Section Main Page

Services at Home

     Home health care can generally be categorized into two types,
acute care and long-term care.  Acute care is often referred to as
skilled care.  Long-term care is often referred to as non-skilled or
custodial care.  Because older people's condition change so often
and with so many variations, there are many overlaps and gray areas.
The definitions are more important in determining reimbursement than
providing care.  This is an unfortunate flaw in our system of health care.
   

     Acute care is focused on the services of a nurse or therapist
(often referred to as skilled services) to assist in the recovery of a
specific medical event.  These services are often accompanied by home
health aide service which provides assistance with personal care and
tasks in the home.  This form of home health care is reimbursed by
Medicare and private health insurance under the assumption that the care is
provided at home instead of a hospital.  When the need for skilled
care ends, the services of the home health aide ends also.  The only
exception to this is when someone can be designated as medically
fragile under Medicare.  If so designated, Medicare will continue to
authorize the services of a home health aide as long as a nurse
provides regular oversight of the person's condition.  This is when
Medicare enters the area of providing long-term care.

     Long-term care at home is generally focused around the
services of a home health aide or homemaker working under the
supervision of a nurse or other health care professional.  This form
of care is generally not reimbursed under Medicare or private health
insurance because it is classified as custodial care.  Nurses also
provide long-term care at home but these services are generally not
reimbursed.  People pay for them with their own funds.

                 ACCESSING LONG-TERM CARE AT HOME
 

     Long-term care at home can be obtained from one of the 60 or so
organizations licensed by the RI Department of Health to provide this
service.  Individuals can also hire someone privately.

                                        WHO PAYS ?

     This is often a critical question.  Long-term care is expensive,
whether it's provided in a nursing home or in a private home.  Private pay
in a nursing home can cost $70,000 a year.  Home health aide service in
the home is billed at $16.00 to $21.00 per hour.  Nursing care costs $35.00
to $40.00 per hour.  Home care can be tailored to an individual's need which
can keep the cost reasonable.  For example, a daily visit of 2 hours, 7 days
a week to assist someone with bathing, dressing and some light household
tasks can cost $14,000 per year.  If this is enough to enable someone to
remain independent in their own home, then the cost is reasonable. 
Especially when compared to the cost of a nursing home.  However, as the
need for additional assistance grows, the cost can grow very quickly.
This usually happens when constant supervision is needed.

     The State has several programs that provide home health aide and
homemaker services.  These programs are funded by the Dept of Elderly
Affairs (DEA), the Dept of Human Services (DHS) and the Dept of Mental
Health, Retardation and Hospitals (MHRH).  Services are generally limited
to 20 or 30 hours per week, although there are some exceptions.  Age,
income, assets and functional status are the primary factors in determining
eligibility.  It is very common for the recipient to pay for part of the
cost.  State funded services are often authorized for three or six month
periods.  As long as someone meets the eligibility requirements, the
services can continue indefinitely.

                                 Department of Elderly Affairs
                        Home Health Aide/Homemaker Service
                                        401-462-0570
    Program                                Age        Eligibility/Income/Assets            Functional Status Program                                Age        Eligibility/Income/Assets            Functional Status      
Home & Community Care       65+            enrolled in Medicaid                   Homebound
At-Home Medicaid Waiver    65+            enrolled in Medicaid                   Homebound
Co-Pay                                       65+            single $7,938 to $16,919              Homebound
                                                                       married $8,440 to $21,149
Nursing Home Waiver            65+            enrolled in Medicaid                   Homebound