Health Affairs estimates that 4 million older adults can only leave their homes with assistance, making accessing care challenging.The Centers for Disease Control and Prevention reports that 1.3 million Americans receive care in nursing homes. According to A Place for Mom, more than 810,000 reside in assisted living.Home health care presents an alternative to nursing homes and assisted living, providing care for homebound people. Those who receive home health care can remain in their residences, reducing expenses, preserving autonomy, and maintaining community ties.Although Medicare funds some home health care services, a recent study has found that Medicare beneficiaries are underutilizing the programs home health care options. Many older adults do not receive the home-based clinical care or home-based long-term services and supports that could benefit them.Medicare Coverage of Home Health ServicesMedicare Parts A and B cover certain home health services. Homebound individuals can receive part-time or intermittent skilled services. Part A covers home health care for people following a hospital stay or a stay in a skilled nursing facility. Part B provides home health care for homebound adults who need skilled nursing care.A Medicare beneficiary is considered homebound in the following situations:Because of an illness or injury, they have trouble leaving their home without help, such as a cane, wheelchair, walker, or crutches, special transportation, or another persons assistance.Their physician recommends staying at home.Leaving their residence takes a major effort.The program covers medically necessary part-time or intermittent skilled nursing care and health assistance, durable medical equipment, and medical supplies for use at home.Medicaid also covers long-term services and supports (LTSS), which include medical and personal care services that aid with activities of daily living (ADLs). These are the kinds of services an assisted living facility typically provides.Use of Home-Based Clinical Care and Long-Term Services and Supports Among Homebound Older AdultsA 2023 study published in the Journal of American Medical Directors Association looked into home-based clinical care and home-based LTSS among homebound older Medicare beneficiaries. The researchers examined the Medicare claims of 974 beneficiaries to shed light on their use of in-home services.The study found that while homebound individuals used these services, no group received high levels of all care types.Homebound individuals more commonly utilized LTSS services than home-based clinical care.Approximately 30 percent of participants received some home-based clinical care.About 80 percent of the sample received home-based LTSS.The researchers identified three levels of home clinical care and LTSS usage among older adults:Low Care and Services (46.6 percent). The largest group of participants received little home-based care. These individuals tended to be younger with fewer chronic conditions and functional impairments.Home Health Only with LTSS (44.5 percent). While this group used some home health services, such as assistance with ADLs, they received little home-based clinical care.High Clinical with LTSS (8.9 percent). Only a few participants had extensive home-based clinical care. In addition to tending to be older, they were more likely to have dementia and live alone.In finding that only roughly 9 percent of participants receive high levels of clinical care and LTSS, the study points to a gap between those who could benefit from these services and the care provided. Although in-home care and support could meet the needs of older adults, many homebound older adults do not take full advantage of the services available.Learn More About Your OptionsIf you or your loved one need help with medicare care of activities of daily living at home, contact Sharek Law Office at 412-347-1731 or click here to schedule a complimentary 15-Minute call to learn more about your options.  This article is a service of Sharek Law Office, LLC. We dont just draft documents; we ensure you make informed and empowered decisions about life and death, for yourself and the people you love. That's why we offer a Life and Legacy Planning Session, during which you will get more financially organized than youve ever been before and make all the best choices for the people you love. You can begin by calling our office today to schedule a Life and Legacy Planning Session and mention this article to find out how to get this $750 session at no charge. Please note this is educational content only and is not intended to act as legal advice.

Home health care is becoming an increasingly popular alternative to traditional hospital and nursing home care. As the population ages and the demand for healthcare services grows, many people are seeking ways to receive care in the comfort of their own homes.A common question that arises is, Does insurance pay for in-home care? and What is the difference between private duty in-home care and Medicare home health?This article aims to answer these questions and provide clear insights into the landscape of in-home care.Understanding In-Home CareIn-home care refers to the wide range of services offered to individuals who need assistance with daily tasks and medical care at home.This type of care can range from supervision to companionship, personal care to light housekeeping, assistance with showers to getting ready for the day, transportation to and from the doctors office, post hospital surgery support and so much more.It allows individuals, especially seniors and those with chronic conditions, to stay at home in a familiar environment while receiving the care they need.Private Duty In-Home Care vs. Medicare Home HealthUnderstanding the difference between private duty in-home care and Medicare home health is crucial in figuring out the best care option and funding source.Private duty in-home care is usually paid for out-of-pocket or by long-term care insurance. It provides comprehensive, round-the-clock care at home, including personal care, companionship, and help with daily activities like meal preparation, bathing, and transportation.This type of care is ideal for individuals who need consistent, non-medical assistance but do not qualify for home health care under Medicare.On the other hand, Medicare home health is a program that provides medically necessary services to individuals at home who meet certain eligibility requirements.This typically includes individuals who are homebound and require intermittent skilled nursing care, physical therapy, or speech-language pathology. These services are usually time-limited and aimed at improving the individuals health and ability to function independently.Decoding the Insurance Coverage for Private In-Home Care vs. Medicare Home HealthWhen it comes to understanding which type of insurance pays for which kind of home care, the lines can seem somewhat blurred. Therefore, lets unpack this to make the distinction clearer between private in-home care insurance and the insurance that covers Medicare home health.Insurance for Private In-Home CarePrivate in-home care refers to non-medical assistance offered round-the-clock, including companionship, personal care, and aid with everyday tasks like preparing meals, bathing, and transportation.Generally, this form of care is funded through private means, such as out-of-pocket payments or via long-term care insurance.Its important to note that every long-term care insurance policy has its unique features and levels of coverage, and not all insurance plans may cover private duty in-home care services.Thus, before investing in such a policy, it is advisable to understand the specifics of what it covers and under what conditions.Moreover, private health insurance plans might cover some aspects of private in-home care, but the extent and conditions would differ based on your policys specifics.Insurance for Medicare Home HealthOn the other side of the spectrum, we have Medicare home health. This program caters to providing medically necessary services for individuals at home who meet certain criteria.Usually, these are individuals who are homebound and require intermittent skilled nursing care, physical therapy, or speech-language pathology.Medicare, particularly Parts A and B, covers eligible home health services.However, it does not cover 24/7 care, long-term care, meal deliveries, or personal care if thats the only assistance required.It is important to remember that Medicare home health is usually time-limited, focusing on improving the patients health and capability to function independently.The covered services are only for those who have a specific medical need and are not for individuals seeking assistance with daily living tasks over an extended period. Deciding on the right type of home care can be a challenging process. It requires a comprehensive understanding of the individuals needs, as well as an understanding of the intricacies of insurance coverage.While some types of in-home care are covered by insurance, others may require out-of-pocket expenses or the utilization of long-term care insurance.Always consult with your insurance provider, a healthcare professional, or a knowledgeable advisor to fully understand your options.Need help understanding whether or not your insurance covers home care? Or need a little more clarity on the differences between Private In-Home Care vs. Medicare Home Health? Schedule a complimentary in home consultation with one of our care advisors.

A massive shift is happening in the senior care industry. Home care, once the go-to solution for many families, is seeing its prominence wane in favor of adult day services. There are many reasons, and they highlight the changing needs and preferences of our aging population. Here are the top four reasons why home care is dead and why adult day is the future of senior care:1. Lack of Socialization in Home CareOne of the most significant drawbacks of home care is the limited social interaction it offers. An aging individual might spend hours, if not days, without meaningful human interaction, save for the occasional visit from the caregiver. This isolation can lead to feelings of loneliness and even precipitate mental health issues like depression.On the contrary, adult day services prioritize group activities, interaction, and camaraderie. Seniors have the opportunity to participate in group exercises, games, and discussions, forging new friendships and relishing the joys of community living.2. The Rising Costs of Home CareHome care, especially when availed round the clock, can be a hefty financial burden for families. Personalized, one-on-one services at home demand a premium, and not every family can shoulder these costs over extended periods.Adult day services, with their group-centric model, often turn out to be more economical. These centers can distribute costs across several participants, making the service more affordable without compromising the quality of care.3. Chronic Staffing Shortages in Home CareThe home care industry has been grappling with staffing shortages for some time now. Given the rising demand for elder care services and the challenging nature of home-based caregiving, recruiting and retaining talent has been an uphill task. Families sometimes find themselves in a bind, unable to secure a reliable caregiver when they most need it.In contrast, adult day services often have a more stable staffing situation. The group setting, regular hours, and team-oriented approach make these centers more appealing for many professionals in the elder care sector.4. The Multifaceted Services of Adult Day CentersHome care, in its traditional sense, usually covers basic needs like meal preparation, bathing, and medication reminders. But what about the other aspects of well-being?Adult day centers often offer a slew of additional services that can greatly enhance the quality of life for seniors. This includes hair and nail services, so participants can feel pampered and well-groomed. More crucially, many centers provide physical and occupational therapy, ensuring that seniors maintain their mobility and dexterity. These services, bundled together, present a holistic approach to care that home-based solutions often miss.While home care has its merits and can be the right choice for some, the shifting needs of our aging population are paving the way for the rise of adult day services. With their emphasis on community, affordability, reliable staffing, and a broad range of services, its no wonder that more families are choosing adult day centers for their loved ones.Adult day is the future of senior care. ActivAge is coming to a city near you!Join the movement and together we can change the world! Interested in owning an ActivAge?Click Here to learn more about ActivAge Franchise Opportunities.