How do I find more affordable home care?

11 answers | Last updated: Aug 13, 2012
Momwacko asked...

My mom is 80 years old, has only Social Security and a little money stashed away for first month of a nursing home. She has a home health agency coming now to my home with physical therapy and an licensed nurse practitioner who gives her showers. This will stop in a month because Medicare believes they can make her more independent in the shower, which she is not safe to do. Mom does well with most areas of the front bathing although she cannot get in and out of the shower alone. Most agencies I have contacted want $45.00 an hour per shower, with a minimum of 2 hours. Even the Council on Aging wants $40.00 per hour. Mom has a problem with my bathing her private areas she can't reach and she has no problem with someone hired to do this. I have a problem with the rates charged. Is there any solution?

Expert Answers

Merrily Orsini, MSSW, was a pioneer in the business of providing geriatric care managed in-home care. She currently serves on the board of the National Association for Home Care and Hospice and is Chair of the Private Duty Homecare Association. She holds a master's degree in social work and is a nationally known writer and speaker on aging, elder issues, and in-home care.

What a complicated issue! Having trouble finding affordable in-home care seems to be an issue for you as well as the government. The issue is that pay is commensurate with getting a trained, kind and loving person to come to your home to perform a simple task. Sounds easy enough, but it takes finding the person, thoroughly screening them, training them, and then scheduling that person to go to a multitude of homes because he/she needs to work 40 hours to make a living wage. Since the caregiver is only paid for the hours worked (the agency is only reimbursed for the hours worked as well), there have to be lots of homes where he/she works for just an hour or so. And who pays for the travel time in between? Thus the cost escalates to cover the time NOT working and not reimbursed. More information than you wanted, I am certain. However, to answer your question: agencies that employee and thus meet the situation I have described above will be expensive. If your mother is income eligible for county services, she should be able to receive them for free or a VERY reduced rate. Call the council on Aging again and ask for assistance with payment for her services, and see if she meets the criteria.

Community Answers

A fellow caregiver answered...

Agencies are a huge part of the problem with getting someone to help at home. I had one agency owner tell me that of the $15 per hour charge, he gets $5. Can you trust a person that makes $10 per hour before taxes? I've heard of another agency that charges $16 and takes $8. You're not going to get a happy person taking care of your loved one going that route.

I am a primary caregiver for my 87 year old dad and have found a workable solution. He only needs companion help. He has early/mid Alz and gets very agitated and depressed when left alone. He can hardly manage to complete simple tasks any more.  I've posted ads in the employment section at I don't mention salary, other than that it's competitive. I say  how easy he is to take care of, including his cheerful disposition, and list job responsibilities as keeping him company, running errands, light housework, etc. The responses come rolling in. The two times I've done this, once in Florida and once in NJ, I've found young mothers who need extra income. They do the basic stuff on a flexible schedule for $10 per hour. Sometimes they bring their kid, which is good therapy for dad.

Just practice due diligence and make sure they are who they claim to be and take proper security measures (nothing of value, especially information, that they can access). I promise them a minimum # of hours per week, usually 25-30. After doing everything by myself for almost a year, I was ready to lose it. The new solution is affordable and a bonus is that I'm helping a mother and child who really need the help. They become like family members too!

Again, just be extra careful who you let into the home until you're sure about them. Young mothers tend to be honest because they've got a child and the accompanying responsibilty.

Pat-1 answered...

I agree with Merrily. I would explore several roads - A) call more agencies and see if anyone is cheaper for bath visits.

B) The Area Agency On Aging.

C) Perhaps the local home care council in your area has some resources.

I am located in San Antonio, Texas, and our local home care council is a wealth of information and contacts.

There are resources available, but it will take investigative work.

I am glad hiring non-agency caregivers worked in the last case, however, I would caution you to ask lots of questions and know all of your responsibilities before you place an ad - payroll taxes for example. Also, what happens if the caregiver is unable to show up? Who provides the backup?

I wish you well, and I hope you find the right solution for you and your mother.

West sac gal answered...

My mother receives her in home care through the county.  A nurse practitioner isn't really necessary to help someone bathe is it? You don't get a nurse to help you bathe in a hospital.  Anyway I called the Social Security office and they told me to call the In Home Health Services through our county. My mom is completely funded by entitlements so she has no money socked away. The first gals sent out didn't work out so good but we now have one by the name of Erica and she's great. She is a trained Certified Nurses Assistant and she only works about 3 hours a day. As Mom's needs have increased in the last 6 months we have asked for re-evaluations and received more care hours. Before this we did the "Comfort Keepers" route and we paid lots. Call your local Social Security Office and see if your Mom qualifies


A fellow caregiver answered...

We need to remember that the agency is not making the difference between what the caregiver is paid and what is billed.  There are huge expenses the agency pays which may include:  State licensing fees, liability insurance, worker's comp insurance, training and all the taxes associated with payroll.

An agency gives the client lots of built in protection by completing background checks, criminal checks, drug screens and possibly even driving checks.  They also offer continuing training and backup caregivers is one is sick or on vacation.

An caregiver that is a friend or neighbor or someone out of the paper does not usually pay any payroll taxes and they are not covered by insurance (liability and accident while working for you).  You can be liable is they are hurt on the job and you can be assessed back payroll taxes if there is an investigation. 

Just be aware of the pros and cons of both situations.

Patrece banks answered...

Home modifications could be part of a solution to reduce home healthcare costs and are often overlooked or unknown. Certified aging in place specialist (CAPS) are trained through the National Association of Home Builders in cooperation with AARP. We work with CAPS all over the country and find them often better informed than therapists about aging in place needs. They are focused on solutions and safety which is a rare combination in this arena.

Be cautious with home healthcare since there is no incentive for them to offer solutions outside of services which can create multiple issues including safety issues. It is important to get input by those with proper knowledge about the safety issues with incentives to provide you with solutions. Home healthcare is there to provide services. Our system is not solution based and your situation is not uncommon. Physical therapy can only do so much. Home modifications may not be the answer yet a walk in tub sounds like it could solve the bathing issue or at least help. Just some thoughts outside-the-box.

Carolyno answered...

My Mom needed a break from caring for her sister in Phoenix and lives in CA. She contracted with a home care agency for 5 days at the rate of $225 per 24 hours or $1,125 for 5 days. My aunt is under hospice and LIKES to have someone around, but does not yet NEED it. I came to help instead and replaced the agent hire within a few hours. I asked what she was paid by agency and learned she got $8 hr/12 hours ONLY for a 24 hour period (not paid "sleep hours"). To summarize: Pay agency $225 day, caregiver gets $96, agency get difference of $129 day.

This does not seem right. The agency is bonded/insured and able to send qualified person quickly. Through networking with hospice and asking around senior community, we will now pay $10-$12 hr or $120 - $144 day for experienced and qualified home care. Quality care workers are typically listed with multiple agencies (screened with references). In my opinion, the best way to get affordable home care is to hire someone listed with agencies direct.

We are exploring group homes now (known as board and care too) that are better and smaller alternatives to nursing homes. They offer LICENSED home like setting, 24 hour care, including meals for 1-6 patients or 7-15, depending on license. Rate is $1 - $3,000 month in Phoenix area and may be partially covered by insurance. Ask hospital case managers, hospice if applicable and ask around. Look for cars that come and go on a regular basis in senior neighborhood. Possibly, your senior's neighbor has a home care worker that may want to work before or after their other shift at a neighbor's home. Again, it can be win-win going direct. Offering $10 - $12 hour when agency only pays $8 helps the home worker. Please be aware there is slight risk when bypassing agency.

Mindy trautman ratigan answered...

I am a 47 year old female,I answered a ad in our local paper to live in and take care of a 93 year old lady,i was hired,i have no experience,this was in august,i have been here for 6 months,she is doing great because of me,iget500:00 a month plus room and board,i put in two hundred for food and buy laundry soap and all toiltries such as toilet paperetc,my relief makes 8:00 an hour,she does nothing,and is eating me out of house and home!what do i do?

Mylilly answered...

Don't blame Agency! There are so many agency, they are very good. Working so hard to hire hard working caregivers. So it can be peace of mind for family, that some one, right person is taking care of their loved one at home. I will not trust if I will hire somebody from craiglist with no back ground check, work history check etc. Agency check their caregiver certification, back ground, work history, and experience.

Crazylady answered...

Merrily Orsini, You mentioned County Services to the one lady. My experience with them was it is not free,I was given forms to fill out when I asked for help bathing & taking the trash to the trash room down the hall, what would take all of an hour. The forms were to turn over my only small life insurance policy to them, $5,000.00. Big help they are.

Caroliso answered...

Not sure I can name names, but this won't get posted if I can't. I suggest you look into two agencies that I have used with success, Griswold Special Care and Right at Home. Both are national agencies with local offices/franchises. They both charge less than what you quoted, and they have sent capable, pleasant, hardworking people. Ask them the questions you have about how much the caregiver receives, how they screen and train, etc. Re: the state agencies, unfortunately if you are receiving more than Social Security there will be a reduced fee but not free, in my experience. But investigate other services including free companion visitors, people to do shopping, etc. This will lighten the load! Good luck.