Many seniors today say that they would prefer to stay in their homes, or “age in place,” for as long as possible. But as people get older, a number of age-related conditions can make living at home increasingly difficult. Challenges like cognitive decline and decreased mobility can make living at home without assistance difficult and unsafe. 

In-home care can make aging in place much safer for most seniors, especially when used in tandem with home modifications and assistive technology. In-home care aides can provide the personal care assistance, companionship, and monitoring that one would receive in a long-term care community while allowing them to remain in the comfort of their own homes. Home care offers the best of both worlds for seniors who need assistance but are not ready to move to a residential care community, which may be part of the reason why millions of Americans use in-home care services each year. 

We’ve created this guide to help you better understand home care services and navigate the caregiver hiring process. Below, you’ll find detailed information on the types of home care, how much home care costs and how to pay for it, signs it’s time for in-home care, and how to find the best provider for your loved one.

What Is In-Home Care?

what is in home care

In-home care, also known as home care, is nonmedical care provided in the client’s home. It includes custodial care for elderly people and assistance with activities of daily living (ADLs) such as eating, bathing, and providing medication reminders. Home care aides also provide companionship, socialization, and cognitive stimulation for seniors. Family caregivers oftentimes use home care services as a respite when they need to travel, work, or attend to other personal errands. 

The assistance of home care aides allows many elderly adults to remain at home when they are not ready to relocate to a residential care community. It’s also a good option for those who just need some assistance and are otherwise independent, as the amount of care can be personalized for each individual’s needs, from one afternoon per week to 24 hours a day, seven days a week.

What Are the Different In-Home Care Options? 

There are different types of in-home care to accommodate elderly adults with different needs. The levels of care span from basic companionship and light housekeeping to skilled medical care administered by specially-trained home health care aides. Below, we break down in-home care into three main categories. 

Companion Care Services

Companion care providers do just what the name says: provide company for older adults, especially those who are isolated at home because of frailty, cognitive impairments (such as mild- to moderate-stage Alzheimer’s disease), or because they live alone.

Sometimes called “elder companions,” these aides keep a watchful eye, drive clients to appointments, safeguard someone unsteady on his or her feet, read aloud, play cards, prepare light meals and snacks, and otherwise function as an extra set of hands, eyes, and feet for your loved one. 

Companion care is ideal for someone who would otherwise have to spend part of the day alone and who requires some light assistance. Companion care also provides a valuable social benefit, decreasing isolation and improving mood. Warm relationships are often formed when a consistent companion is on the job.

Personal Care Assistance

In addition to providing companion care, home care aides offer assistance with all kinds of activities of daily living, from grocery shopping to non-medical personal care like toileting, dressing, grooming, and bathing. They can also provide temporary respite care for families.

Many families enlist personal care assistants to solve problems in their home care situation, such as a small woman hiring a strong aide who can lift a spouse for bathing, or a son concerned about privacy hiring a woman to bathe his mother. Personal care assistants can also fill a need for seniors who are starting to have difficulties maintaining their home or completing all ADLs independently, but who do not yet need the full-time assistance available at an assisted living community

In addition to assistance with ADLs, personal care assistants can arrange for meal preparation, escorts to doctor visits, and any other type of nonmedical assistance your loved one may need in order to live at home longer. If you need to get away for a few hours a week or overnight, in-home care can ease the worry, especially if the in-home caregiver is familiar to your loved one because he or she provides regular services.

Home Health Care

Home health care is a type of in-home care that involves higher-level medical care and therapy. Unlike personal care assistants, who are not able to perform any medical care, home health aides must undergo specialized training and/or have a nursing degree or certification to perform skilled nursing tasks such as administering injections, maintaining oxygen tubes and catheters, and conducting physical or occupational therapy. 

Note that home health care is the only type of home care that involves skilled nursing or therapy services. Standard home care does not include any type of medical services. Those in need of skilled nursing care, medication administration, or physical or occupational therapy should look into home health care rather than regular home care. 

What Services Do In-Home Caregivers Provide?

What services do in home caregivers provide?

In-home caregivers come to the home to help with activities daily living, such as light housekeeping, grocery shopping, meal preparation, medication reminders, and grooming. And while home health care aides can also provide personal care assistance, the opposite is not true (personal care assistants can not provide in-home health care).

Some of the options for in-home care and home health care services can be found below. 

Home Care Services

Personal care assistants do not provide medical care, but otherwise, care can be tailored specifically for each individual’s needs. Available services include: 

  • Assistance with ADLs
  • Assistance with mobility
  • Grocery shopping and meal preparation
  • Housekeeping and cleaning services, including laundry
  • Transportation to doctor’s appointments, social activities, and more
  • Companionship, social engagement, and cognitive stimulation 
  • Medication management (but not administration)
  • Respite for family caregivers

Home Health Care Services

Home health care aides provide more skilled medical care than personal care assistants. The care one receives will depend on their own medical needs, but available services include: 

  • Skilled nursing, first aid, and wound care 
  • Post-surgery recovery care
  • Physical therapy
  • Occupational therapy
  • Respiratory therapy and assistance with oxygen tanks and tubing
  • Assistance with maintaining and cleaning feeding tubes, catheters, and other medical devices
  • Medication administration, including injections 
  • Assistance managing and monitoring chronic conditions
  • Blood withdrawals

How Much Does Home Care Cost? 

According to the Genworth Financial Cost of Care Survey, in-home care costs about $24 an hour. That comes out to $1,950 per month for 20 hours of care a week, or $3,900 per month for 40 hours of care per week. Home health care is slightly more expensive at an average rate of $25 an hour. 

These figures are the national average, so average costs in your state or city may be quite different. For example, in Vermont, where senior care tends to be more expensive than the national average, 20 hours per week of in-home care costs an average of $2,362 per month, about $400 higher than the U.S. average. Meanwhile, in Louisiana, the same amount of in-home care costs just $1,463 per month, on average.

Financial Assistance for In-Home Care

It’s always an option to pay out-of-pocket for in-home care, but many people utilize some form of financial assistance to make the cost more manageable. Below are some of the most commonly used resources available to pay for home care. 

  • Long-Term Care Insurance: Standard health insurance will not pay for personal care assistance, but some long-term care insurance policies may. While long-term care (LTC) insurance policies are specifically designed to cover senior care, the exact coverage details can vary depending on several factors, most notably the age of the beneficiary when they signed up for their policy. LTC insurance oftentimes will not cover in-home care until the client needs help with at least two ADLs. Check the details of your loved one’s policy to see if in-home personal care assistance is a covered benefit.

  • Medicare: Original Medicare does not cover standard in-home care as it is considered “custodial care” and not medical. However, it may cover personal care assistance if it is delivered with home health care services from the same provider. Additionally, some Medicare Advantage and Medicare Supplement plans may cover in-home care services.

  • Medicaid: Medicaid does not cover custodial care, which includes standard in-home care. However, many states have some form of Home and Community-Based Services (HCBS) waiver, designed to expand the state’s Medicaid benefits to cover additional services such as personal care assistance. Medicaid does always cover home health care for those who meet both medical and financial eligibility requirements.

  • Life Insurance: Though one’s life insurance benefit is intended to be accessed after they pass, in some cases it makes more financial sense to access the funds early and use the life insurance payment to finance long-term care. This may be in the form of an “accelerated death benefit” from the insurance provider, or you may look into selling the policy to a third-party for a cash payment. Look into the specifics of your loved one’s policy to see if this option makes sense for your situation.

  • Veterans Benefits: In addition to a VA pension, some veterans are eligible for the Aid and Attendance (A&A) benefit, an additional monthly payment intended to be used towards paying for long-term care. One of the eligibility terms is needing help with one or more ADLs, so most veterans in need of in-home care will likely qualify. You can learn more about the benefit and apply directly on the VA website, or apply in person at your local VA office.

  • Reverse Mortgage Loans: Reverse mortgages are a loan that one can take against the value of their home, essentially converting part of their home’s value into a cash payment while they continue to live there. The only federally-insured, and thus most reliable, form of a reverse mortgage is the Home Equity Conversion Mortgage (HECM), available to adults age 62 and over to help finance long-term care or other expenses. No matter which type of reverse mortgage one chooses, the loan will need to be repaid with interest once the home is eventually sold. 

What Are Some Signs That It May Be Time for In-Home Care?

What Are Some Signs That It May Be Time for In-Home Care?

Decreased Mobility

Trouble walking and moving around can make it tough to complete routine activities of daily living, making in-home care a much-needed help. Mobility issues can have far-reaching effects, making it tough to safely get around the house (especially if stairs are involved), shower, or go out for errands and social visits. This can lead to a host of other problems, from fall-related injuries to malnutrition. Home caregivers can help your loved one get where they need to go and provide valuable companionship.

A Decline in Hygiene and Grooming

One of the biggest indicators that your aging parent needs in-home help is a noticeable decline in hygiene and grooming. This may include infrequent bathing, overgrown facial hair, or a generally unkempt appearance. Typically hygiene and grooming habits decline when a person is no longer able to keep up with these routines, either physically or due to cognitive impairments.

Maintaining one’s hygiene and grooming is considered an activity of daily living, and many people work with a home care provider to help their loved one with these tasks. Personal care assistance can both physically help a client complete their ADLs as well as help a person stick to a more regular routine and grooming schedule. In-home care aides can also help with other hygiene-related ADLs including toileting and bathing. 

Physical Changes

When you give your loved one a hug, you may notice that they feel thinner and frailer than before. Or, maybe you’ve spotted bruises on their body. These types of physical symptoms may be signs that your parent needs some extra help at home. Significant weight loss can be a sign that your aging parent is struggling to prepare meals for themselves, or that they have trouble getting around the kitchen or possibly remembering how to cook properly (a sign of cognitive decline).

Bruises tend to be evidence of falls or other accidents, although your loved one may be reluctant to admit that this is happening. An in-home caregiver can help ensure that your parent is getting the proper nutrition and can help them prevent falls.

Increased Forgetfulness

We all forget things sometimes – the name of that book you read, or whatever it is you walked into the room to get. But increasing incidents of forgetfulness over time, especially when it comes to important to-dos like taking medication or paying bills, may indicate that home care help is needed. If your loved one’s memory issues are interfering with their everyday activities and well-being, it’s a good indication that they should see a physician about their memory problems, as these may be signs of cognitive decline. Working with an in-home care assistant, you can help ensure that your loved one stays on top of their normal activities, despite any cognitive decline.

Difficulty Maintaining One’s Home

Difficulty keeping up with housework is a common indication that an elderly person needs in-home assistance. They may be unable to perform these tasks the way they did before due to mobility issues, cognitive decline, or even depression.

Some signs that your loved one is struggling to keep up with the housework may include dust, dirt, or grime in areas that used to be clean, excessive clutter, or piles of dirty dishes. Many in-home caregivers provide housekeeping assistance such as cleaning countertops and appliances, sweeping the floor, running the dishwasher, and doing laundry.

Loss of Interest in Activities and Hobbies

Have you noticed that your loved one no longer seems to enjoy many of the hobbies they once loved? Maybe their previously well-tended backyard garden has been neglected, or their weekly card game with friends has gone by the wayside. You might notice that your mom or dad has even given up more sedentary activities such as knitting, reading, or watching a favorite TV show.

Losing interest in hobbies and activities can be a sign of numerous underlying problems, notably depression. While an in-home caregiver won’t be able to solve these medical or mental health issues, they can help ensure that your loved one adheres to treatment plans, has regular social interaction and companionship, and can provide much-needed help so that your mom or dad is still able to enjoy favorite pastimes.

How Do I Find an In-Home Caregiver?

When starting the process of finding in-home help for a loved one, doing some homework on your candidates will help ensure that you hire a trustworthy and reliable aide. You can start your search using Caring.com’s extensive directory. 

Caring.com offers a comprehensive directory of both non-medical home care agencies and home health agencies. You can search the directory to find local agencies and read consumer reviews about their quality of care. You can also work with one of Caring.com’s trained Family Advisors for personal, one-on-one assistance finding an in-home caregiver. Family Advisors can be reached by calling (800) 973-1540. 

What Expectations Should I Set for the Caregiver? 

What Expectations Should I Set for the Caregiver?

The exact expectations you need to set will depend on the client’s specific needs. But, in any situation, seniors and their families can benefit from being very clear from the start about the types of care they need and their expectations for their relationship with their in-home caregiver. 

Put Your Needs in Writing

Setting expectations for your in-home caregiver actually begins before you even hire them. When people decide it’s time for in-home care, most are already thinking about what tasks and types of assistance they’ll want the caregiver to provide. Write this information down as it comes to you, even if you haven’t started interviewing in-home care providers. This will help you narrow your search down to providers who offer all of the care you’re looking for and will make the acclimation process smoother once care does begin. 

Provide a Detailed Job Description

One mistake people tend to make when hiring an aide is to simply tell them that their job is “to take care of Dad or Mom.” But, this open-ended explanation can lead to misunderstandings and conflicts between the client and caregiver. It’s best to provide a detailed job description. Do you expect the aide to cook? Clean? Do laundry? Pick up medications from the pharmacy and run errands? Will the caregiver bring their own lunch or cook and eat with your loved ones? Make your expectations clear. If you put all these details in writing, you won’t run the risk of disappointment once you’ve hired your aide. 

Find the Right Fit

It’s important to find an in-home caregiver your family will be comfortable with. The person will be spending hours per day or week in you or your loved one’s home, so in-home care works out better for everyone when there is trust between the client and caregiver. When interviewing aides or working with an agency manager, communicate that comfortability between your older loved one and/or yourself and the aide is important. It’s good to set this expectation from the start, and then if you’re finding that you or your older loved one does not feel comfortable with the first caregiver, do not be afraid to talk to the agency manager about working with a different aide. 

Frequently Asked Questions

What Is the Difference Between Home Health and Home Care?

The difference between home health and home care is that home health involves skilled nursing and therapy services, while standard home care does not. Rather, home care providers offer companionship, housekeeping, and personal care assistance such as assistance with ADLs. Only home health care providers, not personal care assistants, are qualified to provide medical services. 

What Is the Advantage of Home Health Care?

The advantage of home health care is that the client is able to remain in their own home while still receiving the care that they need. This is especially important for seniors who wish to age in place and are not willing to or interested in moving to a residential care facility. Additionally, home health care services can be tailored to each individual’s specific needs, making care more personalized. 

What Are Home Care Services?

Home care services include housekeeping, companionship, transportation, and assistance with the activities of daily living such as eating, bathing, and grooming. The services that one receives will depend on their needs, and care is tailored for each individual. Home care services do not include medication administration, nursing care, therapy services, or any other type of medical care beyond first-aid and wound care. Those in need of these medical services should seek a home health care aide. 

What Is the Average Cost for In-Home Care?

The average cost of in-home care in the United States is approximately $24 an hour. This comes out to $3,900 a month for 40 hours of care per week. Home health care is slightly more expensive, at an average of $25 an hour. 

Does Medicare Pay for In-Home Care?

Medicare does not pay for in-home care because it is considered custodial, non-medical care. However, if the client also receives home health care services from a Medicare-certified provider, their personal care services may also be covered if received from the same provider at the same time as the health care services. Additionally, some Medicare Supplement plans and Medicare Advantage plans may cover standard in-home care. 

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