My mom is living with me now, receives 10 hours of home health care. When she returns to her home how do we get care for the other 14 hours?

Is she on Medicaid? They pay for some home health care, generally. What you need to do is go to your state's Web site and look under aging services or something similar. You should find contact information there. Most help of this kind is local. If you have an Area Agency on Aging, they can help.
Carol

Lisag: I just went through the same thing with my Mom in the past year so I can relate to your situation. It's really generous that you have your Mom in your home. That said, I'm sorry to tell you that if your mother needs care 24 hours a day for non-hospice conditions she should not be at home. Because you said she will return home and that she's getting 10 hours of care now, I assume she is recovering from something. It makes me wonder how long the 10 hours of care will be covered? Who's paying for it? Long term care insurance? Medicare? Medicaide? These benefits MAY NOT BE permenant, be very clear about this before you do anything. If she was recently released from a hospital, the payer may cover the care ONLY until she's well enough to care for herself OR for a certain time period. Contact the case management of the payer to get more information. Carol's suggestion to contact the Area Agency on Aging is good but they are often over worked and may take some time to get back to you.

Who ever is paying it's likely that the 10 hours of care she gets probably assumes her family (you) will provide care the other 14 hours. Unless she has resources to pay for a full time aide, generally, she must move. There are no state or federal agencies that will pay for 24 care in your home or hers. State programs will supplement the cost of care in a licensed facility ( not YOUR HOME) - meaning that she must use all of her monthly income to contribute to the monthly cost and they will pay the rest.

As far as Medicare, a federal insurance program, and Medicaide (state programs), one is temporary and the other permanent. Here's what is generally the norm:
- Medicare will pay for UP TO 120 days of care in rehab or nursing home AFTER a 3 day hospitalization, this is intended to get people back on their feet and return home.
- During the 120 days the elder is evaluated and if it's determined that they will not benefit from continued rehab or therapy, Medicare will STOP paying for the nursing home/rehab/therapy - whatever the doctor ordered. If the elder can't go home, then self-pay requirements plus Medicaide kick in.
- If an elder can't return home, they must use ALL of their resources (cash, stocks, bonds, CDs - any investments) to pay for the monthly fees BEFORE they qualify for Medicaide. This is called a "spend down" and in most states elders get down to their last $2500 before they qualify. States can look back as long as 7 years and any large gifts of cash, stocks, bonds, real estate or other belongings during that "look back" period can disqualify an elder from benefits for months.
- Do not pay an attorney or any other business or even a "non-profit" for "guaranteed" Medicaide qualification, these are scams and the people are taking advantage of the situation. You understand the requirements well enough yourself and help your mother.
- For free information on your state, contact the in-take or new patient services at a reputible assisted-living or nursing home. They deal with this all the time and generally have the time and willingness to help you understand what's possible for your mother. Just tell them you're looking to move your mother and need to understand what's possible to pay for it all.

I am sorry to paint such a bleak picture but the system is designed to ensure people pay their way and get the care they need. As you work through these details ask a LOT of questions and don't feel that any question is stupid. DO NOT TAKE RUDE BEHAVIOR or attitudes PERSONALLY. The people who deal with these details and programs do the same jobs over and over, to them it's clear and easy to understand - to the unexperienced, it's a night mare. These folks often have way too much work to do and large case loads and little patience. Some states have clear and easy to find information some do not but keep digging.

As always, be sure to help your Mom get her legal ducks in a row - she should have a will, a Power of Attorney for health care ( at least for health care but durable for all business is wise) and a living will or health care directive. Best of luck to you and your mother.