STROKE & BRAIN INJURY CARE

Living in the aftermath of a stroke, traumatic brain injury or other neurological condition has far-reaching impact on physical, cognitive, and emotional capabilities.  Mundane activities such as speaking, swallowing, or breathing may be compromised. And physical and mental abilities may have to be relearned.

Skilled nursing care and physical rehabilitation are key factors in optimizing a successfully recovery at home to maximize long-term independence.  Early rehabilitation has been shown to enhance recovery and minimize functional disability. The length of rehabilitation depends on the severity of stroke, brain injury-related deficits, motivation, skilled care professionals and support network.

Tri-County Home Care of Florida’s care team of nurses and aides provide compassionate in-home skilled care that helps ease the transition from a hospital stay to independently recover in the comfort and familiarity of home.

  • CVA (stroke)
  • Parkinson’s disease
  • Neuropathy
  • Multiple sclerosis (MS)
  • ALS (Lou Gehrig’s disease)
  • Myasthenia gravis
  • Huntington’s chorea
  • Cerebral vascular accident (CVA)
  • Ataxia
  • Traumatic brain injury (TBI)
  • Dysphagia
  • Intractable pain
  • Peripheral vascular disease
  • Peripheral neuropathy

Stroke

A stroke generally results in brain injury that creates physical and cognitive deficits. Early rehabilitation has been shown to enhance recovery and minimize functional disability.  The length of rehabilitation, of course, will depend on the severity of stroke, brain injury-related deficits, motivation, skilled care professionals and support network.

Traumatic Brain Injury

Brain injuries are caused by either internal or external factors. Internal factors include stroke, lack of oxygen, tumor, hypoxia, meningitis or encephalitis. External factors — often called traumatic brain injuries (TBI)  — are caused by penetrating objects (bullets); a fall or car crash resulting in significant head trauma; or when the brain is shaken within the skull, an injury often associated with sports or high-energy explosions.

Rehabilitative Services for Stroke & Brain Injury

In some cases, an individual’s private insurance may cover some of the cost of in-home care. This typically applies to people with long-term care insurance, as most long-term care services, including home care, are not covered by regular insurance policies. 

Long-term care insurance is designed to cover senior care, including in-home care. However, coverage varies depending on the insurance provider, the specific policy, and other factors, including the age of the beneficiary when they signed up for the policy. Often, long-term care insurance will only begin to cover care once the beneficiary needs assistance with at least two ADLs. So those only in need of companion care may not be covered even if they do have long-term care insurance.

For seniors (and pediatrics) who qualify, Medicaid does pay for in-home care. In order to receive Medicaid coverage of in-home care, seniors must meet the requirements for both medical need and financial need. In some cases, the senior will need to undergo a medical evaluation to prove that they need the level of care they are receiving. 

These Home and Community-Based Waiver programs (HCBS waivers), also known as 1915(c) waivers, allow seniors to self-direct their care to best meet their needs. Often, this means that someone who requires a nursing home level of care can choose to instead receive in-home health care, and still have the cost covered by Medicaid. Note that while Medicaid is an entitlement benefit, waiver programs are not. Depending on a state’s program laws and budget, some people who qualify for the waiver program may still not receive the benefit or may be placed on a waitlist. 

While home health care that offers the same level of care as a nursing facility is a federally mandated benefit of Medicaid, personal care services are not. So while some states’ Medicaid may cover companion care and personal care assistance, others may only cover home health care. Additionally, the program which delivers assistance can vary. For example, in some states, home care is a benefit of standard Medicaid. In other states, residents in need of financial assistance for in-home care will need to access assistance via a Medicaid waiver program.

Medicare does not cover standard home care, which includes companion care services and personal care assistance. But, it does cover in-home health care, with some limitations, so long as the senior meets a few requirements. 

To be eligible for Medicare coverage of in-home health care, the patient must: 

  • Be under the care of a physician and have a home health care plan that was created and is regularly reviewed by a physician
  • Have doctor certification that the patient needs skilled nursing care, therapy services, or is homebound
  • Receive care from a home health care agency that is Medicare-certified

While Medicare does not cover personal care services including assistance with ADLs if that is the patient’s only need, it will cover these services if they are delivered in tandem with nursing or therapy services from a Medicare-certified provider. 

Additionally, though Original Medicare does not cover personal care services, some Medicare Advantage policies may. Because Medicare Advantage insurance providers can offer several different types of Medicare Advantage plans, it’s important to look into the details of each plan and make sure that the plan you’re interested in includes home care services as a benefit. 

Eligible veterans and their spouses may be able to use the Aid and Attendance benefit to help finance their in-home care. The Aid and Attendance benefit is an extra monthly payment that eligible veterans receive in addition to their regular monthly VA pension. While the funds do not directly cover in-home care, the added monthly income is intended for veterans who have care needs. 

In order to qualify for Aid and Attendance, veterans must be receiving a VA pension and meet all of the associated eligibility requirements, plus meet at least one of four separate eligibility requirements. One of these four criteria is needing assistance performing one’s activities of daily living, so those in need of home care are likely to qualify. Some veterans may need a letter from a physician stating that they are in need of assistance before they are approved for Aid and Attendance. 

Though life insurance is intended to benefit the policyholder’s loved ones following their death, in some cases, it may be used to pay for long-term care, including home care. Some policies, referred to as hybrid life insurance, are designed to cover long-term care, though the specifics of what care is covered will vary. 

Even those with standard life insurance policies may be able to transfer their current insurance policy to a cash payment. Depending on the specific case, policyholders may be able to surrender their policy to the insurance provider. Or they can sell their policy to a third-party group. In both cases, the cash value is almost guaranteed to be less than the original death benefit-sometimes significantly so. For this reason, it’s worth having a family discussion about whether transferring a life insurance policy to cash is the right decision. Some people may be better off keeping their life insurance policy as-is. Some may be unable to surrender or sell their policy, depending on the insurance company’s rules. 

Adults age 62 and older have the option of taking out a reverse mortgage to help finance long-term care, or any other expenses. These loans convert part of the value of one’s home to cash, so they are essentially a cash advance on the home’s equity. Oftentimes, the money received from a reverse mortgage loan is not taxed. This can give seniors some liquid cash to pay for long-term care without needing to sell their home prematurely. This makes it particularly useful for those using in-home care services. 

There are several kinds of reverse mortgages. But the only one that is federally-insured is the Home Equity Conversion Mortgage (HECM). No matter which type of reverse mortgage you choose, you will need to repay it when the last surviving borrower passes away or moves out of the home. Keep in mind that you will have to pay interest on the loan. And borrowing against the home’s value means that you most likely won’t be able to leave the home or the money from its sale to your heirs. Still, reverse mortgages can be a great way to access liquid cash, so long as the borrower is aware of the above stipulations. 

  • Personal savings
  • Life insurance plans with cash value or accelerated benefits
  • Group Long-Term Care Insurance
  • Short-Term Care Insurance
  • Life insurance policies that include long-term care riders
  • Health Savings Accounts/Health IRAs
  • Long-Term Care Annuities
  • Life Plan Communities
  • Home Equity
  • Reverse mortgages
  • Pensions
  • Private Health Insurance
  • Health Maintenance Organizations (HMOs)

*Eligibility varies per investment vehicle

**Private care and personal/home care are, in most cases, tax-deductible expenses.


Accredited by The Joint Commission in Broward County.

Accredited by Accreditation Commission for Health Care (ACHC) in Indian River, Martin, Okeechobee, Palm Beach and Port St. Lucie counties.