Private Pay Long Term Care @ Home

by Louis on October 16, 2014

We need better choices between medicaid and expensive senior housing and care options. Only those with virtually no resources are eligible for government paid long term care. Very few have LTC insurance even as those offering LTC dwindle amid rising prices. Wealthy people pay lots for 24×7 care at home or assisted living. What about the large body- 70% by my calculation – who are in the middle? We need better solutions and there is a huge market opportunity for those who figure it out.

Something is wrong.

The ‘industry’ that delivers care services in homes is a truly lousy customer experience. When you hear that folks quit their job because they cannot hire competent and trustworthy services you know something is wrong.  Opportunities are being missed when a market segment as large as 70% cannot buy what they need and are ready to pay for.  Something is wrong when government, health care systems and insurance companies are spinning their wheels to avoid a well documented and anticipated disaster for the American economy and American enterprise is not filling the gap.

We need to get out of the boxes, silos, business models and mindsets that are holding us back. Talk about a revolution? Give me a call.



{ 4 comments… read them below or add one }

Laurie Miller October 18, 2014 at 3:13 pm

I implemented the “24 hour wait” rule before I responded to your post. However, I still feel the same and will now respond.
1) As an owner of a non medical home care agency, I take offense at your suggestion that our “industry” offers lousy customer service. The in home care industry is highly competitive with new agences opening up every day, or so it seems. In even average sized cities, the consumer has quite a lot of choices between agencies. If they don’t like one, they can call the agency next door. This forces us to have a GREAT customer service policy and do our best to give great care!
I don’t know where you have heard that people are quitting their jobs to care for their parents because the agency is incompetent.
When a family asks that I only send a white (or thin or pretty) caregiver to care for their parent and I explain that I cannot do that….is that what you call incompetence?
When a family asks my caregiver to perform tasks that are not allowed under my license and we refuse…is that what you call incompetence?
When a family gets mad because their regular caregiver is ill and we send a replacement…is that what you call incompetence?
When a family doesn’t pay their bill because they didn’t like the caregiver…is that what you call incompetence?
All of these senarios have lead families to leave my service but I would hardly call that incompetence with my agency.

2) I would love to meet your 70% of people that “cannot buy what they need and are ready to pay for.”
The majority of people calling for care are surprised and upset that Medicare or regular insurance doesn’t cover our services. I have yet to meet one person who is “ready to pay” for in home care. My clients who have LTCI get upset when they run through their policy terms and have to pay out of pocket. Those with money and those who are in the middle are not willing and ready to pay out of pocket for care.
It seems people are more willing to pay for pet care than senior care!
I agree that we are crisis bound but do not blame the out of pocket/private pay industry. We do a great job given the circumstances that we deal with on a day to day basis.
We do need a revolution in thinking…perhaps people need to take better care of themselves, plan for their future, get rid of their “entitlement” thinking, keep working, eat better, lose weight, be more social, volunteer, give back, help others……


Louis October 21, 2014 at 10:26 am


I hear you. Your agency and many like it are not incompetent. AND knowing YOU I have zero doubt your agency is above average and probably offers absolutely exceptional service. But your agency is not the full breadth of long term care@home services.
Home health does not, as you say, include things outside your license, food, transportation, adult day, financial assistance and many other components. A metaphor may be the construction industry. You may be a plumber but the industry also includes electricians, painters, lumber yards and much more. That your plumbing company delivers great service may not be in doubt when consumers reflect that the industry as a whole is inscrutable or hard to manage in a flowing manner. It is true. General Contractors have emerged to connect the dots and some concierge type services try the same approach in LTC@HOME and sometimes it works.
There are plenty of articles about caregivers giving up jobs or cutting back to take care of family and plenty of employers knowing their employees are not fully attentive because of caregiving.The impact on the next generation of retirees is often the focus. It is not hiring great folks like you that is hard. It is hiring the range of services efficiently that will constitute a good customer service experience.


Valerie November 7, 2014 at 11:39 am

Very insightful article! When placing my grandmother in a nursing home, my family and I chose to place a higher emphasis on the quality of care provided rather than simply the cost. Thanks for sharing this post!


Debbie Siegel January 10, 2015 at 4:41 pm

Just saw this link on ur last email to Sam. Turns out you write thoughtfully about something I’ve been living intensely for some 8+ yrs. Surprise, surprise…. I feel I could write a book about it but am too burned out. Many interesting posts on this webpage, but I didn’t see any real life stories e.g., how the issue evolved as my parents declined. If you would like to chat to spark some ideas – about this topic — call me for lunch sometime. – Debbie


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