Home Care for Seniors: 14 Essentials Before Making that Call
Home care provides a variety of services for older adults who need some extra support to live comfortably and safely in their own homes. If you are concerned about an older person who is no longer able to meet all of his or her own needs, live safely, or is isolated and alone, in-home care can be a solution.
You may be wondering what the options are for home care for seniors. In this blog post, we will discuss everything you need to know about in-home care for the elderly and older adults!
What is Home Care for Seniors and What Services Does it Include?
Home care, also known as non-medical home care or in-home supportive services, is a type of care that helps older adults with activities of daily living (ADLs) and several instrumental activities of daily living (IADLs).
To look at this another way, home care falls into two categories:
Personal Care: This home care service helps with ADLs and includes bathing, dressing, toileting, grooming activities, and transferring and mobility support.
Homemaker or Companion Services: This type of home caregiving supports most IADLs, and includes laundry, grocery shopping, meal preparation, light housekeeping, companionship, and engagement.
These non-medical home care services do not require a licensed professional and can be provided by a home care agency or a privately hired caregiver. Some agencies do offer certified nursing aids which is beneficial for clients with greater medical needs.
If assistance is not needed with personal care or ADLs, a companion care provider is an option. This level of service is sometimes available from an agency at a lower cost; if companion care is sufficient look for this option, especially if personal care is also offered in the event needs change.
Is Home Care Different from Home Health Care?
Home Health Provider
There is often confusion about the distinct types of in-home care services. While home care and home health care are often used to describe any care services coming into the home, there is a clear distinction between home care, which is non-medical, and home health care, which is medical.
Someone recovering from an illness or injury may require home health care services during the recovery period. In contrast to non-medical in-home care, medical home healthcare services require a licensed healthcare professional such as a nurse, physical therapist, or occupational therapist.
Home health services include physical, speech, and occupational therapy services, some health aid services, skilled nursing care for a medical care plan management wound care, IV therapy, and medication dispensing.
A Medicare-certified provider, certified through the federal government, delivers these medical services. This can be a home health agency or hospice agency. For eligible seniors, covered services can also include home health aides and medical supplies.
Medicare covers home health care costs based on a Medical Provider's order and for a set number of visits.
Eligible seniors receiving in-home medical care from a hospice provider can receive limited help with personal care from a home health aide and skilled nursing services. This is typically the only situation in which standard health insurance will cover in-home personal care services.
Who is Home Care Beneficial For?
Home care services are designed for people who are unable to live independently due to physical, mental, or cognitive impairments. Care for seniors at home can allow seniors to successfully age in place as their needs increase. Home care can also be helpful for those recovering from an illness or injury.
The main goal of elder care in the home is to enable seniors to age in place for as long as possible, if this is the goal, and avoid moving to a residential care community, an assisted living facility, or a nursing home.
Home care providers can also support residents of an Independent Living Community, again allowing the resident to stay independent longer.
Who is Home Care not For?
Home care is not sufficient for those who require 24/7 medical care, supervision, skilled nursing care, or extensive therapy services. Additional healthcare services would need to come in, and unless this need is short-term, the cost could become prohibitive.
If uncertain as to the best option, consultation with a Care Manager, a Medical Provider, or another professional is helpful. For higher-level needs, a move to an assisted living facility or a nursing home may become necessary.
What are the Benefits of In-Home Care?
There are many benefits of home care for both seniors and their family caregivers. For seniors, in-home care can support a level of independence and allow them to live safely and comfortably in their own homes for a longer period.
Home care can also provide social interaction and companionship, which can help improve mental and physical health, and emotional well-being.
In addition, home care can be more affordable than other types of long-term care options such as assisted living or nursing homes when the in-home care needs are part-time.
For family caregivers, in-home care can provide a much-needed respite from the demands of caregiving. It can also help to ease feelings of guilt or worry about not being able to provide adequate care.
In-home care can give family members peace of mind that their loved one is not alone and help prevent family caregiver burnout by providing help with the many demands.
How Much Does Home Care Cost and How do People Pay?
The cost of at-home care for elderly will vary with the type and frequency of personal care assistance provided, the type of care provider hired, and by geographical location. According to Genworth's Cost of Care Survey, 40 hours per week of in-home care averages about $4500.00 per month. This is comparable nationwide to the cost of full-time residency in an Assisted Living Facility. Remember, home care costs are in addition to all other costs of living in the home. Home care costs often increase over time as the senior's needs change and become more complex.
Medicare does not typically cover senior care for non-medical needs. People often pay out-of-pocket, although there are alternatives such as long-term care insurance or Veteran Benefits.
Non-medical home care may average $28-29.00 per hour nationwide, services can range from $18 to $40 per hour. Some families choose to hire a privately hired caregiver because they can negotiate their hourly rate. Many families, however, are not able to devote the time to managing independent senior care providers.
Are There Downsides to In-Home Care?
Though home care has many advantages and can allow a senior to age in place safely, there are some potential disadvantages.
A potential negative is that staying safely and comfortably in the home may require extensive home modifications to make the home safe and accessible if a significant illness or injury occurs. If modifications have not been completed proactively, the home may be unsafe. While often essential, home modifications can be costly, especially with older, multi-level homes; you can learn more in our article Is Your Home a Candidate for Aging in Place?
This can make home care eventually unaffordable for families and can deplete assets needed for alternative living options.
In situations with significant safety concerns, especially related to dementia or if someone can no longer get up unassisted, 24/7 care may be required. If there is no family caregiving support available to help, the cost of care can be 2-3 times the cost of a quality Assisted Living or Memory Care Community, or even a Nursing Home. Plan ahead if there is evidence of a progressive condition that could lead to these care higher needs.
Another potential downside to home care is that seniors may have limited social interactions and activities if they cannot easily leave home. Though a paid caregiver in the home can help, this does not provide the range of social engagement offered in a Senior Living Community. If there are plenty of family and friends to visit with this may not be a concern.
Unfortunately, there is always the risk of a care provider not showing up as scheduled, a significant issue if the client is reliant on help to meet basic needs.
And lastly, there is the potential for neglect or even abuse by a home care worker. Be especially cautious if there are cognitive or mental health issues. For this reason, it is important to carefully screen when selecting a home care worker and to stay involved in the caregiving process.
In-home care can be a great option for seniors who need some help to age in place safely and comfortably. However, it is important to be aware of the potential downsides to home care to make the best decision for yourself or your loved one.
Long-Term Care Insurance
For seniors with long-term care insurance, policies often pay for non-medical in-home care services. Policies vary and usually require a documented need for assistance with activities of daily living. Many Home Care Agencies will assist with long-term care insurance claims. If you have a policy, be sure to get clarification on coverage for home care services.
Long-term care policies do not pay for companion care. Companion care includes services such as meal preparation, grocery shopping, and transportation to doctor visits that many seniors require if family members are not available.
Many seniors are not eligible for financial assistance, but the cost of needed care services is a concern. Alternative options seniors and their families may consider are a reverse mortgage or a viatical or life settlement on a life insurance policy. Seek professional guidance from a trusted advisor and consult with your insurance provider.
Should you Hire an Agency or a Hire Privately?
There are pros and cons to both hiring an agency and privately hired home care aides or personal care assistants. If you decide to go with the security and greater ease of hiring an agency, you can look for independent local agencies or nationwide franchises.
Advantages of Working with an Agency
Agency Team as Your Partner
- Caregivers are carefully screened and must pass a background check
-In-home care services agencies often provide specialized training for their professional caregivers
- Agency home health care aides and personal care assistants are usually bonded and insured
- The client or responsible family members can request a change in home health care providers if there is not a good fit
- Scheduling is flexible and can be changed if needed
-The agency team is working hard on your behalf to ensure scheduling is consistent and needs are met
- Agencies typically have a backup caregiver available if the primary caregiver is sick or on vacation
- Families do not have to worry about payroll taxes or workers’ compensation for the hired in-home caregivers
-In many states non-medical home care agencies are licensed and overseen by the State Department of Health or another government agency. This oversight provides peace of mind to family caregivers.
Disadvantages of working with an agency
- The cost of home care services is generally higher when using an agency
- Families may have less control over who provides care for their loved ones
- There may be a lack of continuity of care if the agency home health care aide or personal care assistant changes
-There may be an hourly minimum for personal care services, adding to in-home care costs
Advantages of working with a privately hired senior care provider:
- The cost of home care services is typically lower than working with an agency
- Families have more control over who provides care for their loved one
- There is usually a greater sense of continuity of care since the same person is providing care regularly
- Scheduling may be more flexible and can be tailored to meet the needs of the client and family caregiver
Disadvantages of working with a privately hired senior care provider:
Going It Alone Can be Challenging
- The family is responsible for conducting their background and reference checks
- There is no guarantee that the caregiver is professionally trained to provide the personal care assistance needed.
- The client is responsible for paying payroll taxes and workers’ compensation insurance
-With payroll taxes and workers' compensation, there are often minimal cost-savings
- If the caregiver gets sick or goes on vacation, the client or a family member must find a replacement
-There is no outside oversight of the care providers by any state or local agencies, and many families encounter challenges with independent providers.
Clarify Service Needs
The first step in seeking outside help is to clarify what type of help is needed, a preferred schedule, and what type of budget is available for paid care. Make a list of priorities. This can include:
Personal Care: getting in and out of bed, bathing, dressing, using the toilet, eating, and medication reminders
Household Chores: light cleaning, laundry, meal prep, grocery shopping, and other errands
Engagement: conversation, companionship, outings, enriching activities
Consider what hours of assistance are most needed. Recognize there may be a minimum number of hours required for a visit. If there are budget constraints, get clear on those before initiating a search.
Questions to ask Home Care Agencies
Is the agency licensed in your state? Not all states have industry-specific licenses for home care agencies. If your state has the option, be sure to choose a state-licensed home care agency for assurance that state standards are met. Check with your State Department of Health.
Does the agency carry insurance? A well-run agency has professional and general liability insurance. Caregivers should be bonded and insured.
How thorough are the agency's background checks? Potential employees should be thoroughly vetted. The agency should interview them in person and speak to previous employers and other references. Also essential is a full criminal background check to be aware of any felonies, misdemeanors, and driving violations. A national background check is preferred.
What services are offered? With the necessary Medicare certifications, home care agencies may provide medical and non-medical services. Confirm that the desired services are available.
How are caregivers trained? The best home care agencies have full in-person orientations for caregivers and provide continuing education. The best training includes hands-on instruction and a skills assessment. Effective handling of emergencies should be included in employee orientation. Many agencies hire Certified Nursing Assistants when possible. If not, are the care providers trained in fire safety and CPR? Initial and ongoing education lets caregivers build their healthcare skill sets and stay current with best practices in home care.
Are clients assigned more than one caregiver? While clients often prefer one consistent caregiver, it is better if more than one caregiver is assigned to each client. With two or three people as regular workers, someone familiar to the senior is available even if one person takes time off or leaves the agency. Of course, if hours are extensive, multiple caregivers will be assigned.
How is it handled if the senior is unhappy or uncomfortable with a caregiver? Look for an agency that will work to find a better fit. You might also ask the director about any process to match clients with caregivers. Ensure that communication regarding any questions or concerns is encouraged and valued.
How are caregivers supported and managed? Ask how caregivers are supervised, supported, encouraged, and recognized. There should be scheduled quality review visits, and practices in place to recognize the work of the care providers. When caregivers are treated well, the clients can benefit.
What is the pricing and are there minimum hours? Pricing will vary between agencies. Some will have different price tiers dependent on the level of care. Others have a set rate for all clients. And others may charge more for Certified Nursing Aids (CNA's). There is usually a minimum number of hours per shift, and some agencies will offer a discount on the hourly rate when the number of hours reaches a certain amount. Ask! Sometimes this is negotiable.
What is the owner or administrator's qualifications? Many types of people with varied backgrounds direct home care agencies, and some are more qualified than others! The director has a variety of essential duties, so ensure that they are qualified. Also, get a feel for their motivation. Do they have a passion for serving seniors, or do they seem more money motivated? Do they express sincere appreciation for the caregivers and the need to support them? This will impact the quality of care received.
Questions to ask Caregivers if Hiring Directly
If you decide to pursue hiring a private caregiver, plan on doing your due diligence! For initial phone interviews, screen with basic questions regarding work experience, hours available, any expectations for pay and benefits, transportation, and motivation for working with the elderly.
Once you decide you are comfortable to proceed with an in-person interview, request that they bring any paperwork related to a resume, certifications, immunizations, and references. The following are additional questions for an in-person interview. Ideally, the senior receiving care should be present and involved! Their involvement and buy-in is important.
Tell me more about your caregiving experience
What motivates you to do this work?
What do you find challenging about caregiving?
Can you describe an experience where someone wouldn't follow the care plan, and how you handled it?
Can you describe the training you have had? Any certifications?
What is your availability? Transportation? Can you work weekends if needed?
Why did you leave your last position?
Do you have documentation of any training, certifications, and immunizations?
Once you've identified a potentially good fit, but sure to check references and pay for a criminal background check. You will need the applicant to agree to this in writing, so have a basic form ready!
If you do not have a personal recommendation for a private caregiver from someone you trust, consider using a Caregiver Employment Agency that will conduct the initial vetting with a background check. Either way, look for caregivers who connect well with you and your loved one! Trust your gut instincts and be prepared to be involved in managing this process.
Stay Organized with Tasks, Medications, Household Supplies, Schedules
One of the benefits of home care is that it allows you or your loved one to maintain a certain level of independence. However, to do this, you need to be organized to ensure care and service needs are met.
Make a list of everything that needs to be done daily and weekly. This will help you stay on top of things and ensure that essential tasks aren't forgotten.
Review a detailed care plan with the care providers or agency. An Agency will assess needs, with your input, and create a care plan.
Create a designated space for all prescriptions and home care supplies. This will make it easier to find what is needed.
Establish a routine and stick to it as much as possible. This will help reduce stress and make things simpler for everyone.
Have physician and emergency contact information clearly posted.
Whenever possible, spend some time getting the caregivers comfortable with the routine, and ensuring the relationship is off to a good start. If you are not local or have limited time, using an Agency is highly recommended. In all cases, keep the lines of communication open and be prepared for necessary changes along the way.
Community-Based Support
There are several community-based services and social services that can help with financial assistance toward the cost of home care or companion care services for eligible seniors to stay in their own homes. Some of the human services programs that may provide financial assistance for the financially eligible include:
- Medicaid Coverage and Medicaid Waiver Program
- Medicare Advantage (extremely limited coverage, but growing)
- Veterans Affairs benefits
- Social Security Disability Insurance
- Supplemental Security Income
-PACE
-Programs through your local office of the Area Agency on Aging
Here in El Paso County, CO, our Area Agency on Aging has an excellent Caregiver Support department. All caregivers can receive vouchers to cover the cost of a minimal number of home care hours. This allows for much-needed breaks for a family caregiver and time for necessary errands or appointments. There are solutions available!
In Closing
Home care can be an excellent option for older people who are unable to live fully independently but desire to age in place. It can provide them with various services that allow them to live comfortably and safely in their own home.
Companion or personal home care can be cost-effective and offer many benefits for both the caregiver and the cared for. However, we've also highlighted some potential drawbacks to home care. It's important to weigh the pros and cons of your unique situation, and realize if the needs increase, an alternative may be needed.
For questions or personalized guidance, use our Contact Me Now form! I am here to help.