited insurance coverage available, most people currently rely on private
funds to pay for these type services.
The most optimistic news in this area is that people are discovering and buying long-term care insurance, which
covers this type of service.
The status of third party insurance programs is discussed below.
Most commercial health insurers do not cover services provided at home by home health aides. There are some exceptions however: SCAN, an alternative to Medicare in Southern California and other health care plans that follow a "social model" offer a home healthcare benefit. These organizations wisely view this service as a way of reducing their overall health costs by allowing their members to stay in a familiar, healthy living environment as long as possible.
Medicare Reimbursement
Medicare will only pay for skilled services that are ordered by a physician. Assistance with activities of daily living such as those services provided by in-home care providers are considered "custodial services" which are not covered by Medicare or Medicare supplemental insurance.
Long Term Care Insurance
Long-term care insurance covers in-home care aide services. When coverage is offered, there are usually limitations on benefits such as requiring that the insured be unable to perform at least two activities of daily living. These policies cover assistance with bathing, incontinence and other Activities of Daily Living. The quality and amount of time the in-home care benefit provides depends on the daily reimbursement rate that was selected when the policy was purchased. As an example, if the policy pays $100 per day and the home care charge is $180 per day, your responsibility is for $80 per day. Many long-term care insurance companies are looking at this type of care since there is a growing demand based on the recognition of the frequency of the need for custodial care and the cost of same. Currently, monthly premiums are relatively inexpensive when you compare the monthly cost of care.
Charitable Organizations
While relatively rare, some charitable organizations that target long term debilitating illnesses have established programs to pay for in-home care. As an example, in California there are a number of organizations that provide in-home care services to AIDS victims, clients with brain impairment and services to low-income elderly. The amount of care authorized is usually less than 20 hrs. per month.
