How much for a home healthcare aide?
March 14, 2011 3:19 AM   Subscribe

Mom's sick. I don't live in the United States and haven't for sometime. I don't know how stuff works there in terms of health care.

My mom had a pretty severe heath scare, which landed her in the hospital for a period. She's back home now but very weak and would benefit from someone to help her.

I haven't lived in The United States since 1997 so I don't really know how things work in practical terms. She's limited in terms of income (Social Security, no pension, no savings but I match her Social Security payment every month) and so is being treated by what I understand is a combination of Medicare / Medicaid. I've got a few questions:
  • Family is light on the ground there (Western New York) and she's expressed a desire for someone to help her for part of the day. What would be a reasonable rate for this service? I don't mind paying but would rather not be exploited. Earlier I called one service in the region (found online) and they asked me lots of questions that seemed to be focused on my ability to pay, and did little to resolve my query ("how much for the nurse?").
  • Also timing - can we purchase this service on a daily basis, or do they typically require monthly / annual contracts?
  • How do we transition this service to being funded by Medicare / Medicaid? I simply don't know how to proceed here in spite of googling about.
  • What is likely to be the timing for the government bodies to pick this up? I'd like to understand this before engaging in the home healthcare aide service.
  • Is relative liquidity likely to have an impact? Specifically, is it conceivable Medicare / Medicaid could bill me for some or all of the services I'm hoping they'll provide?
  • Does anyone have a rec for a home health aide / visiting nurse service in Western New York?
Another other points I should be aware of? I'm hoping to get up there personally however I'm very highly leveraged timewise at the present and simply can't, but will get there in the next month or so.

Thanks for any help!

posted by Mutant to Health & Fitness (12 answers total) 3 users marked this as a favorite
A home health aide (who is not a nurse but can provide basic home assistance) cost $22.50 per hour when we needed these services for my grandmother recently in northern New York. I am useless with the rest of your questions but I hope that gives you a ballpark for initial budgeting.
posted by DarlingBri at 3:31 AM on March 14, 2011

Been using a local agency at the same cost as DarlingBri for a certified nursing assistant- in Michigan. Might cost you more or less depending on level of qualification of person and locale/agency you're dealing with. For us it was all out of pocket - don't know how Medicaid changes that picture. Agency we're dealing with requires 24 hour notice on any change in staffing and required a $3500 deposit to start. Don't know how typical either of those is - here, because the family member in question was getting additional nursing in a nursing home they required the home health person have the certification. Good luck - am in the thick of this myself and it's challenging to deal with here. Doing it long distance is hard!
posted by leslies at 3:48 AM on March 14, 2011

When I worked at a service in Buffalo, the going rate was $25 an hour, for an aid. Interesting if it's a tad less. The customers usually had doctor's recommendation. Medicaid will pick it up. Wish I remembered more, but this was ~15 years ago. (I was involved in billing and payroll, not care)
posted by Goofyy at 5:53 AM on March 14, 2011

Mutant, the question of whether Medicare/Medicaid will pick up any of the tab depends on your mother's specific health issues and prognosis. Have you spoken with her doctor directly? And if they do approve an aide, be prepared for it to be for a ridiculously low amount of hours a week, like four or six.
posted by crankylex at 6:57 AM on March 14, 2011

A few state resources that might be useful:

NYConnects: Long Term Care in NY
NYS Office For the Aging

One issue you should unfortunately keep in mind is that there will be cuts to Medicaid in this year's budget. While they are not as severe as Cuamo initially proposed, there will soon be caps on the amount of home care covered by the state.
posted by susanvance at 7:00 AM on March 14, 2011

"Earlier I called one service in the region (found online) and they asked me lots of questions that seemed to be focused on my ability to pay, and did little to resolve my query ("how much for the nurse?")."

This MAY be because rates often depend on whether you have insurance/Medicaid and, if so, what kind. (For example, the insurance-billing rate for my C-section was around HALF of what the "official" rate for my C-section would have been if I paid cash.) This is typical in the U.S., for rates to vary based on insurance, etc.

However, it MAY have been because they're shady. (In my state there's a law that they have to provide a cash price when people ask, and make available certain information about contracted insurance prices, but I don't know about New York.)
posted by Eyebrows McGee at 7:07 AM on March 14, 2011

Home health aids aren't paid very well, and may not be well-educated. Quality and reliability vary a lot. Check any agency with the BB. I have a sister who works with hospices a lot, and she feels strongly that non-profit hospice and home care agencies offer higher-quality services. Social workers at the hospital should be able to offer referreals.

Best wishes to your Mom.
posted by theora55 at 8:24 AM on March 14, 2011

You can pay for a home health care aide fully out of pocket or, if your mother's doctor thinks it's medically necessary, he or she can "prescribe" the aide and then her insurance will pick up some portion of the cost. You need to check with her doctor first and then with her insurance to see what they cover. My father-in-law has had a home aide for over 2 years for 8 hours a day 5 days a week and about 75% of it is covered by his private insurance.
posted by otherwordlyglow at 9:38 AM on March 14, 2011

Contact a Center for Independent Living in her area. They should be up to date on all the regulations and resources for helping someone continue to live in the community.

There are a couple of different names for these kinds of services (home health care, personal assistance services), so don't start your call by asking for home health agencies. Instead, explain the situation and ask what options might be best for your mom's particular needs.
posted by jasper411 at 12:26 PM on March 14, 2011

You may be in for a rude awakening. Do not assume that Medicare or Medicaid will be paying for or providing home care services. Medicaid or Medicare is not going to bill you for services that they provide, because they are not going to "provide" anything unless payment arrangements are settled first. You may very likely end up having to bear the bills on your own. The agencies call this "private pay."

First, you need to figure out exactly what sort of medical insurance coverage your mother has. Medicaid is only available for people with very low income, and very few assets. All of the questions you got when you called the agency were probably about trying to determine whether your mother was qualified for Medicaid. Medicare is for the elderly and disabled--generally, anyone over 65, regardless of income or assets. But, Medicare does not pay for home care unless it is medically necessary (according to their arcane definition) beginning immediately after a hospital stay. (And/or, your mother may have private or secondary insurance, from prior employment, or that she bought on her own?)

How long has it been since your mother's hospital admission? The need for home health care, and how it will be paid for, is usually sorted out by a hospital social worker just before a patient is discharged from the hospital. If the arrangement is not made at that time, it's very difficult (very close to impossible) to get Medicare to pick it up later. If your mother is eligible for Medicaid, the application process can be long and gnarly. And "liquidity" matters a lot in applying for Medicaid--you have to be nearly destitute.

When my mother was in this position, I found it very helpful to have a consultation with an elder care attorney. The initial consultation was cheap, and gave me enough information to figure out that we didn't need any further legal services to get the Medicare coverage worked out.
posted by Corvid at 4:38 PM on March 14, 2011

My grandmother (who is 93) has home health care come a couple of times a week for a shower and laundry and it is covered by Medicare.
posted by IndigoRain at 6:38 PM on March 14, 2011

Thanks everyone for all the tips; Mum is doing much better. I especially appreciate all the well wishes emailed my way. Apologies for my tardy followup, between Mum and work and University I was pretty heavily leveraged for a long while there.

Thanks again!

PS - Mum is really good now, hopefully we're gonna get her back to 100% independent living in the next couple of weeks.
posted by Mutant at 11:57 AM on April 30, 2011

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