First of all, kudos to you for getting involved with Visiting Angels !!! You will have so many families whose lives you make easier by this. But do realize that Visiting Angels is franchised; whomever owns the one you work at paid a franchise fee and has a protected territory. VA is mainly personal in home care, so is not covered by Medicare or other health insurance. BUT If your VA does have employees that can do skilled care, then Medicare as health insurance can pay for a very narrow time limited period based on a patient’s ICD-10 codes. State Medicaid might if it decided to cover personal services.
Abt IHHS / in home healthcare services, just what options there are will be dependent on State has as budget priorities & then what your city / county budget also does.
Hang with me on this as I do my health policy wonk explanation: back when Medicare & Medicaid were put into law in 1960’s, law placed a federal requirement that all States had to use a demographically defined % of its $ to pay for long Term skilled nursing care services in a facility (SNF). A required spend aka dedicated funding for those “at need” for a NH had to be done in all States. % elderly was somewhat small as they would be born 1880/90s. In 70’s NH expansion; the 80’s came the era of “tiered” where a build out would be IL, AL & NH; 90’s MC. This millennium LTACH, hospice expansion, PACE. The # of folks at need increased every decade. And the costs of care increased as well. States budgets started getting pummeled. OMG WHAT 2 DO?? The % required spend has an option for States. State can file to get a “waiver” to use some of the dedicated SNF $ to go via a waiver for services for the same demographic but done somewhere other than a NH. Voila! State can choose to do waivers for AL, PACE, IHHS, MC.
In theory keeping a person in their home way cheaper than NH. So IHHS waivers was looked upon favorably way to do this. Whether a State requires caregivers to come only from an Agency or can be an already living in the house nonspouse family member depends on your States waiver programs.
It’s on a State to decide if they will file an application for a waiver program & monitor & manage that will pass federal review (done by CMS, the Centers for Medicare & Medicaid). Waivers NOT permanent dedicated funding like SNF placement is. States tend to do waivers that can be accomplished with vendors with a track record that are committed to being in a waiver process. But for many vendors - like an AL - as the payment stream could be cut off down the road, they really are not interested or if they do it it’s teeny # of beds at the AL set for residents who have been there forever. Or for In Home type of companies, the requirements to be a vendor may not be achievable plus rates paid by the State may not be competitive enough to keep workers.
For State supported IHHS, whatever State minimum wage usually determines what worker paid. Tends to be minimum wage plus 10%. Is all taxable income. Like my state is crap $7.25 hr and hard to keep any minimum wage workers, as folks can work at Target for double. NY & CA is $16 hr (CA is $20 for fast food) & both do HCOLA add on for IHHS so a worker could be getting $20+ hr. Agency paid administrative fee.
For State paid family provided IHHS, the at need person will be assessed for a care plan. Caregiver paid # of hours determined by the plan. Tends to be 20-28 hrs a week max; maybe 30. If it goes higher it - w/administrative time included - takes them into FT care needed. And that means 24/7 oversight in a NH needed. So,watch what you wish for. A spouse cannot be a paid caregiver for their spouse.
Abt IHHS / in home healthcare services, just what options there are will be dependent on State has as budget priorities & then what your city / county budget also does.
Hang with me on this as I do my health policy wonk explanation: back when Medicare & Medicaid were put into law in 1960’s, law placed a federal requirement that all States had to use a demographically defined % of its $ to pay for long Term skilled nursing care services in a facility (SNF). A required spend aka dedicated funding for those “at need” for a NH had to be done in all States. % elderly was somewhat small as they would be born 1880/90s. In 70’s NH expansion; the 80’s came the era of “tiered” where a build out would be IL, AL & NH; 90’s MC. This millennium LTACH, hospice expansion, PACE. The # of folks at need increased every decade. And the costs of care increased as well. States budgets started getting pummeled.
OMG WHAT 2 DO??
The % required spend has an option for States. State can file to get a “waiver” to use some of the dedicated SNF $ to go via a waiver for services for the same demographic but done somewhere other than a NH. Voila! State can choose to do waivers for AL, PACE, IHHS, MC.
In theory keeping a person in their home way cheaper than NH. So IHHS waivers was looked upon favorably way to do this. Whether a State requires caregivers to come only from an Agency or can be an already living in the house nonspouse family member depends on your States waiver programs.
It’s on a State to decide if they will file an application for a waiver program & monitor & manage that will pass federal review (done by CMS, the Centers for Medicare & Medicaid). Waivers NOT permanent dedicated funding like SNF placement is. States tend to do waivers that can be accomplished with vendors with a track record that are committed to being in a waiver process. But for many vendors - like an AL - as the payment stream could be cut off down the road, they really are not interested or if they do it it’s teeny # of beds at the AL set for residents who have been there forever. Or for In Home type of companies, the requirements to be a vendor may not be achievable plus rates paid by the State may not be competitive enough to keep workers.
For State supported IHHS, whatever State minimum wage usually determines what worker paid. Tends to be minimum wage plus 10%. Is all taxable income. Like my state is crap $7.25 hr and hard to keep any minimum wage workers, as folks can work at Target for double. NY & CA is $16 hr (CA is $20 for fast food) & both do HCOLA add on for IHHS so a worker could be getting $20+ hr. Agency paid administrative fee.
For State paid family provided IHHS, the at need person will be assessed for a care plan. Caregiver paid # of hours determined by the plan. Tends to be 20-28 hrs a week max; maybe 30. If it goes higher it - w/administrative time included - takes them into FT care needed. And that means 24/7 oversight in a NH needed. So,watch what you wish for. A spouse cannot be a paid caregiver for their spouse.
https://www.agingcare.com/articles/how-to-get-paid-for-being-a-caregiver-135476.htm