North Carolina has information resources and publicly funded programs for seniors who want in-home programs but cannot afford to privately pay for home care.
One resource is the North Carolina Seniors’ Health Insurance Information Program (SHIIP), which has become a model for similar state programs nationwide.
For free unbiased information, contact SHIIP at (800) 443-9354 or (919) 807-6900. SHIIP counsels about Medicare, Medicare supplements, Medicare Advantage and prescription drug plans.
And SHIIP can assist you with other insurance questions and refer you to other resources. One is long-term care insurance, which covers long-term care that Medicare and supplemental insurance don’t cover. You can discuss options before you purchase a policy, or get help figuring out if your existing policy includes care at home.
Long-term care policies specify kinds of care and conditions you must meet before the insurer will begin to pay for home care. You must have problems with several “activities of daily living” – bathing, eating, dressing, walking, moving from bed or chair and back again.
Also look at your medical insurance policies. Some include limited coverage at home for certain conditions. Again, read the fine print.
There are strict rules for home-care paid under Medicare, the federal health program for people over age 65, and Medicaid, the state-federal health program for low-income people. Some North Carolina programs with home services are on a sliding fee scale; others are free.
A quick source of finding financial aid and services that you qualify for is the National Council on Aging’s free comprehensive online program, www.BenefitsCheckUp.org
Another first-step in finding local benefits and care is the Eldercare Locator, a national information and referral service sponsored by the Administration on Aging at (800) 677-1116.
In Raleigh/Durham, Eldercare Locator will refer you to Triangle J Council of Governments Area Agency on Aging, 4307 Emperor Blvd., Suite 110, Durham, NC 27703, (919) 558-2711 or (800) 310-9777, and www.tjaaa.org It is a useful place to start finding resources and information for seniors and caregivers in Chatham, Durham, Johnson, Lee, Moore, Orange and Wake counties.
Most Triangle J consumer questions are referred to Resources for Seniors in Wake County
(919) 713-1556 or to the Council for Senior Citizens in Durham at (919) 688-8247.
Many erroneously believe Medicare will pay for in-home custodial care for life.
But according to Medicare literature, According to Medicare literature, “Medicare covers only a small proportion of the long-term care services you may need if you have a chronic illness or disability. Most importantly, it will not cover ‘personal or custodial’ care or supportive services, such as homemaker or Meals on Wheels.”
Instead, Medicare focuses on acute care rehabilitation. It pays for limited home health care requiring skilled nursing such as intravenous and medication administration and physical, speech and occupational therapies. The recipient must be homebound with a physician-approved care plan.
“Medicare pays all medically necessary home care for limited hours for a limited number of days, and, after deductibles are met, will pay 80 percent of Medicare-approved durable medical equipment – such as a walker or wheelchair. Your Medicare supplemental insurance typically pays for the remaining 20 percent once you’ve met the insurance deductibles,” Medicare information states.
Medicare-certified home health agencies can’t charge more than they are paid for Medicare-approved services. They’re required to tell you in writing and verbally costs that Medicare won’t cover.
For details on the Medicare Home Health Benefit in original Medicare, visit www.medicare.gov or call (800) 633-4227. Or visit www.ssa.gov or call (800) 772-1213. Other information sources are your local Social Security office or the North Carolina Seniors’ Health Insurance Information Program (SHIIP). Ask if you qualify for the Medicare Low-Income Subsidy (LIS) program and the Medicare Savings Programs (MSP).
The Qualified Medicare Beneficiary and Special Low-income Medicare Beneficiary programs help low-income seniors pay for some the Medicare Part A and B premiums, co-payments and deductible.
If your Medicare insurance is through a Medicare health plan or Medicare Advantage Plan, check your plan for in-home services.
Medicaid is the state-federal program for medical and long-term care assistance for people of all ages with very low incomes and assets. Medicaid is the main funding source for late-life care nationwide.
Most services under Medicaid are free – but there are strict enrollment limits. For seniors, that often means “spending down” assets, savings and income before qualifying. Total asset limits take into consideration a spouse who still lives at home. The government has restrictions about divesting yourself of assets to qualify.
Medicaid covers such things as home health care; homemaker and chore services; care by physicians, podiatrists, optometrists, dentists, chiropractors and psychologists, hospice care, medical transportation, eyeglasses, dentures, hearing aids and prescription drugs.
For specific requirements in the Raleigh/Durham area, check with the Council on Aging, Resources for Seniors or your county department of social services.
In addition to home care services through Medicare and Medicaid, other Medicaid programs help pay for in-home services. Included are Medicaid Community Alternatives Programs (CAP), Medicaid Personal Care Services (PCS), Medicaid Home Infusion Therapy (HIT), Medicaid Durable Medical Equipment (DME) and Medicaid Private Duty Nursing (PDN).
For more information about long-term care payment sources, visit http://www.ncdhhs.gov/dhsr/ahc/consumer.html
Home-delivered nutrition programs such as Meals on Wheels deliver a daily chilled, frozen or hot meal to people 60 and older who can’t fix a meal, attend a group meals center or who are homebound. Meals are free to the disabled senior and his or her spouse, but donations are welcome. Contact Meals on Wheels of Durham, (919) 667-9424, or Meals on Wheels of Wake County, (919) 833-1749, for the Raleigh metro area, or the county where you live.
Veterans programs are complex, and the easiest way to find ones you and
your family qualify for is to have a guide. Contact the North Carolina Division of Veterans Services at www.doa.nc.gov/vets/ The site also lists county benefit service contacts who assist with finding and submitting benefits paperwork.
Eligible military retirees may be covered by TRICARE For Life, a Medicare wrap-around insurance available to all Medicare-eligible TRICARE beneficiaries, regardless of age, provided they have Medicare Parts A and B.
For more information, contact WPS TRICARE For Life, P.O. Box 7889, Madison, WI 53707-7889 or (866) 773-0404, TDD (866) 773-0405 or www.tricare4u.com
TRICARE includes a low-cost prescription benefit.
Family Respite Care Grant
Family caregivers of those with Alzheimer’s disease and other dementias can apply for a grant to get respite care only through local non-profit organizations that are members of the Alzheimer’s Foundation of America. For information and lists of member organizations, visit http://www.alzfdn.org or call (866) 232-8484.