Home Care and Community Care Benefits

The provisions in the sample long term care insurance policy clearly state the specific conditions under which benefits will be paid. Most policies contain provisions similar to those outlined below.

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We will pay up to the Home Care and Community Care Maximum Daily Benefit Amount, shown on the Schedule of Benefits page, for the actual charges You incur for the following Covered Services:

  1. Home Health Care Services performed by a Nurse, Therapist or Certified Private Aide;
  2. Home Health Care Services performed by a Home Health Aide from a Home Health Care Agency;
  3. Homemaker Services performed by a Homemaker from a Home Health Care Agency;
  4. Ongoing Care Advisory Services performed by a Care Advisor;
  5. At-home Hospice Care;
  6. Adult Day Care.

Ongoing Care Advisory Services are considered a Home Care and Community Care Benefit under this Policy.

COMMENT: Just as there is a Maximum Daily Benefit Amount for Nursing Home, Assisted Living Facility and Hospice facility, there is also a Maximum Daily Benefit Amount for Home Care and Community Care. As shown above, Home Care and Community Careencompasses a variety of services, providing another example of the diverse scope of long term care insurance coverage, especially compared to what it was only a few years ago when coverage was limited to nursing home benefits.

A “Certified Private Aide” is a health care worker who has received formal training for the delivery of Maintenance or Personal Care services in the Home and is primarily employed to provide Home Health Care Services, but whose services are not necessarily arranged and supervised by a Home Health Care Agency. The person must be licensed or certified as a Certified Nurse’s Assistant or a Home Health Aide under the laws where the services are provided. A Certified Private Aide can provide both medical and non-medical services, including Homemaker Services, assistance with Activities of Daily Living, and Respite Care. A Certified Private Aidecan be an independent service provider as long as he or she is properly certified.

One of the great advantages of home care is that it permits an older person to remain independent and comfortable in familiar surroundings. Also you and your family are better able to supervise the care received, both as to quality and cost, and to prevent care that in neither necessary nor desired.

On the other hand, for home care to work well, the family must take the initiative to find services, coordinate different programs and personnel, monitor home care needs and performance, figure costs and budgets, and make changes when necessary. And the family will be making these decisions without a professional guidance. With home care, the family becomes much more intimately involved, which will be either a burden or an enriching experience for the entire family.

There can be significant financial savings if the care needed is not too complicated or frequent and if family and friends help out. While residential care facilities average $30,000 to $100,000 per year (Long Term Care, Joseph L. Matthews, NOLO, 5th edition, 2004, p. 2/6], home care can average 25% to 90% less, depending on what care is required. You save by not paying for unnecessary services or for institutional overhead.

Other things to think about if you are considering the home care approach:

Be sure what is covered by your long term care insurance:

(1) When counting the total costs, don’t forget transportation expenses and the cost of missed work to help out;

(2) You should also factor in the cost of temporary care workers to fill in when family members can’t make it or need a break and when regularly schedule care can’t make it.