What home care is covered by Medicare
Is there any financial help for caregivers?

Starting home care is often a challenging time for both the patient and the caregiver. Factoring in the financial component and what’s covered and by whom can make a stressful situation even harder. 

Home care services are a valuable Medicare benefit. They supply therapy, skilled medical care and other assistance to people that are who are largely or entirely confined to their homes.

In order to be covered, the services must be ordered by a doctor, and one of the 11,000 home health agencies nationwide that Medicare has certified must provide the care. If these conditions are met, Medicare pays the complete cost of home health care up to 60 days at a time. 

That period is renewable, meaning Medicare will still provide coverage if your doctor recertifies a minimum of once every 60 days that the house services remain medically necessary.

The specific conditions enrollees must meet for home care under Medicare Parts A and B are: 

• A doctor has certified that the person is homebound.
• The patient is under the care of a doctor who reviews his or her treatment plan regularly.
• A doctor has certified that the patient needs skilled medical care or some sort of therapy.
• The patient only needs physical, speech, or physical therapy for a limited amount of time
• The home health agency to provide care is approved by Medicare.
• Additionally, other than durable medical aid, patients usually don’t pay anything for in-home care.
• The need for skilled nursing is merely part-time or intermittent.

There are several items Medicare won’t cover, including:

• Meals delivered to your home
• Homemaker services (like shopping, cleaning, and laundry), when these are the only types of services needed
• Personal or custodial care (like bathing, dressing, or using the bathroom), when these are the only types of services needed
• 24-hour-a-day home care

Many patients may require assistance with activities of daily living but might not have an actual medical condition. While Medicare doesn’t cover that scenario, a long-term care policy can help with the expense of home health aides who provide custodial services. It can also help pay for assisted living facilities, which offer seniors the ability to live independently but receive the help and care they need daily.

Is there any financial help for caregivers?

According to a 2016 AARP study, they estimate that family caregivers spend a mean of $6,954 on out-of-pocket costs for caregiving, which equates to approximately 20% of their annual income. In order to cover the out-of-pocket expenses, many caregivers make sacrifices in their own lives. 

Overall the study found that caregiving puts a financial strain on individuals caring for an adult family member:

• On average, caregivers lose 33% of their income
• Approximately 11% of caregivers quit working to provide care for a loved one full-time
• Women who quit working to become caregivers lose approximately a total of $300,000 in wages, pensions, and Social Security benefits
• 78% of caregivers incur out-of-pocket costs due to caregiving
• 56% of employed caregivers experience at least one work-related strain, in the form of reduced hours, different work hours, or taking paid or unpaid time off
• 16% of caregivers reduce contributions to their retirement savings
• Approximately 50% of caregivers reduce leisure spending (dining out or vacations) due to caregiving expenses

Fortunately, there are several options for finical aid for caregivers. 

• Medicaid – Aid may be available from the state for elderly loved ones who are low-income and eligible for Medicaid. To learn about the financial aid programs available in your state, contact your local Medicaid office.

• Long-Term Care Insurance – this is another financial aid option for caregivers. However, it is important to note that only a few such policies allow for family caregiver payments. Older policies tend to have such a provision, so it is more likely that older seniors who have long-term care insurance have policies that will pay family caregivers. It is a good idea to contact the insurance company or agent who sold the policy to determine whether the plan allows for caregiver payments.

• Veteran-Directed Home and Community-Based Services Program – This program provides caregiver support and authorizes a monthly flexible spending account for purchasing goods and securing services for disabled veterans to live at home. Veterans who opt for this program may hire family to act as their caregivers or to provide support to family caregivers. 

• Tax Incentives – Caregivers also may find some financial assistance via tax incentives. Caregivers who are adult children younger than age 65 may deduct the costs of qualified medical expenses and mileage that are greater than 10% of their adjusted gross income if they itemize their deductions. However, it is in your best interests to discuss your options with an accountant or other tax professional to determine whether taking a standard deduction makes more financial sense. There also may be other deductions caregivers can take at tax time. While tax incentives are not as immediate as financial aid, they are one way to relieve the financial burden on caregivers.
• The Family Medical Leave Act (FMLA) – Workplace benefits may be available to caregivers as a form of financial aid as well. The Family Medical Leave Act (FMLA) ensures employees working for any company with more than 50 employees and who have been employed for 12 months (working a minimum of 1,250 hours during that period) are offered 12 weeks of leave; however, the leave overwhelmingly is unpaid. 
• Paid Leave for Caregiving Employees – If you don’t live in one of the four states that have implemented paid family leave options, don’t get discouraged yet. Fortunately, more companies are assisting caregiving employees today with paid leave, and larger companies are most likely to offer elder care programs. 
• Family Payments – If the care recipient is ineligible for Medicaid or another state program, and the tax breaks are not as large as you need them to be to compensate you for your caregiving time and related out-of-pocket expenses, look into whether he can afford to pay you himself or if other family members are willing to pay you for your caregiving services.. However, this is a subject that should be discussed openly with all involved family members and any arrangement should be agreed upon by all parties. If your family determines that family payments are manageable, be sure to meet with an attorney and draft a contract that outlines your work and payment schedule so everyone in the family knows the situation. The contract also may become useful later if your loved one eventually needs to apply for Medicaid or enter an assisted living facility or nursing home.
• Home and Community-Based Services Program – Care recipients who are not veterans can opt into a home and community-based services program (HCBS) if they meet the eligibility criteria (which varies by state, but is typically based on income and a qualifying medical condition, though recipients need not be age 65 or older to qualify). These programs offer guidance and financial assistance to caregivers to ensure they can provide the best possible care for their loved ones. They can also boost caregivers’ confidence and make it easier for them to provide a high level of care to their family member.

Last updated Jan 23, 2020. Information subject to change without notice. Due diligence is required.

Best Practices and Process Improvement

Why are business professionals publically in favor of terms such as Best Practices and Process Improvement, but silently dread them in private?

One would think identifying the top methods in their industry would have great appeal. Improving procedures would be near the top of all professional’s on-going education.  Yet, far too many of these individuals revel in putting major stumbling blocks for transformation between them and the success they ultimately seek.

We often encounter these business professionals fighting this change every inch of the way, with arms folded and heels dug in. Fears include increasing costs, demonstrating competency and sustaining quality.  The ego of leadership can also be a major stumbling block. Past failures with innovation can make a company shy about new efforts. Yet, none of these are valid excuses.

Many organizations lack the brutal honesty to deal with changes in policies, processes and procedures. Only when laws are passed and mandates are made will these companies react to these better practices. Trusted, tried and true methods often have with them a perceived safety net effect. If it worked in the past, many rationalize that it still has to be relevant.

A young equipment leasing sales rep once reported that he was calling on a capital equipment dealer and his contact was the company’s general manager, a man many years his senior. His company appeared perfect for leasing and finance programs. When he would ask the general manager questions about financing options for their customer, the prospect would reply, “Steve wouldn’t like it.”  Each question would inadvertently boil down to the same response, “Steve wouldn’t like it.”  About forty minutes into the sales call, the young account manager asked the sales manager, “I keep hearing you say that Steve wouldn’t like it. May I talk to him and find out what he really thinks?” The general manager responded, “Steve died in 1977.”  The tried and true methods from preserving “The Legacy of Steve” had won out over offering their customers payment plans and finance options.   The account manager reported the company was sold eighteen months later.

Leading and innovative organizations know differently. They are part of the disruption culture. They fully understand that if they don’t look to the horizon and watch what’s coming, they will be found out of style, obsolete or part of the past just like a Montgomery Ward’s catalogue. Having an empowered team of professionals who do the right thing every time, see their part in the picture and can adapt to new tools, techniques and thoughts on how their industry works is critical to maintaining long term success.

In today’s evolving business marketplace, companies need to respond with every best possible method to leverage efficiencies, protect margins, improve process and remain responsive to competitive pressures. The idea behind studying and implementing Best Practices and Process Improvement is crucial. Organizations who perceive change as a strategy to avoid are as outdated as continuing to manage one’s operations by the Gospel according to Steve, circa 1977.

Major events and steaks just seem to go together and there’s seemingly no more of a classic American meal than steak and potatoes. This means that steakhouses have become American, and particularly Midwestern, staples. It of course was not and has not always been this way. So, how did these oh-so delicious establishments come to be popular?  How are they being reinterpreted for the modern palette? Let’s explore.

In the 1800s, the popularity of red meat was on the rise, and those seeking the best cuts were located in New York City, the home of the first steakhouse. Because of the demand in the city for quality products, restaurants opened in order to cater to that need. Thus, the steakhouse was born.

They started, though, as food establishments that served meat along with beer and other pub and bar style drinks. They also played on many of the European food concepts. Take the porterhouse steak, for example. The name of the porterhouse steak was derived from a cut of meat often served in pubs with porter ale. As time went on, and these establishments became known for having alcohol and meat, steakhouses became masculinized, and with that, became exclusive. Prohibition made the growth of steakhouses a bit difficult, but people continued to want delicious meals and premium steaks. And nothing makes people want a product more than exclusivity. As exclusivity continued to rise and steaks and masculinity became synonymous with one another, prohibition was ending and popularity rose astronomically.

People flocked to steakhouses in New York City, and word spread until the meals served there became American staples. This trumped the foods many had previously considered elements of an all-American meal, namely hot dogs and hamburgers. And while a hot dot at a baseball game and apple pie for dessert are ingrained in our hearts as edible representations of America, this is a hearty meat and potatoes country. Steakhouses continued to spread to other parts of the country, and arguably made their most welcome stay in the Midwest.

But it wasn’t just about the food. Yes, steaks have clearly been the defining factor of the steakhouse concept, but people could easily buy and make steaks at home. There was a very specific ambiance that these restaurants created. Going out to dinner became a special occasion, and with that so did steaks. Steakhouses became an excellent place for couples to enjoy a meal together, and they also were a welcome environment for families who wanted to treat themselves to a lovely dinner out.  But this was not always how families celebrated; it was a progression over time. So, if you love your local steakhouse and you equally love dining out, you can thank 1960s America.

Since then, several steakhouses can be found in each city, and choosing the right one can seem daunting. Premium cuts of meat, interesting takes on classic dishes as well as expertly cooked favorites are all signs of a wonderful steakhouse. Some might have a more formal ambiance while others are casual, and of course, that makes for exciting restaurant options. And options, paired with quality cooking, are beautiful things.

Once you’ve found a favorite steakhouse (or two—they’re wonderful establishments) you’ve also found the perfect hosting spot for a large dinner event or even a banquet. What better way to showcase appreciation, happiness, love, celebration or excitement than with a delicious, filling meal? What better way to talk something out or ease a bad time than with a cooked to perfection medium rare steak?

Though steak options are primary on the menu because, let’s face it, they are steakhouses, there are a variety of options to choose from at your favorite local steakhouse. From chicken dishes to varieties of potatoes to salads and soups and excellent starters, the options for a delicious meal and an entertaining banquet are plentiful.

Really, once you’ve found a steakhouse and location you love, any occasion is the perfect occasion to get together and have a meal or host an event. Celebrate anything from a birthday to a holiday to a family get together to girls or guys nights with a delectable and always memorable meal at your favorite steakhouse.

So grab your date, your friends, or your family and get ready for a classic, delicious, and hearty meal. And, of course, don’t forget to thank the wonderful people of New York for creating a genre of restaurants that plays off of European tradition, but is American to its core.