Unfortunately, neither health insurance nor Medicare covers long-term care. Medicaid could become your only option, so do what you can to plan ahead.
Health Affairs estimates that 4 million older adults can only leave their homes with assistance, making accessing care challenging.
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 program’s 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 Services
Medicare 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 person’s 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 Adults
A 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 Options
If you or your loved one need help with medical care or activities of daily living at home, consult with an elder law attorney to learn more about your options. An elder law attorney can help you determine and obtain the services for which you or your loved one are eligible.