Senior Citizen's Guide digital books
Senior Citizen's Guide

A Home Healthcare Primer
In-Home Health Services Available to Older Adults

What Is Home Care?

Homecare is a general term that represents a wide range of community-based services that support someone recuperating from an acute situation, such as a hip fracture, or services needed by persons with on-going chronic conditions, such as stroke or cerebral palsy. The skills and duties of home care personnel vary, but all have one thing in common—they make it possible for care recipients to remain at home in a safe, environment and in some cases have more independence than they did before. In the process, they also provide family caregivers with a chance to replenish their depleted physical and emotional reserves. Homecare personnel include:

Getting Started with Homecare

  1. The first step is to make sure you and your loved one are comfortable with the idea of someone else taking on some of the tasks that you've been doing by yourself. Consider getting counseling from a social service organization or geriatric care manager.
  1. Define tasks that need to be done by the homecare worker to determine exactly what type of homecare is most appropriate in your situation.
  1. The inevitable questions about where to find homecare services, how much they will cost, and whether any of the cost is covered by insurance or provided by government programs must be asked and answered.
  1. If you're like the majority of family caregivers, you need the most help with personal care tasks—the very type of care that is not typically covered by private health insurance programs or Medicare. So unless your loved one had the foresight and the funds to purchase long-term-care insurance prior to becoming ill, your access to homecare will be limited by what you can afford. You may be able to get some help from state programs that take into account your ability to pay, and the age or extent of disability of your care recipient, but the sad reality is that typically the costs of homecare services will have to come out of your own pocket.

Choosing the Right In-Home Care

Home Care Agencies are companies in the business of meeting homecare needs. Not all home care agencies provide the same variety and level of service however, so make sure the agency you are considering can provide all the services you need. The issue isn't bigger or smaller but rather which one meets your criteria.

If your care recipient is approved for skilled care that Medicare will pay for, it's vital that the agency be Medicare certified. This ensures that the agency has met federal minimum requirements. If your loved one only requires personal care or companion/homemaker care, Medicare certification need not be a factor in your decision. Some companies actually have two agencies that are legally separate but work together, one that is Medicare certified and one that is strictly private pay.
Some agencies are accredited in addition to being certified. Well-known accrediting organizations are the National League for Nursing, the Joint Committee for Accreditation of Healthcare Organizations, and the National Foundation of Hospice and Home Care. This type of certification tells you that the agency conforms to national industry standards, and there is always comfort in knowing you are dealing with an organization that has proven its worth to its peers.

What do home care services cost through an agency?

Some agencies charge flat fees ranging from $100 to $120 per visit. Others have a minimum two or four-hour fee. The actual hourly rate will vary depending on the services you require and the part of the country you live in, but don't be surprised to find rates ranging anywhere from $13 to $35 per hour.

Privately Employed Home Caregivers can be hired on your own, especially if you are not looking for skilled medical care, but rather for someone to act as a companion or personal aide on a regular, long-term basis. You can start your search by putting the word out to friends and neighbors that may know of a homecare worker. Also check with the nursing staff in your doctor's office, a hospital discharge planner, or community-based social service agencies for reliable candidates.

Home Care Registries are a good middle ground between home care agencies and hiring help on your own. Registries are somewhat like an employment agency. They screen, interview, and reference-check workers they refer to clients so you don't have to, but just as with homecare agencies you need to ask a lot of questions to assure yourself that they can provide the right personnel to meet your needs.

Government In-Home Aide Services are offered by many states and counties to residents who are aged or disabled. Some even offer services to family caregivers. Applications for aid are evaluated by state social workers that rank a candidate's needs according to a number of objective criteria including whether the care recipient lives alone and what activities he or she can perform. To find out what services your state offers, call your state Department of Human Resources or state Health Department. But be forewarned: usually these agencies are overwhelmed with applications and the waiting list can be long.

Hospice can help a loved one with a terminal illness with a number of services. To qualify for in-home hospice care, you must have a doctor certify that your loved one is no longer seeking curative treatments and that he or she has "months rather than years to live." Depending on your situation, Hospice will provide a social worker, a nurse who comes regularly to check medicines and vital signs, volunteers to sit with your loved one while you run errands or just get some rest, and home health aides who will bathe and clean the patient, etc. Payment is usually through Medicare or private insurance.

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