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What You Need To Know About In-Home Senior Care

As a family caregiver for an aging adult, your life can be stressful and exhausting. Balancing work with caregiving responsibilities can be challenging, along with your other family responsibilities. You may need help but don’t know what home care services and other care options your family member is eligible for and what it will cost. 

Finding supportive in-home senior care for older adults can be a little like a treasure hunt - you don’t know where to look first or how to create a beneficial and affordable plan. There are no easy answers, but understanding your options will help ease your burden and provide a path forward that you can tailor to your loved one’s needs.

How To Get Started

Acquainting yourself with home care services is the first place to start. But beyond that, it can be helpful to assess your loved one’s needs now and in the future. If you feel you don’t have a grasp on what they need, start the process of reviewing their health, medications, diagnoses, and prognosis.

In-home care requirements will likely change over time, depending on your family member’s disabilities, and you will want to be prepared. 

Also, consider the current level of family caregiving and if it is sustainable. Starting in-home senior care is an individual choice and can often depend on caregiver stress and time. Most elders prefer aging in place in their own homes, and home care assistance is vital to making that happen.

What Is Home Care?

Home care services often get confused with home health.The two are very different in several ways, but the most significant is that in-home care is private pay except under Medicaid or long-term care insurance coverage.

Home care provides non-clinical assistance to individuals requiring help with personal care, meal prep, and companionship.

Sometimes the care needs of an older adult will exceed what in-home care can provide.

States determine the scope of practice for home care workers, making it confusing for families. The agency will be bound by state regulations if you contract with a home care agency.

However, if you hire someone independently, the caregiver may perform tasks outside the state requirements. Remember that you are still responsible for taking legal liability for any mishaps, mistakes, or lawsuits.

Home care can augment family caregiving, home health, and hospice services.

  • In most but not all cases, home care caregivers assist with activities of daily living or personal care

  • Some states allow in-home care workers to perform minor types of care such as medical tasks like diabetes checks or administering medications. But most don’t.

  • Home care hours are very flexible with everything from a few hours a week to live-in care.

  • Home care workers can provide transportation, recreational activities, light housekeeping, grocery shopping, meal preparation, and toileting.

  • The cost of home care will depend on where you live and how many hours of care you need. On average, you can expect to pay from $20 and up if you are using an agency.

  • Most agency in-home caregivers are bonded and insured.

  • Home-care providers can work with individuals with Alzheimer's or other neurological problems.

  • Home-care providers can also offer companion care which is valuable for older adults who are isolated or lonely.

  • In most states, home-care providers can give medication reminders but not dispense medications.

  • In-home providers can provide much-needed respite care for family members.

Home care can offer valuable services, but the cost of care can increase if many hours are needed each week or if you require overnight or around-the-clock care. Some families eventually decide that an assisted living community is more cost-effective as home care costs increase.

What Is Home Health Care?

Home health care is a medical service provided in someone’s home - whether that home is a personal residence, senior living, or an assisted living community

Home health care services can be a significant benefit for someone who has had surgery, been in skilled nursing, or has a decline in functioning. Home health care also provides a layer of support for family members. In some situations, home health care can prevent nursing home admission.

Home health care aims to assist the patient, so they can return to their previous level of functioning - or as close as possible by developing an individual care plan.  

  • A physician must write an order for home health care indicating that the services are necessary.

  • Home health care is covered under Medicare and most other health insurance plans.

  • The patient must be homebound, except for religious services and medical appointments.

  • Except under specific circumstances, home health services are time-limited.

  • Home health consists of nurses, physical, occupational, speech therapists, and aides who can assist with activities of daily living. Aides are not permitted to go shopping, provide transportation, cook, or do housekeeping.

  • In most cases, a nurse, therapists, and home health aides come to the home approximately three times a week to help with medical care.

  • Any home health patient must demonstrate progress; otherwise, the home health care company could discontinue services. 

What Is Hospice Care?

Most people think of hospice as a place, and it can be, but more often, it is a philosophy of care and a service that can help someone wherever they live.

Hospice care is a service provided by healthcare professionals to people reaching the end of their life. For many people, hospice is a frightening idea because it means their loved one is at the end of their life. 

You may think of hospice as a stand-alone service, but in reality, hospice combined with home care can help families with what matters most - spending quality time with someone they love and care about

  • A physician must write an order stating that the patient has a terminal condition likely to end in death in six months. However, it is not unusual for patients to live much longer.

  • Hospice focuses on comfort care, emotional support, and pain relief.

  • Hospice support is limited to nursing one or two times a week (except when the patient is actively dying) and an aide approximately three times a week.

  • Hospice care staff will not perform such tasks as housekeeping, transportation, shopping, or meal preparation. This is where private home caregivers can be a big help.

  • While on hospice, the patient agrees not to seek outpatient treatment for the hospice qualifying medical condition.

  • A patient can not have home health and hospice simultaneously, but they can have in-home care.

  • Medicare, Medicaid, and most private insurance pay for hospice.

As beneficial as it is, hospice does not provide anywhere near 24-hour care, which can put enormous pressure on family members or private caregivers to fill the gaps in care. 

Does Your Loved One Require In-Home Senior Care?

Each in-home senior care service has its pros and cons, and there is no one size fits all solution for everyone. 

As your loved one ages, they may require each of these in-home programs more than once over their lifetime.

As a family caregiver, your familiarity with home care, home health, and hospice will inform you of different options for supportive and safe care.  

Amanda Lambert

Amanda Lambert is a Certified Care Manager, Aging Life Care Professional, and Certified Master Guardian Emeritus.
She is also the founder of Lambert Care Management, providing care management and consultation services to older and disabled adults.

She has 20+ years of experience in geriatrics, with expertise in mental health, home health, and guardianship, as well as all aspects of care planning, including assessment, projected costs of care, client advocacy and education, caregiver coaching, and advanced directives. She is also co-author with Leslie Eckford of Choose Your Place: Rethinking Home as You Age (2020), Aging with Care: Your Guide to Hiring and Managing Caregivers at Home (Rowman and Littlefield 2018).

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