Virginia has publicly funded in-home programs for those who cannot afford private-pay home care.
To find Home Care options in your area, visit http://www.homecarechoice.com
Among them the Community Living Program, a nursing home diversion program, and Home and Community Services, a program to enable low-income seniors to live at home.
How To Pay For Home Care in Virginia
There are diverse ways to pay for home care and in-home services and organizations to help find funds.
For example, long-term care insurance covers long-term care that Medicare and supplemental insurance don’t cover – if your policy includes care at home, so study the small print.
Policies specify kinds of care and conditions you must meet before the insurer will begin paying for home care. You must have problems with several “activities of daily living” – bathing, eating, dressing, toileting, walking and moving from one place in the home to another.
For unbiased information about long-term care insurance you have or want to buy, contact the Virginia Bureau of Insurance life and health consumer services at (804) 371-9691 or toll free at (877) 310-6560.
Other unbiased information about health insurance is available through the Virginia Insurance Counseling and Assistance Program (VICAP) located in area agencies on aging statewide. VICAP gives free confidential help dealing with enrollment, medical claims, billing problems, filing for benefits and understanding statements. In Richmond, call (804) 343-3000 or (804) 343-3014 for VICAP.
Some medical insurance policies 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 others, and Medicaid, the state-federal health program for low-income people. Some Virginia 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 free comprehensive online program, www.BenefitsCheckUp.org
Another first-step in finding benefits and care is the Eldercare Locator, a national information and referral service sponsored by the Administration on Aging at (800) 677-1116. The Web site is www.eldercare.gov Enter your zip code to find your nearest Area Agency on Aging (AAA). Services vary at hundreds of AAAs nationwide, but their shared mission is to help older adults remain independent at home with unbiased information and connection to resources.
In the Richmond area, Eldercare Locator will refer you to Senior Connections, The Capital Area Agency on Aging, 24 E. Cary St., Richmond, VA 23219; (804) 343-3000 or www.seniorconnections-va.org This is a useful place to start finding resources and information for seniors and caregivers in Richmond and the counties of Chesterfield, Henrico, Hanover, Goochland, Charles City, New Kent and Powhatan.
Senior Connections offers a comprehensive range of home and community services aimed at helping seniors maintain quality independence. It emphasizes help to frail, low-income elders who are along and physically or economically at risk.
It also offers a free long-term care home consultation by a nurse or social worker. You can get help finding payment sources. Call Majoria “Jo” Norton, care coordination manager, at (804) 343-3000.
Another go-to source is www.SeniorNavigator.com, which provides online resources statewide on health and community support for seniors, caregivers, adults with disabilities and families.
Medicare, the federal health insurance for seniors over 65 and others, “covers only a small proportion of the long-term care services you may need if you have a chronic illness or disability,” according to Medicare literature.
“Most importantly, it will not cover ‘personal or custodial’ care or supportive services, such as homemaker or Meals on Wheels. 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.”
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-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. Other information sources are Social Security at www.ssa.gov or (800) 772-1213, your local Social Security office, state Bureau of Insurance life and health consumer services at (804) 371-9691 or toll free at (877) 310-6560 or VICAP at (804) 343-3000 or (804) 343-3014.
Ask about Medicare Part A’s benefit that may pay for hospice at home, including for a serious medical condition like dementia.
If your Medicare insurance is through a Medicare health plan or Medicare Advantage Plan, check your plan for in-home services.
The Qualified Medicare Beneficiary and Special Low-income Medicare Beneficiary programs help low-income seniors pay for some of the Medicare Part A and B premiums, co-payments and deductibles.
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, the payer of last resort, 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. Medicaid investigates to see if you’ve deliberately divested yourself of assets to qualify.
There is a Medicaid online enrollment form at www.easyaccess.virginia.gov
Senior Connections also will help fill out applications.
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.
Home and Community Services for the Elderly is Senior Connection’s program for seniors whose income is too high to qualify for Medicaid but who still need financial help to stay at home. Seniors in this program wouldn’t be able to live independently without help, and may or may not be impaired enough to enter a nursing home. Seniors can receive help such as personal care, home-delivered meals and transportation to medical appointments. Services are free or based on a sliding scale. Call (804) 343-3000.
The Community Living Program is a nursing home alternative that begins Oct. 1 for a limited number of low-income seniors age 65 or older who are eligible for Medicaid and who need skilled or intermediate health care. The goal is to prevent costly institutionalization or Medicaid useage by providing needed home services. Seniors can get help with such activities as bathing, dressing, using the toilet, hygiene, eating, walking and moving from one place in the home to another; home-delivered meals and medical equipment. The cost is free or at an affordable level based on income and assets. Call (804) 343-3000.
Medicaid also covers in-home and community-based long-term care services through several programs in Virginia via Assisted Living Waivers, if you’re medically or financially eligible.
Home-delivered nutrition programs such as Meals on Wheels deliver a weekday chilled meal to adults who cannot shop or cook for themselves. Meals are to qualified homebound seniors based on ability to pay, but donations are welcome. Call (804) 673-5035.
Veterans programs are complex, and the easiest way to find ones you and your family qualify for is to have a guide. Contact the Virginia Department of Veterans Services, whose benefit service officers will assist veterans with finding and submitting benefits paperwork. In Richmond, call benefit service officers at (804) 675-6546.
An overview pamphlet is “Federal Benefits for Veterans, Dependent & Survivors (2010 edition)” is athttp://www1.va.gov/OPA/publications/benefits_book.asp
Eligible military retirees may be covered by TRICARE For Life, an original Medicare wrap-around insurance available to all Medicare-eligible TRICARE beneficiaries, regardless of age, provided they have Medicare Parts A and B. TRICARE has a low-cost prescription benefit.
Beneficiaries also include Medicare-eligible family members and widow/widowers and certain former spouses if they were eligible for TRICARE before age 65.
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. For more information about dementia, call the Alzheimer’s Association, Greater Richmond Chapter’s 24/7 Helpline at (800) 272-3900.