Home Care

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Home Care: Common Terms, How to pay for Home Care, Licensing and Questions to ask

A majority of senior citizens prefer to age in place as long as possible, rather than move into a senior living community. However, challenges of aging may cause living at home to become increasingly difficult. The focus of home care is to keep seniors who have difficulty with mobility or cognitive issues healthy and safe. Home care Caregivers assist in activities of daily living (ADLs), monitoring health status and providing friendly companionship. All while they remain in the comfort of their own home.

People typically think of a retirement home or a nursing home when the time comes for seniors to retire or can no longer manage all day to day tasks. This isn’t the case.

What is home care?

This type of care, also known as In Home Care, is provided in the person’s home. Home Care is suited for seniors who may only require some basic assistance at home. Care plans can be customized for each individual. The home aides may support with activities of daily living (ADLs), which could include medication reminders, assisting with bathing and eating. Home Care may be an excellent care options for family if they must leave town or just need a break from caring for their loved one. The Home Care aides bring a sense of personalization, providing companionship and socialization, a sense of connection (24/7 when necessary).

When the time comes to finding the right care for your loved one, it is beneficial to have as much information as possible about different levels of care. 

Definitions of types of care

Home Care: Caregiver assistance related to activities of daily living, including: mobility, eating, toileting, bathing and personal hygiene, dressing and grooming or cognition support. These services are typically not covered by medical insurance and do not require a physician’s order.

Home Health: includes skilled nursing services, physical therapy, occupational therapy, speech language therapy and medical social services. A home health care agency may choose to be Medicare certified to be reimbursed for their services. Home health agencies may also teach you how to care for yourself. Services ordered by a physician, covered by Medical Insurance and typically provided following a hospital or skilled rehab stay.

Rehabilitation & Therapy: treatment for an injury, illness, or pain with the goal of restoring function, including nursing and therapy services. Rehab is ordered by
a physician and services are provided by nurses and physical, occupational, and speech therapists. Examples include working with a physical therapist to help you walk and with an occupational therapist to help you get dressed.

Respite Care: short term relief for family caregivers to take a break from the caregiving responsibilities and allows for a healthier and better quality of life for both the caregiver and care receiver. Respite services include: companionship, personal care, recreational activities and security. Respite care can be provided as short stay or for a longer period that allows the family caregiver to go on vacation or a business trip. Longer duration respite care is generally found at select senior housing communities although some Companion services may provide this service in the home.

Hospice Care (Palliative Care): emphasizes comfort measures and counseling to provide social, spiritual and physical support to the dying patient and his or her family. The goals of hospice are to keep the patient as comfortable as possible by relieving pain and other symptoms. Hospice care, is typically offered in the last six months of life and covered under Medicare Part A .

What Assistance do In-Home Care Aides Provide?

Home Care Aides provide a variety of services and assistance. Depending on the individuals condition, elderly adults may require different types of care.

Services included in home care:

  • Companionship 
  • Socialization 
  • Cognitive stimulation 
  • Medication reminders 
  • Grocery shopping 
  • Transportation 
  • Respite for family caregivers 

Often times, people think of nursing homes or retirement homes as the only places for senior care. As we’ve discussed earlier, there are multiple care options. And even within home care, there are levels of care suited for an individuals needs. The specific services offered in home care will vary state by state.

What are the different Home care options? 

Personal Care Assistant 

  • Assistance with activities of daily living, toileting, dressing, grooming, and bathing.  
  • They can help with grocery shopping and meal preparation. 
  • A personal care assistant can help with family difficulties. If a family caregiver must leave town or be away from the home overnight the caretaker can stay with the individual and monitor and assist as needed. 
  • If a spouse is too heavy and may cause risk of injury, a personal assistant may help the individual transfer from bed or assist with mobility.
  • These care assistants (with exception to some states) cannot perform any medical care. 

Companion Care 

  • Spend time with older adults, providing companionship, which is especially relevant for people who live alone, or do not leave the house due to cognitive impairments or frailty.  
  • These companions are there to look after the person, keep a watchful eye and act as an extension of the person to help with mobility and general physic functions.  
  • They may drive the person to appointments, prepare light meals and snacks.
  • They may play games or read and listen to music together. 

How do you know it may be time for Home Care?

What are the signs to look for?

Have you noticed your loved one is spending less and less time managing their hygiene or personal appearance. They may stop brushing their teeth or let their facial hair grow in an unkempt fashion when they didn’t before. Are they going longer periods of time in the same clothing, or neglecting relatively scheduled eating habits? Grooming and hygiene live under the umbrella of ADLs, and as such a Personal Care Assistant may help with these tasks.

Is your loved one forgetting things more frequently? Typically, people forget things sometimes, but if you notice they are forgetting simple tasks they normally perform regularly, this may be a a sign that assistance is necessary.

It is not uncommon for elderly adults to experience trouble walking, getting up from a seated position or need help getting in and out of bed. Signs like this can be dangerous. The risk of a fall increases as mobility declines. The aide of a home care caregiver may assist with moving around the house safely.

Did you notice your loved one’s home is in disarray? Have they usually shown signs of tidiness or regular cleanliness, and now the home is disheveled and dirty. In Home Aides may assist in normal household maintenance like dusting and sweeping, cleaning the kitchen or doing laundry.

How much does Home Care cost?

The average national monthly cost of home care is about $4,850. Costs may vary depending on what region of the country you live in and where you live within your own state.

How to pay for home care

Medicare: 

Medicare does NOT cover standard home care including: 

  • Companion services 
  • Grocery shopping 
  • Meal preparation 
  • Light housekeeping 
  • Transportation 

Medicare does NOT cover personal care assistance including ADLS: 

  • Bathing 
  • Dressing 
  • Eating

Medicaid: 

Medicaid does cover home health for seniors who are eligible. 

Each state has its own Medicaid programs in place. As a result, eligibility and services fluctuate state to state.  

  • Home care services may be covered by regular state ran Medicaid and may also be offered under the Home and Community Based Services Medicaid Waivers. 

State Medicaid: 

In-home personal care services (dressing, bathing, eating, etc.) are not federally mandated, some states may offer them via Regular Medicaid. 

Long-term care insurance: 

An individual’s private insurance may help with some of the cost of home care. This usually pertains to long-term care insurance. 

  • The purpose of long-term care insurance is to cover senior care, which includes home care. Though, be aware that coverage varies depending on the insurance provider, the specific policy, and other factors. 
  • It is common that long-term care insurance will only start to cover care when the person with the policy requires assistance with two or more ADLs. 
  • As a result of the above, individuals who only need companion care may not be covered by their long-term care insurance.  
  • Typically, purchasing long-term care insurance is not an option if you are at the point where you already need care. 

Veteran aid and assistance: 

This benefit is available to some military veterans or surviving spouses. 

  • A veteran may qualify for as much as $2,050 each month. 
  • A veteran with a sick spouse may be eligible for $1,600 per month. 
  • If a veteran has passed, their surviving spouse can qualify for $1,300 per month. 

Private pay: 

  • Many families pay for care with private funds. 
  • Private pay can be a combination of retirement funds, personal savings, and pension payments. 
  • Family members may contribute funds toward a loved one’s care. 

Questions and inquiries about home care

Agency Information

  • Is the agency RN operated?
  • Is the agency a franchise or locally owned and operated?
  • Is the agency licensed by WA State Department of Health?
  • Is the agency licensed for both home care and home health?
  • Does the agency have liability insurance?
  • Can the agency respond to you 24/7?

Caregiver Information

  • Are employees licensed, bonded & insured? Or are they independent contractors?
  • Does the agency test skills, conduct behavioral interviews and verify caregiver credentials?
  • Are caregivers required to have current certifications for First Aid, CPR, and TB?
  • Are caregivers provided continuing education/training?
  • Can authorized individuals monitor care and make requests online in real time?
  • Does the agency offer caregiver replacement when the “fit” may not be right?

Documentation and Supervision

  • Does an RN/MSW/Care Manager conduct a free home care assessment?
  • Does an RN/MSW/Care Manager create a home care plan?
  • Does an RN/MSW/Care Manager supervise the caregivers?
  • Do caregivers receive client orientation before arriving at a client’s home?

Policies and Cost

  • Can services be cancelled with a 4-hour notification?
  • Does the agency offer flexible scheduling, custom care plans, and  a continuum of care?
  • Does the agency have weekly or monthly minimums?
  • What is the hourly minimum per shift?
  • Does the agency offer home care discounts?
  • What is the required deposit?
  • Will the agency accept long-term care insurance?

Eldercare Locator is a nationwide service that connects older Americans and their caregivers with trustworthy local support resources. Connect with services such as meals, home care or transportation, or a caregiver education or respite from caregiving responsibilities. The Eldercare Locator is a public service of the Administration on Aging (AoA), an agency of the U.S. Administration for Community Living.

Medicare provides a search feature to find & compare providers near you, most senior housing and care providers are included on CareAvailability.com. Find & compare plans in your area. Determine if you qualify for premium savings.

Medicaid offers information on how to apply for Medicaid, eligibility criteria, links to local state offices, and additional resources.

The Alzheimer’s Association is the leading voluntary health organization in Alzheimer’s care, support and research. Whether you are living with Alzheimer’s or caring for someone with the disease, information and resources are available. 

Hospice Foundation of America is to provide leadership in the development and application of hospice and its philosophy of care with the goal of enhancing the U.S. health care system and the role of hospice within it.

National Association for Home Care & Hospice is a trade association that represents the nation’s 33,000 home care and hospice organizations and the caregivers who provide in-home health and hospice services.

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Written by The Care Availability Team
Experts in the senior care & retirement living industries

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