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Legal-Ease: An Attorney’s Perspective: How to Pay for Home Care

By August 28, 2020September 8th, 2020No Comments

Did you know that about 2 million older adults age 65 and older visit emergency rooms each year? And almost one-third of those visits are related to injuries, with many of those injuries sustained in the home. Here are some interesting statistics from the National Council on Aging:

  • 1 in 4 older adults fall each year.
  • Every 11 seconds, an older adult is treated in the ER for falls.
  • Every 19 minutes, older adults die from falls.
  • Falls are costly — hip fractures, broken bones and head injuries. The average cost is in the range of $30,000.

Judd Matsunaga, Esq.

ER doctors report that most families say, “We were afraid that something like this would happen.” According to surveyed ER physicians in the U.S. and Canada, 48 percent of home accidents can be prevented. Why? Seniors might feel unsafe in their own home, and they also might be ashamed to admit it, too embarrassed to ask for help or just plain stubborn.

Your adult children might be insisting that they move you into a nursing home or move you closer to them, but they live out of town (or out of state). Or, you might feel that if you admit you need help, your children might insist that you move in with them, but you don’t want to be a burden. You want your independence!

“Home is where the heart is,” the phrase might be a timeworn cliché, but its sentiment remains as true as ever. According to one AARP 2011 survey, “Aging in Place,” roughly 90 percent of American seniors wish to live at home for as long as possible. A person’s home is the most important place in his or her life, offering a sense of familiarity, comfort and security.

Elderly adults cherish having a space that is truly their own — a space that doesn’t simply act as a home but actually feels like one. Most important of all, you have control over your routine, activities and life decisions. You can live your life as you see fit, and you enjoy a sense of dignity unavailable to many other seniors you know.

Even in cases where physical or cognitive decline makes it difficult to live independently, seniors vastly prefer aging in place to moving into a long-term care facility. Seniors who age in place enjoy a sense of independence and comfort that only home can provide. They also enjoy better health outcomes on average, despite lower care costs.

This kind of independence isn’t possible for elderly adults who move to senior living facilities. In these facilities, residents have less control over their lives and routines. Many seniors become dependent on nursing staff, who are forced to split their time and attention between multiple residents.

However, aging in place also comes with a price tag. Many seniors need to modify their homes to make them safer and more livable. In addition, many seniors also need to hire an in-home caregiver to assist with activities of daily living. But, despite these costs, aging in place is typically less expensive than living in an assisted living or nursing facility.

According to Genworth Financials’ Cost of Care Survey, the average cost of home health care in the United States is $4,385 a month. Home health care will almost always be more expensive than basic home care because of the medical certifications and training required of the caregivers.

Home health aides offer skilled care such as checking a patient’s pulse, temperature and respiration, as well as assisting with medical equipment such as ventilators. They will visit the home as much as medically necessary but typically for shorter periods of time than home care aide visits. In 2019, the national average was $22/hour with different state averages ranging from $16-$29/hour.

Typically, a home care aide will visit a home several times a week for visits lasting from 2-8 hours. In 2019, the national average for nonmedical, in-home care was $21/hour, with different state averages ranging from $16-$28/hour. It should be noted that these are average costs from home care agencies. Private individuals can be retained to provide some of the same services with fees 20 percent-30 percent lower.

“But Judd, I can’t afford that — I’m on a fixed income.” Good news: There’s help. It’s called In-Home-Supportive-Services, or IHSS. The goal of the IHSS program is to allow you to live safely in your own home and avoid the need for out-of-home care, i.e., nursing homes. The types of services that the IHSS will pay for include housecleaning, meal preparation, laundry and grocery shopping.

IHSS will also pay for services that need to be provided in the privacy of your own home. Personal care services such as bowel and bladder care, bathing, grooming and paramedical services, accompaniment to medical appointments and protective supervision for the mentally impaired are also covered.

Fortunately, most IHSS recipients can hire, fire and supervise their own caregivers under the Independent Provider (IP) mode of service. Most IP’s are relatives of the client. In other words, that means that IHSS will pay your son or daughter for your care giving. Or, better yet, you can hire outside care so that your son and daughter can “visit” rather than “care-take.”

Since IHSS is run by the Department of Social Services, all you must do is first qualify for Medi-Cal. “But I was told I don’t qualify since I have more than $2,000 in the bank. Can you still help me?” You bet! You are legally allowed to convert nonexempt assets into exempt assets, “spend-down” excess assets or transfer them to a trusted adult child. “Won’t that trigger a three-year waiting period?” No, not if you see an attorney experienced in Medi-Cal planning.

Judd Matsunaga is the founding attorney of Elder Law Services of California, a law firm that specializes in Medi-Cal Planning, Estate Planning and Probate. He can be contacted at (310) 348-2995 or The opinions expressed in this article are the author’s own and do not necessarily reflect the view of the Pacific Citizen or constitute legal or tax advice and should not be treated as such.