Families often begin the search for home care when it becomes evident that an aging parent needs at-home medical services or help with personal care, meal preparation, transportation, or household tasks.  The right home care services can make it possible for seniors to live safely and comfortably in their own homes, especially when family members live at a distance or have limited ability to help.

Determining the appropriate type of care is the first step. If the family is fortunate enough to have a care manager on board, he/she can assess the services needed, make recommendations to the individual and/or family members, and monitor how things are going.

Home care services include the following:

  • Personal care which may include assistance with eating, dressing, bathing, toileting, and hygiene.
  • Companionship: Besides providing emotional support through conversation and other activities, companions may perform other duties such as light housework, meal preparation, and transportation.
  • Household services such as laundry, cooking, and cleaning. Often a home health aide or companion-homemaker can provide personal care as well as household services.
  • Home health care services refer to health care provided by a skilled medical professional such as a registered nurse or physical therapist. Home health care services, which may be prescribed after a hospitalization, can include physical or occupational therapy, administration of medication, wound care, pain management, medical tests, and health status monitoring. Home health care services are considered medical care and are usually covered under insurance, including Medicare and Medicaid. Individuals who provide home health care services do not prepare meals, provide transportation, or assist the patient with personal care.
  • Live-in caregiving: Live-in caregivers may be an option for seniors who need someone with them around the clock.

There are many agencies and many choices. Key questions to ask an agency regarding their home care services include:

  • Are there minimum time frames required for services?
  • How are staff screened? Are background checks done?
  • How are agency staff trained? Does the care provider have any special certifications?
  • Is the care provider current with immunizations and a TB test?
  • Is the agency bonded and insured? Is the care provider an employee who is covered under the agency’s workers comp policy?
  • Who will supervise the care provider?
  • What is the back-up plan if the care provider gets sick or can’t come?

Affordability of home care services is another important consideration. Other than home health services, which are medical and usually covered under insurance, home care services are generally private-pay unless the senior qualifies for services under a state’s Medicaid or Medicaid waiver plan. Long term care insurance may cover certain types of home care services if specified in the policy.

Sometimes families circumvent an agency and hire someone privately. While it may be less expensive, it’s also a lot riskier. As the employer, the family is responsible for compliance with payroll taxes, social security withholding, and wage and overtime laws. They must do their own screening, background and reference checks, there is no back-up coverage, and they risk being sued if the care provider gets hurt on the job. For many families, this is simply too much to handle.