Winning Tactics for Planning Home Care Services9 minute read

9 minute read


Updated for August, 2019

Home health care agencies and caregivers have been governed by a set of rules and legislation that has remained static for the greater part of the last three decades. In 2017, those regulations experienced their first large-scale overhaul in the form of a bevy of newly instituted federal regulations that simultaneously add a layer of complexity to an already labyrinth-like industry while also providing a spectrum of crucial benefits to patients.

Home Care Planning

Seniors are now more than ever able to enjoy a streamlined process for their home care service agency selection.

As a result of the all-new federal regulations put in place, the adult day care and in-home care industry has changed in a multitude of ways, with the bolstering of patients’ rights topping the list of most readily apparent changes made. The transformational shift of the home health and long term care towards strengthening patient rights as well as those of their families has resulted in the amelioration of many of the stresses involved in the process of choosing at-home care services that are best suited for an individual’s health needs.

Widely considered to be a revolutionized industry with immense changes looming in the not-so-distant future, patients are now more than ever able to enjoy a streamlined process for their home care service agency selection while also being able to implement a set of winning tactics for planning the scope, depth, and breadth of their home care service needs.

Read on to learn more about the types of winning tactics to undertake in planning your home care services and ensuring your future comfort and happiness.

Home health care, as it is defined today, is a range of in-home services provided to patients experiencing illness or injury, while enabling clients to regain or maintain a modicum of independence. As has been the case for the last three decades, home health care is still considered to be a pragmatic health care choice offering effective health care that is vastly more affordable than the care a patient would receive in a skilled nurse facility or hospital setting.

The cost of in-home long-term care is projected to increase upwards of 330% over the next three decades, resulting in the eventuality of many aging citizens unable to provide health care assistance for themselves due to being priced out of the market.

  • The care, treatment, and overall assistance you will need and the type of in-home health care professional best suited to provide these services (Important considerations include: medication management, health care tasks, specialized care needs, transportation, household management, coordinating with family and medical providers)
  • The frequency and duration you will need in-home health care assistance services
  • Any medical equipment you may require for your condition(s)
  • Your short and long-term prognosis
  • Finances

Available funding options for in-home health care assistance services are limited. Medicare does not pay for what it refers to as “ongoing home health care services,” although some Medicare recipients are able to take advantage of limited-time, in-home nursing care to assist in recovery from illness or injury. Conversely, Medicaid will cover in-home health care assistance services (depending on the state in which you reside), with some states even offering assistance with personal care and non-medical home care issues. That being said, Medicaid has stringent income requirements, and patients must be low-income to take advantage of Medicaid’s many services.

Many seniors find that they do not qualify for Medicaid due to their income exceeding Medicaid thresholds. As a result, the only other option available that many seniors find themselves turning to is long-term care insurance that can include things like home safety modifications such as ramps, grab bars, and lighting, medical equipment, and, of course, in-home nursing and assisted care.

Retaining insurance continues to be a problem for millions of U.S. citizens who find themselves in what has been colloquially termed as the “insurance gap,” where they simultaneously make too much money to qualify for things like Medicaid but too little money to be approved by insurance carriers. North Carolina, for example, has nearly 800,000 citizens who fall into the insurance gap and live precarious lives without healthcare coverage.

As many seniors start the planning process of securing home in-home care services for their future, they quickly find out the financial dilemma that precludes millions of other seniors across the country from receiving the necessary home health care that is essential to their ongoing health and survival. For those fortunate enough to procure long-term insurance care, benefits will reimburse the cost of home care services that can provide a range of assistance with health care needs, monitoring chronic illnesses, activities of daily living (ADLs), finance management, medication administration, and the overall upkeep of a patient’s home.

It is disconcerting to note, however, that the cost of in-home long-term care is projected to increase upwards of 330% over the next three decades, resulting in the eventuality of many aging citizens unable to provide health care assistance for themselves due to being priced out of the market. Today’s home health care pricing may be far more affordable than skilled nursing facilities, for example, but they are still costly ventures that require a combination of planning and decision-making to ensure the funds are available for the time when in-home health care is absolutely needed.

With Medicare’s stringent qualification process, Medicaid’s low-income threshold rules, and a deeply complex and difficult private insurance system existing in the United States a precarious situation has resulted for countless seniors poised to make their next critical decisions for the future of their health care and, for many others, has served as the kind of eye-opening information needed to spring into action and develop an action plan for the future.

States that expanded Medicaid tend to have far more private insurance options that are more affordable and less restrictive in obtaining coverage.

  • Determine the type and range of assistance you will require in addition to the frequency and duration. (Consider your condition, prognosis, and ability to complete ADLs)
  • Determine if you will require any medical equipment
  • Determine if you are Medicare or Medicaid eligible
  • Review private insurance options in your state and their corresponding costs and included benefits
  • Apply for the best insurance program possible with respect to availability within your state and your individual budget
  • Denied? It’s not over yet. Are you able to move? Will family and loved ones support such a move? If you live in a state that did not expand Medicaid, your chances of obtaining services are next to nothing. However, if you live in a state that did expand Medicaid, income thresholds may be much higher. Additionally, states that expanded Medicaid tend to have far more private insurance options that are more affordable and less restrictive in obtaining coverage

Centers for Medicaid and Medicare services

2017 was a revolutionary year for the home health care industry with an immense shift taking place that has resulted in patient-centered care that is reflective of the highly individualized needs of patients. While providing a boon of benefits for many seniors who are either Medicaid eligible or fortunate enough to have long-term private insurance, home health care remains a costly venture for millions of Americans who just happen to be stuck in the wrong state.

Although hard to fathom, insurance can be nearly impossible for an elderly couple to obtain in South Carolina today if they don’t make enough money. Worth mentioning is the fact that if they make too much money, they are not eligible for Medicaid assistance services. Thus, they become one of the millions of Americans who are left in the “insurance gap” and are left without basic health care coverage.

At the same time, across the Pacific Ocean in Hawaii, obtaining private health insurance is a relatively easy and straightforward process that involves merely being able to afford the premiums (which can be difficult for many seniors). Absent of the stringent processes found in the more conservative states who opted not to expand Medicaid, states such as Hawaii have readily available private insurance in addition to Medicaid eligibility income standards that are comparatively relaxed.

Thus, obtaining the coverage for home health care can actually come down to the state that you reside in, the insurance marketplace that exists within that state, and whether or not that state opted to expand Medicaid. It’s difficult to imagine the future of your health care hinging on your locale, but for millions of ailing seniors, it comes down to that very distinct point.

As private insurance carriers make the decision to pull out of certain states every day, many states are left with just a single insurance company having the power to accept and deny patients (e.g., North Carolina and Blue Cross). In comparison, other states may have a robust insurance marketplace that gives consumers the choice of up to 5 or 6 different insurance carriers offering an array of benefits and premiums.

Now more than ever, it becomes abundantly clear that developing a plan for your health care needs is of paramount importance. Beginning with a thorough assessment of your needs and ending with a countdown to finding coverage and/or funding, the planning and decisions you make now can serve to become winning strategies that will secure your future health, comfort, and ultimately your happiness in life.