You asked whether round-the-clock home health care services are available in Connecticut and if the state pays for such services.

Most of Connecticut's licensed home health and homemaker-home health agencies provide round-the-clock services to clients in their homes.   They can send nurses, therapists, and other licensed personnel to provide medical care services and home health aides, homemakers, and personal care attendants to provide nonmedical, supportive services such as help with bathing, dressing, and toileting.   These services are costly. VNA HealthCare, for example, charges $ 250 a day for 24-hour personal care attendant services.

Private health insurance, depending on the policy terms, typically pays for medical, but not nonmedical, services. Medicare also covers medical, but not nonmedical, services. Other types of insurance, such as disability or long-term care, may pay for certain nonmedical services. If insurance does not cover a service, the client must pay for it.   

The Department of Social Services' (DSS) Connecticut Home Care Program for the Elderly (CHCPE) pays for both medical and nonmedical home health care for eligible participants, but it will not pay more than the cost of such care in a nursing home.   The Center for Medicare Advocacy, Inc. estimates the average monthly self-pay cost of a Connecticut nursing home is nearly $ 8,000 or about $ 260 a day.

CHCPE eligibility is based on income and medical need. The program provides three levels of medical service depending on a person's frailty and care plan.   Each level has cost limits, which are tied to the cost that the state would incur if the person were institutionalized; these limits rise as the level of need rises.

1. Category 1 provides limited care for moderately frail people who are at risk of hospitalization or short-term nursing home placement.   Per client monthly expenditures must be less than 25% of what nursing care would cost.

2. Category 2 provides care for people who would otherwise need short- or long-term nursing home care.   Per client monthly expenditures must be less than 50% of what nursing care would cost.

3. Category 3 uses Medicaid funds to pay for people who would otherwise be in a nursing home where Medicaid would pay for their care.   Care costs cannot exceed 100% of the nursing home cost.

In addition to medical care, the program pays for nonmedical services such as homemakers, companions, and adult day care. But the cost of any nonmedical services may not exceed 60% of the average Medicaid nursing home costs. CMA notes that under these caps, 24-hour care would never be considered cost effective, unless the individual had other resources available to him, such as family funds.

DSS also operates a personal care assistant program for people who are financially and functionally eligible for CHCPE and who need help with at least one of the following activities of daily living: bathing, toileting, dressing, preparing meals, eating, bed to chair transfer, and medication administration. But DSS must determine that these services are cost-effective. Under this program, the client can hire his or her own assistant rather than go through an agency as under the regular CHCPE procedure. You can find more information about this program at http: //www. ct. gov/dss/cwp/view. asp?a=2353&q=384084.

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