In-Home Elder Care

For financing in-home care, either you have enough money (and you can get tax breaks ), or you don't (and you should seek Medicaid assistance ).

A few disclaimers: forget Medicare - it only covers short-term, physician-prescribed home health care services like physical and speech therapy, and some assistance with bathing, feeding, etc. Also, all of this assumes that Medicaid will survive further cuts by the Governor and that the Health Care Act will survive. None of this is certain.

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For tax breaks , an elderly parent can be considered a dependent. But you will need to prove you are paying more than half of your parent's living expenses in-home. Then you deduct medical/dental expenses that you paid out of pocket for your parent's care as an itemized deduction. There are limits though: there is no write-off for the first 7.5% of your adjusted gross income and help with housekeeping is not deductible. Details here.

To be eligible for Medicaid assistance, you or your parent first must have Social Security income and Medicaid (Medi-Cal in California), so if they aren't signed up, read this. Only then will assistance under California’s IHSS Program kick in. Their website in LA County is here. This Program pays for home-based care workers - you or someone you hire. It covers “household chores such as housecleaning, changing bed linen, laundry, meal preparation, meal clean-up, food shopping and errands; personal care services such as non-medical assistance with respiration, bowel and bladder care, feeding, bathing, grooming, dressing, assistance with ambulation, help in and out of bed, assistance with medications and prosthesis care; accompaniment to medical appointments; protective supervision and paramedic services.” Check the Eligibility page and Program Process tabs on the County website. Applications for IHSS are made by telephone (the number is on the website). If you are the one needing the care, pay special attention to whether you may be required to pay for a portion of your IHSS benefits (this is called a "Share of Cost").

For the disabled perspective on IHSS, go here.
For local in-home services, check the Encino Directory here.

The bad news:

Costs are skyrocketing as the elderly population grows. The previous Governor slashed IHSS’s budget and the cuts are tied up in lawsuits and they may not survive the new Governor. This likely will mean - at the very least - stricter eligibility, reduced hours of assistance, higher out of pocket expenses and reduced wages for caregivers. The IHSS payments aren’t huge – I have read that $300 to $800 a month is common – and fraud, while it does exist, is not widespread.

So what do we do? Research indicates that in-home care for most people still costs less than 1/3 the cost of keeping someone in a nursing home. Some say it’s even less: the Sacramento Bee reported that “state studies show that the average cost of in-home care is about $891 a month. That's 18 percent of the average nursing home cost of more than $161 a day, or $59,000 a year,” which Medicaid now pays for.

The CLASS program (Community Living Assistance Services and Supports) was established with the new U.S. health care reform act. CLASS was intended to be a self-funded and voluntary long-term care insurance, however it appears to have been shelved.