Home Care and Community Care Benefits

UPDATED: Jul 13, 2023Fact Checked

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Jeffrey Johnson

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Jeffrey Johnson is a legal writer with a focus on personal injury. He has worked on personal injury and sovereign immunity litigation in addition to experience in family, estate, and criminal law. He earned a J.D. from the University of Baltimore and has worked in legal offices and non-profits in Maryland, Texas, and North Carolina. He has also earned an MFA in screenwriting from Chapman Univer...

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UPDATED: Jul 13, 2023

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UPDATED: Jul 13, 2023Fact Checked

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.

Case Studies: Exploring Home Care and Community Care Benefits

Case Study 1: Empowering Independence Through Home Care

Mrs. Thompson, a 75-year-old retiree, had been living alone in her suburban home for several years. She valued her independence and cherished the comfort of her familiar surroundings.

However, she began experiencing difficulties with daily activities due to age-related health issues. Concerned for her well-being, Mrs. Thompson’s family explored home care options. They decided to hire a certified private aide who could provide the necessary assistance.

With the help of a certified private aide, Mrs. Thompson regained her independence and could continue living in her beloved home. The aide assisted her with personal care, household chores, and transportation to medical appointments.

Mrs. Thompson’s family also played an active role in coordinating services, ensuring quality care, and monitoring her well-being. The home care approach allowed Mrs. Thompson to maintain her dignity, comfort, and autonomy, all while receiving the support she needed.

Case Study 2: Navigating Long-Term Care Insurance for Home Care

Mr. and Mrs. Johnson, a retired couple in their late 60s, had diligently purchased a long-term care insurance policy years ago, understanding the potential need for assistance in the future.

Recently, Mr. Johnson’s health declined, and the couple decided to explore home care services. They wanted to ensure their long-term care insurance policy covered the necessary benefits.

The Johnsons reviewed their policy provisions carefully to understand the conditions under which benefits would be paid. They discovered that their policy included coverage for a range of home care services, including ongoing care advisory services.

Armed with this knowledge, they proceeded to select a certified private aide who could provide the required assistance at home. By leveraging their long-term care insurance, the Johnsons could access the benefits they needed to support Mr. Johnson’s health and well-being.

Case Study 3: The Financial Benefits of Home Care

The Rodriguez family faced the challenge of finding suitable care for their elderly father, Mr. Rodriguez. They considered both residential care facilities and home care options.

After conducting extensive research and assessing their financial situation, they discovered the significant financial advantages of choosing home care.

By opting for home care, the Rodriguez family could save substantially compared to the cost of residential care facilities. Residential care facilities typically averaged $30,000 to $100,000 per year, while home care costs ranged from 25% to 90% less, depending on the required level of care.

The family calculated the expenses involved, including transportation costs and missed work, but found that the overall cost of home care, with occasional assistance from temporary care workers, fit well within their budget.

By choosing home care, the Rodriguez family could provide their father with personalized care while enjoying significant financial savings.

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Jeffrey Johnson

Insurance Lawyer

Jeffrey Johnson is a legal writer with a focus on personal injury. He has worked on personal injury and sovereign immunity litigation in addition to experience in family, estate, and criminal law. He earned a J.D. from the University of Baltimore and has worked in legal offices and non-profits in Maryland, Texas, and North Carolina. He has also earned an MFA in screenwriting from Chapman Univer...

Insurance Lawyer

Editorial Guidelines: We are a free online resource for anyone interested in learning more about legal topics and insurance. Our goal is to be an objective, third-party resource for everything legal and insurance related. We update our site regularly, and all content is reviewed by experts.

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