How To Pay for In Home Care-
Part II

Home Care


As we age, the cost of maintaining our quality of life increases. Medical costs rise and new services such as in home care may become necessary. While medical care costs are covered by insurance policies, Medicare and Medicaid, in home caregiving costs are not, and instead must usually be paid for out-of-pocket. With a little planning, though, you can make it easier to handle the expense.

In Part I we described several of the methods available for covering the cost of in home care, and now we will describe the rest of the available approaches.

Medicaid-Based Programs Such As In Home Supportive Services

In many states, there may be financial assistance from the state through the use of special Medicaid funds. Normally, Medicaid must be used for medical care, but the states can create programs using a portion of their Medicaid dollars to provide limited in home care for the very needy members of their populations.
Here in California we have such a program. It is called the In Home Supportive Services (“IHSS”) and you have to be able to qualify for Federal Supplemental Security Income (“SSI”) benefits in order to be eligible to receive assistance through IHHS.

The IHHS program in San Diego County works best when the consumer who will receive the care can identify a trusted person such as a family member or friend who is willing to be paid as the IHHS worker to provide the care. IHSS workers receive little or no supervision, so using a person you personally know and trust as the IHSS worker is often the best plan. The San Diego County Grand Jury has investigated the county’s IHSS program on several occasions and has reported each time that the program has many problems, calling it “an open door to abuse and fraud”.

Family Resources

Lastly, many families facing elder care expenses have found the best option is split the cost among the children and grandchildren. Dividing the responsibility several ways makes it easier on everyone. Most family members are willing to help pay for attentive and reliable care for the parent or grandparent who gave them so much throughout their lives when there are no other resources available.

Geriatric Care Managers Can Provide Help and Advice

One last suggestion: before making any decision about how to pay for in-home care for seniors, talk to a certified professional geriatric care manager (“GCM”). They are your best source of information about options to help defray the costs of growing older.

Many unqualified people call themselves GCMs, so be sure that you find a truly qualified GCM and not someone who isn’t certified. The best way to do that is visiting the website of the National Association of Professional Geriatric Care Managers and searching there by using their Find a Care Manager search tool.


Paying for in home caregiving is not an easy task, generally isn’t paid for by the government, and requires advance planning. By knowing what to expect, though, you will be better prepared by knowing what you can, and cannot, count on to help cover the cost.


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About Tim Colling

Tim Colling has more than 30 years of experience in management in a variety of industries and has served in the past as a member of the statewide steering committee for the Home Care Aide Section of the California Association for Health Services At Home (“CAHSAH”). He is a Certified Public Accountant (licensed but not actively in practice), and received his Bachelor’s Degree in Accounting from California State University at San Diego. He has held the credential Care Manager Certified ("CMC") from the National Academy of Certified Care Managers, and has practiced actively as a Professional Geriatric Care Manager. Tim has worked as a CPA in Public Accounting, a corporate Chief Financial Officer for a chemical manufacturing company, and a software engineering manager for several private and public software companies, in addition to working as an eldercare manager, in-home caregiver agency administrator and professional geriatric care manager since 2003. Learn more about his in-home caregiving company at A Servant's Heart In-Home Care

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