Home Care Funding: Sources, Real Costs and Reimbursement

When a parent or beloved family member requires constant care, many families face the same dilemma: how do we ensure quality care at home without exhausting our financial resources? The reality is that professional home care involves significant costs, yet there are also sources of financial support from the state that many families are unaware of or don't know how to access.

The good news is that the Romanian system offers several forms of support – from allowances and personal assistants to reimbursements for medical services and equipment. The challenge is understanding exactly what you can access, how these sources can be combined, and what the actual monthly costs will be. Without careful planning, many families discover too late that their initial estimated budget was far from reality.

In this article, we will examine together all the financial aspects of home care – from the rates charged by professionals, to state support programmes, and the mistakes that can prove costly. Our aim is to help you make informed decisions and build a sustainable financial plan for your loved one's care.

Contents

1. The real costs of professional home care
2. What the Romanian state reimburses and subsidises
3. How to combine the companion allowance with private services
4. Personal assistant versus accredited service
5. Common mistakes when estimating monthly budgets
6. Long-term financial planning
7. Frequently asked questions

The real costs of professional home care

The first step towards realistic financial planning is understanding exactly what rates home care professionals charge. Costs vary significantly depending on the senior's level of dependency, the qualifications of the carer, and the region in which you live.

A professional carer without medical qualifications may cost between 2,500 and 4,500 RON per month for an 8-hour day, five days a week. If you require 24/7 supervision, costs can reach 5,000–8,000 RON per month, depending on the carer's experience and the complexity of the individual's needs. In major cities such as București, Cluj, or Timișoara, rates tend to be 20–30% higher than the national average.

Rates for specialist medical services

When your loved one also requires medical care, costs increase considerably. A qualified nurse costs an average of 3,500–6,000 RON per month for a similar schedule, and for nurses experienced in caring for chronically ill patients or those with complex conditions (Alzheimer's, Parkinson's, post-stroke), rates can exceed 7,000 RON.

• Home physiotherapy: 150–250 RON per session, typically recommended 2–3 times per week (1,200–3,000 RON/month)
• Occasional nursing care: 100–200 RON per visit for procedures such as administering injections, changing catheters, or wound care
• Home healthcare assistant: 200–400 RON per visit for complex care needs
• Home medical consultations: 300–600 RON per visit, depending on the specialist

Auxiliary costs that are often overlooked

Beyond carer fees, there are additional expenses that must be included in the budget: medical supplies (incontinence pads, hygiene products, disinfectants – approximately 400–800 RON/month), supplementary medications, medical equipment (hospital bed, pressure-relief mattress, wheelchair), home accessibility adaptations, and increased utility bills. Many families are surprised to discover that these auxiliary costs can add 1,000–2,000 RON on top of the estimated monthly budget.

What the Romanian state reimburses and subsidises

The Romanian system offers several forms of financial support for families caring for elderly people or those with disabilities. The difficulty is that information is fragmented, and the process of accessing it can seem bureaucratic and complicated. Let us clarify what you can actually obtain.

Through the General Directorates for Social Assistance and Child Protection (DGASPC) or through local councils, you can access subsidised social services, including home care. These services are provided free of charge or at reduced rates to elderly people without sufficient income. Assessment is carried out on the basis of a social inquiry, and eligibility criteria vary from one county to another, but they generally target people living alone, with income below a certain threshold and a recognised level of dependency.

The companion allowance and personal assistant

One of the most accessible forms of support is the allowance for a person accompanying someone with severe disability. This allowance is currently approximately 1,310 RON per month and can be received by a family member who gives up work to care for the person with a disability. A certificate of classification as severely or significantly disabled is required.

Alternatively, you can engage a personal assistant through the ANPIS programme (National Agency for Payments and Social Inspection), in which case their salary is paid by the state. A personal assistant's salary is approximately 2,000–2,500 RON net per month, with the family only responsible for social contributions. This option is available for people with severe disability who do not have a family member available to provide care.

Reimbursements through the Health Insurance House

Through the National Health Insurance House (CNAS) you can obtain:

• Reimbursement for home medical nursing services for immobilised patients or those with severe chronic conditions – a medical referral is required
• Home medical rehabilitation for certain conditions – partially or fully reimbursed
• Medical equipment (hospital beds, medical supplies) – under certain conditions, with a medical prescription
• Subsidised and free medications – depending on diagnosis and the list of reimbursed medicines

To access these services, the GP must complete the necessary documentation and submit it to the health insurance house. Unfortunately, not all services are fully covered, and waiting lists can be lengthy in some areas.

How to combine the companion allowance with private services

Many families wonder whether the companion allowance can be combined with other forms of support or with paid private services. The answer is yes, but with certain important clarifications that can help you optimise your budget.

If you receive the companion allowance (approximately 1,310 RON per month), you can still hire a private carer for the hours when you are not available. For example, many companions work part-time or have their own family responsibilities, so they engage a professional carer for 4–6 hours a day or at weekends. In this case, your allowance partially offsets the cost of the private carer.

Practical strategies for combining support

• Mixed family-professional care: You (or a family member) receive the allowance and provide basic care, whilst for specialist medical procedures you engage a nurse for a few hours per week
• Split schedule: A personal assistant through ANPIS for the daytime (8am–4pm) and a private carer for nights or weekends
• Respite care: Use the allowance for day-to-day care and draw on private services occasionally when you need a break (respite care) – a few days per month
• Supplementing with DGASPC services: Combine the allowance with subsidised services from the local council (meals at home, cleaning, social assistance)

It is important to check with ANPIS and DGASPC in your county for the exact rules on combining support, as there are regional differences. Additionally, if the person being cared for receives a pension or other income, this can be partially redirected towards care costs, supplementing the available budget.

Personal assistant versus accredited service

One of the most important financial and practical decisions you will make is choosing between engaging a personal assistant (whether a family member or an external person paid by the state) and contracting an accredited home care service. Each option has very different implications.

When you engage a personal assistant through ANPIS, the state pays the salary (approximately 2,000–2,500 RON net), whilst you as a family must manage the administrative aspects: the employment contract, timesheets, and adherence to the schedule. The personal assistant can be a family member or an external individual. The advantage is the lower cost to the family; the main disadvantage is dependency on a single person – if that person becomes ill or goes on holiday, you must find a replacement.

Accredited services – flexibility at a higher cost

An accredited home care service is provided by a specialist company that is licensed and supervised by local authorities. Costs are higher (3,500–7,000 RON per month on average), but the benefits include:

• Guaranteed cover – if the regular carer is absent, the company sends a replacement
• Supervision and quality control – the company monitors performance and maintains standards
• Trained and vetted staff – carers have professional training, background checks, and medical clearance
• Flexibility in adjusting the schedule – hours or days can be changed more easily
• No administrative obligations for the family – the company handles contracts and payroll

A comparative look at the financial implications

Let us compare the monthly costs concretely for the same level of care (8 hours/day, 5 days/week):

ANPIS personal assistant: The family pays approximately 300–500 RON per month (social contributions) plus minimal administrative costs. Total: under 600 RON/month out of pocket.

Private accredited service: The family pays 3,500–5,500 RON per month, with no hidden costs. Total: 3,500–5,500 RON/month.

Privately employed carer: The family pays the net salary (2,500–4,000 RON) plus all social contributions and taxes (a further 40–50% of the net salary). Total: 3,500–6,000 RON/month plus administrative risks.

The decision depends on the available budget, the level of care required, and the degree of involvement the family is able to take on in managing the care arrangement.

Common mistakes when estimating monthly budgets

From the experience of many families who have been through this process, several recurring mistakes have emerged that lead to financial difficulties. Being aware of them can help you avoid them and arrive at a more realistic plan.

Mistake no. 1: Underestimating auxiliary costs. Many families calculate only the carer's salary, forgetting medical supplies, supplementary medications, medical equipment, and increased utility bills. In reality, these costs can add 30–40% to the initially estimated monthly budget.

Mistake no. 2: Failing to account for evolving needs. Caring for a senior is not a static situation – needs change, often becoming more demanding over time. A budget that works today may become insufficient within 6–12 months as health deteriorates and additional medical services or constant supervision become necessary.

Other common financial pitfalls

• Overlooking replacement costs: When the carer is on holiday or ill, families often discover too late that they need additional funds for a temporary replacement
• Failing to verify eligibility for state support: Many families do not check in time whether they are eligible for the allowance, personal assistant, or subsidised services, and miss months of financial support as a result
• Undervaluing one's own time: If a family member gives up work to provide care, the financial impact includes the loss of their salary, not just the direct costs of care
• Planning only for the short term: The budget must be planned over at least 12–24 months, not just the following month, and should include reserves for medical emergencies
• Disregarding training costs: If you hire an inexperienced carer at a lower rate, you may spend time and potentially money on training them

How to avoid these mistakes

Create a detailed budget broken down by category: carer's salary, medical services, medications, medical supplies, equipment, home adaptations, medical transport, administrative costs, and an emergency reserve of at least 20% of the monthly total. Review this budget every 3 months and adjust it according to changes in the person's health.

From the outset, investigate all available sources of support – visit DGASPC, ANPIS, and the Health Insurance House in person to find out exactly what you can access. Do not rely on hearsay or unverified online information, as rules and eligibility criteria change and vary by region.

Long-term financial planning

Home care can last for years, and financial sustainability depends on careful long-term planning. It is crucial to view the situation as a marathon, not a sprint.

Begin by assessing the total available resources: the cared-for person's pension, family savings, possible contributions from other family members, and the state support accessed or accessible to you. Then, estimate realistic monthly costs based on the information in this article, adding a safety margin of 20–30% for unforeseen expenses.

Financial optimisation strategies

• Maximise state support: Ensure you access all programmes for which you are eligible – allowance, personal assistant, DGASPC services, CNAS reimbursements
• Explore cost-sharing: If there are several siblings or close relatives, discuss a fair division of monthly costs
• Use community resources: Some NGOs and religious organisations offer free or subsidised care services, meals at home, or medical transport
• Prioritise key investments: Quality medical equipment (a good hospital bed, a pressure-relief mattress) can prevent costly complications in the long term
• Invest in prevention: Physiotherapy and preventive medical care can help avoid expensive hospitalisations and complications

Last but not least, explore private health insurance options that cover home care or extended medical services. Whilst these involve an additional monthly expense, they can dramatically reduce costs in the event of a medical emergency or the need for specialist services. Review the policies available and read carefully which services are covered and under what conditions.

Frequently asked questions

Can the companion allowance be combined with the cared-for person's disability pension?

Yes, the companion allowance and the disability pension (or old-age pension) are independent sources of income and can be received simultaneously. The pension remains with the person being cared for, whilst the allowance is paid to the companion providing the care.

How long does the approval process take for a personal assistant through ANPIS?

The process takes an average of 2–4 months from the submission of complete documentation to approval and payment of the first salary. It is important to begin the process as early as possible and to ensure you have all the necessary documents: a disability classification certificate, a copy of your national identity card, a medical certificate, and a correctly completed application form.

What happens if the carer engaged through ANPIS resigns?

If the personal assistant resigns or is no longer able to continue, the family must find a replacement and restart the engagement process through ANPIS. During the transition period, the family must arrange care through their own resources or use temporary private services, which may generate additional costs.

Are home care expenses tax-deductible?

Under certain conditions, medical expenses may be deducted from income tax, including physiotherapy services, medical care, and medical equipment, provided they are supported by fiscal documents (invoice, receipt) and a medical prescription. Consult an accountant for advice specific to your situation.

Can a neighbour or friend be engaged as a personal assistant?

Yes, a personal assistant through ANPIS can be any person who meets the legal requirements (not necessarily a relative), with the exception of the spouse of the person with a disability. The consent of the person being cared for is required (if they are able to express their wishes), along with the completion of the relevant legal documentation.

What should I do if the family's income exceeds the threshold for free social services?

If income exceeds the threshold for free services through DGASPC, you can opt for social services at a reduced rate (a contribution proportional to income) or for private services. Consider whether combining the companion allowance with a part-time private carer may be more cost-effective than a fully private service.

Managing the financing of home care can seem overwhelming at first, but with the right information and careful planning, you can build a sustainable arrangement that ensures quality care for your loved one without exhausting the family's resources. Begin by assessing all available sources of support, calculate realistic costs, and build a budget that includes reserves for the unexpected. If you need further clarification, speak with a social worker at the DGASPC in your county or with a consultant specialising in home care – the investment in becoming informed will pay dividends many times over through better financial decisions.

This article is for informational purposes only and does not replace medical advice. For specific situations, please consult a specialist.