Almost every family starts in the same place. They assume Medicare covers it, they spend a week or two operating on that assumption, and then somebody tells them it doesn't.
That week is expensive, because it's usually the week a decision needed making. So here's the honest version, laid out before you need it.
What Medicare does and doesn't cover
Medicare does not pay for the kind of care most families are looking for. The help with mornings, meals, bathing, dressing, errands and company. In the system's language that's custodial care, and it sits outside what Medicare pays for.
What Medicare does cover is short-term care that a doctor orders after a hospital stay or a specific event. It's time-limited, it has conditions attached, and it ends. Families often experience that ending as a surprise, because the care was working and then it simply stopped.
If somebody tells you Medicare will cover a caregiver at home three mornings a week indefinitely, they're mistaken. It's worth knowing that now rather than in six weeks.
Medicare Advantage is a different question
If your parent is on a Medicare Advantage plan rather than original Medicare, the answer changes.
Some of those plans now include a limited amount of in-home support as a supplemental benefit. Not all of them do, and the ones that do vary a lot in what they'll actually approve and how many hours they'll cover.
There's no way to know from the outside. Call the number on the back of the card and ask specifically whether the plan includes in-home support services or personal care benefits. We've written more about what Medicare Advantage plans can cover at home, and it's worth five minutes on the phone before assuming the answer is no.
Long term care insurance, the one families forget they have
This is the most commonly missed source of money in the whole process.
A policy bought twenty years ago, premiums paid quietly ever since, and the person who bought it is now the person who needs it and can't always remember they have it. Adult children find out when they're going through paperwork for something else.
So look. Check the filing cabinet, check the bank statements for a recurring premium, and check with whoever handled their insurance. If a policy exists, read what it says about an elimination period, which is the stretch you have to pay for yourselves before the policy starts, and what it requires as proof that care is needed.
Agencies deal with these policies regularly and can usually tell you what documentation the insurer will want, which saves a lot of back and forth.
If your parent is a veteran
There's a benefit called Aid and Attendance, and most people have never heard of it.
It's an addition to a VA pension for veterans and surviving spouses who need help with daily activities. It has service and financial requirements, the application takes a while, and the paperwork is heavy enough that a lot of families give up partway through.
It's still worth starting. A veterans service officer at the county level will help with the application at no charge, and that's a much better route than doing it alone or paying somebody to do it for you.
California's own program
California runs In-Home Supportive Services, usually called IHSS, through Medi-Cal. It pays for help at home for people who qualify financially, and it's administered county by county, so the waiting times and the process differ depending on where your parent lives.
It's means tested, so it won't apply to every family. Where it does apply it matters a great deal, and the application is worth starting early because it isn't quick.
Most families pay privately, and that's normal
After all of the above, the majority of in-home care is paid for out of pocket, usually from savings, a pension, the sale of a house, or several family members contributing.
Two things make that more manageable than it looks at first.
The first is that most people don't need somebody all day. They need somebody for the two or three stretches that have gotten hard, and that's usually the morning. We've written separately about how the cost is actually worked out, and the short version is that hours drive everything.
The second is that these sources combine. A Medicare Advantage benefit covering a few hours, a long term care policy covering more, family paying the balance. Very few people fund it from one place.
What to do with this before you need it
Three things, in order, and all of them are easier while nothing is urgent.
Find out whether a long term care policy exists. Call the Medicare Advantage plan and ask the specific question. If your parent served, contact the county veterans service office.
Then bring whatever you've found to the assessment. An agency that looks at the actual paperwork can tell you what's usable and what isn't, and that's a far more useful conversation than a number over the phone.
This article is general information for families and is not medical, legal, financial or insurance advice. Benefit rules and eligibility change, so confirm anything here with the plan, the insurer or the agency directly.
How Golden Years helps
Golden Years Home Care provides in-home care across California. That includes companion care, personal care, dementia care and Alzheimer's care at home, plus 24 hour home care when the nights need covering too.
Our caregivers are our own employees, not contractors, so we carry the payroll, the taxes, the workers' compensation and the insurance rather than your family. Everyone is screened and background checked before they set foot in a home.
We've been family owned since 1996. Care starts with a free in-home assessment, with no obligation and nothing to sign, and you're welcome to bring any policies or plan documents to it so we can go through them with you, whether you're looking at a few hours a week, dementia care, Alzheimer's care at home or 24 hour home care. Licensed as a Home Care Organization, HCO #344700040.
