How families pay for in-home care in California
Medicare does not pay for it. Long-term care insurance usually does. Here is how the money typically works for Placer County families.
The first question most families ask after 'can you help' is 'how do people afford this.' The honest answer is that most non-medical home care in California is paid privately, but there are several sources that reduce the cost and a few that families assume will help and will not. This is a plain overview, not financial or legal advice; talk to an elder law attorney or financial planner for your specific situation.
Private pay
The majority of home care clients pay from savings, retirement income, a reverse mortgage or the proceeds of selling a home. Agencies bill by the hour, usually weekly or twice a month. Rates in the Sacramento region for licensed agency care are meaningfully higher than what a private hire costs, and the difference buys screening, training, insurance, backup coverage and someone accountable when things go wrong. We explain the factors that drive our rates on our pricing page and quote exact numbers after a free in-home assessment.
Long-term care insurance
If your parent bought a long-term care policy, this is often the single most valuable thing to check. Most policies reimburse in-home care from a licensed agency once the insured needs help with two or more activities of daily living (bathing, dressing, toileting, transferring, continence, eating) or has a cognitive impairment. There is usually an elimination period (30 to 90 days of paid care before benefits start) and a daily or monthly maximum. Call the carrier, ask for the policy's schedule of benefits, and ask specifically whether 'home care agency' or 'home health aide' services are covered. We provide the visit documentation carriers require.
Veterans benefits
Two programs matter most. Aid and Attendance is a VA pension supplement for wartime veterans and surviving spouses who need help with daily activities; it pays cash monthly that can be used for home care. Separately, some veterans enrolled in VA health care qualify for Homemaker and Home Health Aide services or respite hours arranged through the VA. The Placer County Veterans Service Office in Auburn helps with applications at no charge.
Medicare
Medicare does not cover non-medical home care. It covers home health, which is skilled nursing and therapy ordered by a physician, typically after a hospitalization, delivered in short visits for a limited time. Families are often surprised by this. A few Medicare Advantage plans include a small in-home support benefit; check the plan's evidence of coverage. Home health and home care frequently run at the same time after a discharge, with the nurse or therapist visiting two or three times a week and the caregiver covering the hours in between.
Medi-Cal and IHSS
California's In-Home Supportive Services program pays for home care for low-income seniors who qualify for Medi-Cal. IHSS is administered by the county (Placer County Health and Human Services) and typically pays a provider the client chooses, often a family member. It is a real resource for families with limited assets, but it is a separate system from licensed private agencies like ours.
What we recommend
- Find out whether a long-term care policy exists before doing anything else.
- If your parent is a veteran or the surviving spouse of one, call the Placer County Veterans Service Office.
- Ask any agency for the factors that drive its rates and what is included. Vague answers are a warning sign.
- Start with the hours that solve the most pressing problem, then adjust. Care plans are not contracts for life.
This guide is general information from a licensed non-medical home care agency in Roseville, California. It is not legal, financial or medical advice. Written by the Home Care by Athena team.