In-home care is a generic term to describe the services one may receive in their home to recover or to live as independently as possible.
How does in-home care work when someone needs dementia-specific care? What are those costs? This article will discuss in-home care that supports dementia care services.
Overview of In-Home Dementia Care Costs
In-home dementia care means that an in-home care provider either has received training or has specialized experience in providing dementia and Alzheimer’s support. These caregivers are often trained in therapeutic supports to assist with memory loss, agitation, and even grief and loss for the person experiencing dementia and also potentially for the family.
Average Costs of In-Home Dementia Care
According to the National Bureau of Labor Statistics, an in-home care nurse can cost around $41-$42 per hour, and a home health aide can cost around $18-$19 per hour. The Alzheimer’s Association cites the Genworth Cost of Care Survey as showing up to $33 per hour for in-home care services.
Factors Influencing In-Home Dementia Care Costs
In-home care costs can vary dramatically based on your state, region, and the severity of your loved one’s dementia care needs.
Care costs can also be influenced by whether you or your loved one require additional medical care or specialized equipment beyond dementia-specific care. It is recommended to interview a few agencies in your home area to understand your loved one’s dementia care needs and how that will impact your costs of care.
Types of In-Home Dementia Care Services and Their Costs
In-home care and dementia in-home care are very similar with the main difference being the training and experience of the in-home care provider. If you have not already started researching in-home care in general, below is a list of services that can be provided to individuals who need in-home care regardless of whether or not they need dementia-specific services.
Personal Care Assistance
Cost: $18-19 per hour.
Personal care assistance entails assisting with activities of daily living. These activities include but are not limited to:
- Showering, bathing, and grooming
- Repositioning in bed
- Dressing
- Toileting
- Changing bed linens
- Supervision and companionship
- Assistance to leave the home safely
- Feeding including hand feeding or comfort-focused feeding
- *Giving medications only if certified and allowed in your state and allowed by the agency that is providing the care.
Skilled Nursing Care
Cost: $41-42 per hour.
In-home care nurses can assist with several activities based on their licensure and training level. These include but are not limited to:
- Taking vitals
- Giving medications and or setting up and filling medication lock boxes
- Medication monitoring to ensure medications are not forgotten or taken too frequently
- Activities of daily living
- Wound care/dressing changes
- Tube feeding care and cleaning
Companionship Care
Cost: Varies depending on the type of companion care needed.
Companion care is hiring someone to provide memory care and wander risk supervision, emotional support, or companionship to you or your loved one. Some companions assist with mobility to leave the home, while others may stay in the home with you to converse, play music, read a book, or assist with light chores.
Specialized Medical Care
Cost: Varies depending on the specifics needed to provide safe medical care.
Specialized medical care includes hiring providers who have knowledge and expertise on medical devices (i.e. trachs, ventilators, tube feedings, etc.) or knowledge of dementia and Alzheimer’s care. These providers understand how someone with dementia may react or respond to medical interventions and whether or not there may be specialty equipment needs. Examples of specialty equipment needs include a wander alarm system, a medication lock box with reminders, or other supportive equipment for dementia care needs.
Costs of specialized medical care will be determined based on the medical care needed. This can include cleaning wounds, dressing changes, suction, supplies provided, and hourly time. Because these costs are incredibly variable and medical complexity is hard to sum up in a blog, it is recommended to speak with at least 2-3 home care agencies to get a sense of what the hourly cost would be in your area for your unique type of medical care.
Comparing In-Home Dementia Care Costs to Other Care Options
When deciding between in-home care and living in a facility, be it an assisted living facility or a nursing home, it is important to understand what is available for care services and the potential cost drivers.
In-Home Dementia Care
Cost: Around $5,700 per week for a home health aide at 40 hours per week (8 hours of care for each of 5 days).
When living at home, these are common services needed and the cost drivers:
- Hourly in-home caregiver rates. Rates per hour can vary from $18-$42 based on the type of caregiver needed and the services you want provided. The more medical needs that you or a loved one has, the greater the cost of hourly care will likely be.
- Meal preparation and assistance with feeding. If you or a loved one is no longer able to safely monitor a stove or cook food, a homemaker may be a needed service. On average, homemakers cost around $30-31 per hour.
- If around-the-clock care is needed due to safety risks, then care costs will dramatically rise as you will need to pay for both daytime and overnight supervision. Examples of potential safety risks include wandering, accidentally burning food, or starting small fires due to forgetting to turn off the stove or oven, and forgetting to bathe, dress, or eat.
Assisted Living
Cost: Around $5,400 per month for the apartment rental without in-home care support. Additional touchpoints are extra and paid per service as not all services are hourly.
Please note that buildings may be either locked or unlocked. Locked buildings are to prevent wandering and may have increased costs due to the increased staffing that is needed to monitor wandering needs.
It is a misconception that assisted living apartments come with built-in caregiver support 24 hours per day, 7 days per week. While assisted living buildings offer caregiver support, and may have a nurse on site at all times, assisted living facilities are not staffed like a nursing home and you need to “pay by the service” to get additional help in your apartment.
As such, residents are expected to be able to live alone most days and only need these few touch points:
- Meal reminders. Most assisted living facilities offer reminders to go to a meal but do not assist with actively feeding a facility resident
- Bathing care, usually 1-2 times a week
- Medication reminders
- Assistance with dressing or going to bed (daily is usually not offered)
Each of the bulleted touch points or check-ins carries its own cost based on the specific assisted living building and staffing availability. It is important to remember that, while the name assisted living sounds like it provides extra care, it often is not the level of care that families are hoping to provide for their loved ones with dementia.
Nursing Homes
Cost: Around $9,800 for room and board to start. There can be additional costs for memory care and medical complexity.
Nursing homes or skilled nursing facilities have two different types of memory care rooms. One is locked, and the other is unlocked. Similar to assisted living buildings, some nursing home wings are locked to prevent wandering. Other wings are unlocked to allow residents to come and go as they like.
Some common costs associated with nursing homes include but are not limited to:
- Room and board charges. These charges are not covered by Medicare or any other private insurance plan. Some room and board charges may be covered through Veterans Administration Benefits or Medicaid enrollment.
- Medical complexity. Beyond dementia care, if a person needs additional medical equipment or additional staff support for their medical care, then there may be higher costs per day.
- Locked or unlocked units. Depending on the staffing and security measures needed to provide a locked or unlocked unit, prices may fluctuate between different nursing homes.
When comparing in-home care and other types of living, cost is an important factor, but so is safety. Families often hope that assisted living will prevent a nursing home placement and will be cheaper than paying for in-home care. However, if an assisted living facility does not offer the safety and support that a person needs, then families may need to prepare for an eventual nursing home placement to be guaranteed on site staff supervision 24 hours per day, 7 days per week.
Financial Assistance and Payment Options
After reading this blog, costs may seem daunting and may create a sense that in-home care or care outside of a nursing home is unattainable for your loved one. Below are some financial assistance options to consider for financing in-home care.
Medicare and Medicaid
Medicare is the most common insurance plan held by either those who are 65 and older or those who are medically disabled. While Medicare has options for home health services, these services are only available when deemed medically necessary.
If deemed medically necessary, Medicare home health services cover a wide range of services, to those needing part-time or intermittent care and are homebound. It is important to note that Medicare may not always agree with you or your loved one about what’s considered medically necessary. If Medicare denies coverage, it’s recommended to check with your Part B supplemental coverage provider to see if there are services covered outside of Medicare.
Conversely, Medicaid is a joint program between the federal government and a state government. You or your loved one may qualify for Medicaid insurance based on the following criteria:
- Low income
- Qualified pregnant women and children
- Those with medical or mental health disabilities
- Other mandatory groups
If you are eligible for Medicaid, in-home dementia care services may be available to you under this insurance plan if there is a demonstrated medical need.
It is important to note that neither Medicare nor Medicaid covers 24/7 in-home care services and that the majority of in-home care needed is covered by family, loved ones, or private pay services.
Long-Term Care Insurance
Long-term care insurance plans are individual plans that you can buy through an insurance broker, much like life insurance plans. Long-term care insurance plans are specifically designed to cover services like private pay in-home care or room and board at a skilled nursing facility.
It is also important to read the fine print of your plan. For example, how much do you need to pay out of pocket first before your insurance kicks in? After you have met this requirement, does your insurance plan pay for only some expenses for care, or does it pay for all expenses for care?
Not all insurances pay 100% of your care needs, so it is important to know if a long-term care insurance plan is the right level of financial assistance for you.
Veterans Benefits
Veterans who have been discharged with service-connected benefits may be eligible for coverage of some in-home care support or some assisted living support for dementia.
To find out what you or your loved one may be eligible for, it is recommended to contact your local Veterans Administration (VA) clinic or hospital to ask about your service-connected benefits.
Nonprofit and Charity Assistance
Various community and nonprofit programs exist to aid those who are aging with living independently.
You can often find programs like these through your local community centers, county health and human services departments, and county financial aid offices.
Other little-known resources are support systems through places of worship. Some places of worship have volunteer programs for companionship and respite for short periods of time.
For any community or nonprofit programs, please know that volunteers are not always the same as licensed nurses and they may not be able to provide all of the care you or your loved one needs.
Tips for Reducing In-Home Dementia Care Costs
In-home care, including dementia in-home care, can get very costly very quickly due to the specialized needs of persons living with dementia. The next section will discuss ways to reduce costs for in-home dementia care.
Utilizing Community Resources
While community resources can be less expensive, or even free through volunteers, there are limitations to the care a community-based program or volunteer can provide.
Here are some tips to evaluate if a community-based program is right for you or your loved one:
- Be honest, be honest, be honest. If you do not give the full or complete story to a community group, then they may initially say yes to providing care only to then quickly close out care due to safety concerns or the complexity of mental health or medical health needs. Being honest and upfront about what is truly happening saves you time, cost, and stress from starting and stopping programs.
- Be mindful of change. With dementia, some individuals can become very stressed with new volunteers every shift or even with leaving their home environment. You will need to evaluate if a rotating group of people or traveling to and from a community program (i.e. an adult day program) is supportive of your loved one.
Negotiating Rates
When negotiating rates, families or loved ones may think that they can do the medical care to enable negotiating a lower rate or cost of care.
When considering this route, please be mindful of the following:
- Is it safe for me to provide the medical care they need?
- What if I am sick and cannot get there? Can someone else perform the medical care needs as soon as possible?
- Are we negotiating rates to “cut corners” rather than being honest with the reality that sometimes living at home is not the safest or most cost-efficient plan?
Navigating In-Home Dementia Care Costs
Navigating the stages of dementia can be tiring both emotionally and physically, especially when trying to keep a loved one at home or trying to live as independently as possible.
Costs can be a burden and can make you or your loved ones feel overwhelmed. Know that you are not alone and that it takes time to learn the medical care that is needed as well as how to manage costs for the long term.
This article was reviewed and fact-checked by Megan Jones, MSW, LSWAIC.
Sources
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