In-Home Care: Your Definitive Guide for 2022

In-Home Care: Your Definitive Guide for 2022

See if in-home care is right for your family

Home care definition

By Arthur Bretschneider, last updated August 8, 2022

Home care (sometimes also known as in-home care or private duty care) is personal, non-medical senior care provided right in a senior's own home. These personal care services were once provided only on a short-term basis to those recovering from surgery or other hospitalizations. Now, it's available to let seniors age in place at home while remaining safe and comfortable. Professionally-trained caregivers work to keep older adults as independent as possible while providing the assistance they need to be able to stay in their homes.

In-home caregivers typically help older adults with daily tasks such as bathing and dressing, preparing meals, and managing medication. Often these daily tasks are referred to activities of daily living, or ADLs, a concept healthcare professionals use when measuring someone’s ability to live independently. Depending on a senior’s needs, home care may consist of a caregiver who comes in one day a week or someone who lives in the home to provide 24/7 assistance. 

What is home health care?

Home health care typically refers to medical care provided at home by licensed professionals: this might include services like physical therapy, occupational therapy, wound care, or the administration of prescription drugs or injections. Typically, “home care” refers to help with ADLs, while “home health care” refers to receiving medical care, or nursing care, at home. Both are a type of in-home care.

Many seniors would rather stay in their own homes than move into a retirement community, an assisted living community, or even a skilled nursing facility. Home care is a viable alternative that makes that possible.

Also, it helps families experience peace of mind. They know their loved one is safe and cared for on a daily basis, and it provides extra companionship for lonely seniors.

What does in-home care typically look like?

Most home care focuses on non-medical services. Caregivers help seniors with the activities of daily living (ADLs). This includes assistance with bathing, grooming, and toileting. They also handle meal preparation with a personal touch that takes into consideration each senior's food preferences and dietary restrictions.

Since many seniors are no longer able to drive, in-home caregivers provide transportation, either by driving their clients to appointments and errands or by accompanying them on public transportation. When seniors have limited mobility, caregivers help them with moving and transferring to beds, chairs, or showers.

Caregivers often perform light housekeeping duties, such as making beds, laundry, and washing dishes. In addition, they can provide medication reminders, to make sure their clients take all their medications in a timely fashion (they cannot administer medicine, however).

Seniors with significant medical needs are often able to augment their basic non-medical home care with home health care services provided by licensed medical professionals. Nurses, nurse practitioners, and other medical professionals can come to the home to handle injections, wound care, therapy, and testing.

In some cases, seniors require care around the clock. This may occur during recovery from surgery. Or it may be necessary if your loved one experiences the frequent waking and nighttime wandering that sometimes accompany dementia. If your loved one requires 24/7 care, you have a couple of options.

You can seek out live-in eldercare, or you can bring in multiple professional caregivers who work opposite shifts.

If you hire a live-in caregiver, you need to provide them with a place to sleep and allow them eight hours a day to do so. You should also arrange for other downtime, including substitute caregivers on the weekends. If you don't want to go this route, check out the possibility of hiring two caregivers, each working a 12-hour shift. While this type of caregiving is typically more costly, it can be a good choice if your loved one requires significant medical care around the clock.

Home care vs assisted living

Many people consider assisted living communities to be the primary choice for aging adults who need some assistance, however home care is a viable alternative. Assisted living communities provide meals, personal care, and housekeeping services to seniors within a residential setting. However, each senior resident in assisted living shares their caregivers, as well as amenities and perhaps even their room(s), with other residents.

With home care, seniors gain the emotional comfort of remaining in familiar surroundings. Even when dealing with chronic medical problems or memory loss, they can still enjoy a sense of independence. In addition, because they have the undivided attention of their caregivers, seniors in home care enjoy personalized care plans that take into consideration their own preferences, physical status and lifestyle choices.

There are pros and cons to both home care and assisted living. One benefit of assisted living is that seniors have the opportunity to socialize with their peers, something that may become increasingly difficult if they become housebound. Additionally, assisted living communities are designed to be easily navigated by people with canes, walkers and wheelchairs, while multi-story family homes with stairs, thresholds, and deep bathtubs might be difficult to age in. On the other hand, if a senior is living at home with family members, moving into an assisted living community might mean they see less of them than before. And although many assisted living communities allow pets, there may be weight limits or additional fees: staying at home means staying close to furry friends.

The decision to stay at home or move into a senior living community will depend on each seniors’ individual needs and circumstances. Consider making your own pros and cons list if you’re trying to decide.

How much does home care cost?

The cost of hiring a caregiver will depend upon the type of assistance you need. Home care services can be provided four to 24 hours a day. Depending upon your needs, home care is often the least expensive approach when compared to assisted living or nursing home costs. 

If you're bringing in a home health aide for a few hours a week, you should expect the cost of home care to be anywhere from $14 per hour to an hourly rate as high as $40. The average cost for a full-time in-home caregiver is about $46,000 per year. Like all types of senior care, cost varies by location.

Costs associated with home care can vary widely depending on the type of care your loved one needs. For example, if dementia care is involved, you will want a private duty home care aide who specializes in providing this kind of help. Also, the going rate in your region will impact the cost of home care. Home care is often more expensive in cities than it is in rural areas, due in part to the higher cost of living overall.

How to pay for home care

Medicare doesn't cover the costs of non-medical home care. Nor is social security an option. While Medicare and Medicaid can cover some costs of medical home health care, usually coverage is limited to a few hours per week for the duration of a specific, demonstrable medical need.

To receive this coverage from Medicare, a senior usually has to be homebound. Private health insurance usually follows the same rules as Medicare and doesn't cover home care.

If you are in California, be sure to look into Medical. This won’t cover in-home care, but if a move into assisted living could happen it’s better to plan ahead.

Some long-term care insurance policies will cover home health care. These policies vary widely in terms of what they cover and for how long, and many of them have financial caps.

Military veterans and their spouses may be eligible for pension benefits that include non-medical home care services.

One way to mitigate the costs of home care is to take advantage of the adult day care programs offered in your neighborhood. Adult day care is typically set up to provide both social interaction and some basic medical care within a safe, controlled environment. This makes it an ideal choice for seniors who are experiencing early levels of dementia.

Costs are low — generally about $60 per day. Use adult day care as a chance to give caregivers a break, or schedule it into your loved one's routine as a regular occurrence. Seniorly CEO Arthur Bretschneider wrote about this "hack" in his article, "A Story About an Assisted Living Alternative."

Read more:: What is Medicare?
Read more:: What is Medicaid?

Different types of home care services

Take a look at these pros and cons understand some of the types of care available to you if you choose home care.

Types of home care

Family member:

  • Pro:Senior loved one feels more comfortable because of familiarity
  • Pro: No additional costs
  • Con: Added pressure on family members
  • Con: High burnout rates and increased stress for entire family
  • Con: Lack of formal training means seniors may not receive expert care

Personal hire (referred by friends, etc.):

  • Pro: Costs are often lower
  • Con: Family must handle taxes, unemployment insurance, etc.
  • Con: Privately hired caregivers often lack training, licensing and insurance
  • Con: No backup plan if caregiver cannot come in or quits suddenly

Home care agency:

  • Pro: Agency usually handles taxes and insurance
  • Pro: Caregivers are trained and licensed
  • Pro: Agencies handle scheduling in the event of emergencies or days off
  • Con: More costly than other options

Many seniors want to stay in their own homes as they grow older. Some seniors, however, require a little more than personal care and meal preparation. Fortunately, options for levels of care are available to help in these circumstances.

In-home health care for chronic and acute medical conditions

Health care aides, physical therapists, registered nurses, physicians' assistants, and other medical care professionals can be part of your loved one's home care team when needed.

For example, what if your loved one requires a hip or knee replacement? In many circumstances, they would be sent to a skilled nursing facility for recovery. It's possible, however, to bring physical therapists and other aides to the home to assist in recovery.

If your loved one requires diabetes care or other regular health care for a chronic condition, you can typically make arrangements for healthcare professionals to come to your home to provide treatment or therapy. Combining these periodic visits with an in-home caregiver can make the difference that lets your senior loved one age in place at home.

In-home care for seniors with Alzheimer's or dementia

In the early stages of Alzheimer's disease or dementia, home care can be an excellent option to provide the safety that seniors need while keeping them connected to others socially.

Memory loss is the most well-known symptom of Alzheimer's and dementia, but it is far from the only one that requires round-the-clock monitoring. Seniors with dementia may have difficulty with their sense of balance or visual perception. They may experience problems with focus or clear communication. In later stages of Alzheimer's disease, seniors may become easily agitated or even aggressive.

Because of the complex symptoms involved with Alzheimer's disease and dementia, in-home caregivers should be specially trained and licensed. That gives you the peace of mind that your loved one's caregiver is able to provide the calming environment needed, to adjust daily routines based on the ebb and flow of symptoms, and to minimize any outbursts.

A trained caregiver can maximize the social interactions and stimulation that helps delay the onset of further symptoms while keeping you notified about the progression of your loved one's condition.

What are some signs that it’s time to consider home care?

Two factors are involved in the decision to bring in home care to help your loved one. One, is the issue of whether your loved one needs some assistance around the house. The other is whether your loved one needs more assistance than home care can provide.

Take a look at your senior loved one's home to see if a little help is needed.

  • Has your loved one started being lax about cleaning up?
  • Are dishes left in the sink?
  • Is their laundry undone?
  • Do they need grooming?
  • Do they need bathing?

If your loved one is no longer able to drive, care at home can provide the bridge that's needed to keep them connected to the outside world. Most seniors are extremely reluctant to abandon the freedom that driving brings, so keep an eye open for traffic tickets or scratches on the car that indicate it's time to take away the car keys.

Older people who lose interest in meal preparation or who become unable to care for themselves often lose weight dramatically. While they try to live independently, they may gain weight because they start making poor nutrition choices and just eat the easiest thing available.

In both cases, it's a sign that home care may be needed. Seniors who are becoming isolated and withdrawing from others may also need the companionship that home care provides.

What should I look for in-home care providers?

Finding the right home care company is key to finding a caregiver whom you can trust to provide your loved one with the care they need. Because you're making a big decision, prepare all the necessary questions. Here are a few key questions for home health agencies to help you get started.

  1. How does this home care agency differentiate itself from similar agencies? What does it offer that its competitors may not?
  2. Does the agency require a minimum number of years of experience from the caregivers it places?
  3. Are caregivers encouraged or required to take continuing education classes?
  4. How long do this agency's caregivers tend to stay with a client? What arrangements are made for replacements if a caregiver should leave?
  5. How does the agency choose its caregivers? Does it perform background checks?
  6. How selective is the agency in choosing caregivers? How many applicants does it interview compared to the number it ends up hiring?
  7. How are new caregivers trained or vetted?
  8. How do the agency's scheduling and payment procedures work? Does the agency handle taxes, workman's compensation, and disability payments for the caregivers?
  9. What happens if your regular caregiver is sick or unavailable for some other reason?
  10. Are the caregivers licensed and insured?

It's important to make sure that your loved one's caregiver is a good match in personality. Also, make sure you feel comfortable with them. Make sure to interview the finalists suggested by the home care agency before you make your final choice.

Here are some questions to ask potential caregivers themselves:

  1. Tell me about other aging seniors you've cared for.
  2. Do you have specific experience caring for people in my loved one's condition?
  3. How will you respond to any emergency?
  4. May I speak to your references?

Home care FAQs

What is hospice care at home?

Hospice care at home is about maintaining comfort during the end of life process. Often, morphine is administered on request to help with pain management. You need a doctor’s prescription to get hospice care at home covered by Medicare or other private health insurance. Always check with your insurance to know what is allowed.

How are in-home caregivers paid?

If you're working with a home care agency, the agency takes care of all payment, including any tax withholding. In most cases, you can expect to be invoiced regularly or to set up automatic payments. Unless you forgo using a home care agency and try to hire a caregiver independently, you should never have to handle money directly with a caregiver.

How frequently does a home caregiver come to my loved one's home?

That depends on your loved one's care needs. Some aging seniors require only a few hours of help each week or a brief visit daily to help with medication or meals. Perhaps you're a family caregiver who wants some outside help to give yourself a break now and then. Others, especially those in need of memory care, may require round-the-clock monitoring and services. Discuss your loved one's needs with their physician and with your home care agency.

How do I hire a home care agency?

Start by discussing your loved one's needs with the agency to see how they're able to help. The agency should be willing to answer any questions you have, including questions about costs. They should also arrange a visit with you and optimally with your loved one. After that visit, the agency should prepare a care plan for your loved one and suggest potential caregivers for you to interview. Get more information on evaluating home care companies.

If your loved one requires more care than you can provide at home, consider looking for assisted living communities near you:

Arthur Bretschneider is a Co-founder and CEO at Seniorly, and third-generation senior housing operator with 20 years experience

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