I believe that Medicare will pay for a PCA (personal care attendant), but you have to find an agency to come out to your home and assess her needs first, get a letter from her doctor, etc.
This is from Massachusetts, but the program through the feds will be similar:
"Personal Care Attendant (PCA) Program: Determining Eligibility
The following areas determine whether an applicant is eligible for the Medicaid funded Personal Care Assistance program.
Physical need
The applicant must have a need for hands-on, physical assistance (personal care) in two or more activities of daily living, such as bathing, in addition to housekeeping assistance.
The PCA Program is designed to provide assistance for people that have limited upper body strength or mobility, making it difficult to perform ADLs, activities of daily living Tasks such as, bathing, dressing, toileting, and home care are typical PCA activities. PCA services are designed to provide physical assistance. Supervision and teaching/cueing are not allowable PCA activities.
Insurance Coverage
The applicant must have an active Medicaid (Masshealth/CommonHealth) Number
Medicaid comes in many forms. In Massachusetts a valid Masshealth Standard or CommonHealth number is require to begin the process of applying for the personal care attendant program. One can apply for Medicaid (Masshealth or CommonHealth) by calling 1-888-665-9993 (voice) or 1-888-665-9997 TTY.
How to apply for MassHealth or CommonHealth
If, for any reason, the applicant needs assistance to complete the Medicaid application, an independent living center and other programs, such as an Aging Services Access Point (ASAP or elder services program) and the SHINE program can provide assistance. Other forms of Medicaid, such as Masshealth Basic and Medicare do not cover the PCA program. CommonHealth is a form of Medicaid for persons with disabilities who are over income for standard Medicaid. There is a work requirement of 40 hours per month to be eligible for CommonHealth, but even a minimal amount of work is acceptable if the applicant is not able to maintain a fixed schedule or physical labor. The liberal work requirements allow many people with disabilities to re-enter the workforce and still maintain PCA services. If the applicant is over-income for MassHealth Standard or CommonHealth they may be asked to meet a spend down. The agencies noted above can also offer help with questions regarding Medicaid spend downs.
How to apply for the Personal Care Assistance Program in Massachusetts
Some service providers, including most of the Independent Living Centers manage PCA programs in Massachusetts. The agencies help people through the process of getting on the program and managing one's PCAs independently, or with the help of a trusted friend or family member chosen by the consumer to act as a "surrogate".
Some agencies offer case management services to help people manage the PCA program if the applicant requires help and a suitable surrogate cannot be identified. Contacting the local ASAP or Independent Living Center (ILC), can begin the application process, or help the applicant find the assistance necessary to apply for the PCA program.
Determining Medical Necessity
A letter of medical necessity from the primary care physician stating a medical need for hands-on assistance is required as well as a face-to-face evaluation from a registered nurse. The primary care physician must also state how the disability limits mobility and that it is expected to last for a full year or more. The evaluation is then sent to Masshealth for prior approval."
