What is In-Home Care?

InHomeCare.com helps seniors live their best lives, regardless of location or health. Our experts put you in contact with in-home caregivers all across America.

In
home care services can provide companionship, supervision, and assistance in the comfort of a person’s own home. This allows older adults to live at home rather than move into a senior living community. As baby boomers start collecting social security, their adult children may find themselves caring for elderly parents. When routine phone calls or even alert systems are not enough, their loved ones can still assure their well-being in their home.

“Home health care” means licensed nursing care, while “in-home care” or “home care” refers to non-medical care or personal care. These differences are important because they help determine the appropriate level of care provided, which will determine the actual care cost and also the funding sources available to pay for care.

In-home care from a professional agency is appropriate whenever an individual prefers to stay at home, but needs ongoing care that cannot easily or effectively be provided solely by family and friends. As their physical and cognitive abilities diminish, a growing number of elderly are electing to keep living independent, non-institutionalized lives by receiving care at home. Most senior citizens want to age independently while not burdening their families. Professional in-home care makes that possible. Families, meanwhile, are provided with peace of mind and assurance that their loved ones are well-cared for and comfortable in their own home.

Skilled home health care vs. Non-medical home care

Skilled Home Health Agency vs Non-Medical Home Care

In-home, non-medical care services include supervision and help with personal care. It usually includes meal preparation, medication reminders, laundry, light housekeeping, errands, shopping, transportation, and companionship. While there are differences between in-home care or home health care, most older adults eventually need both as they age.

Skilled home health agencies are the most well-known care providers. The main purpose of this type of agency is to provide skilled, professional care for medical treatment or rehabilitation services to homebound patients. Home health care professionals must strictly adhere to a physician-approved plan of care.

Services provided generally include:

  • Medical/Psychological services
  • Wound care
  • Pain and medication management
  • Disease management
  • Nursing care services
  • Oxygen services
  • Medical supplies and equipment
  • Physical therapy
  • Speech therapy
  • Occupational therapy
  • Other basic home health aide care

The same agency may deliver different kinds of home care services through registered nurses, therapists, social workers, home care aides, medical equipment and supply dealers, and volunteers. Some agencies limit their services to nursing and one or two other specialties. If care is needed from more than one specialist, the home health agency will set up a team to provide care that covers the patient’s needs. Because home health agencies hire and supervise their personnel, they assume liability for their services.

Skilled home healthcare services generally are available 24 hours a day, 7 days a week. The home health agency is state-licensed and usually Medicare and Medicaid (Med-Cal in California) certified and may also accept other third-party health insurances. Medicare certification means that the agency has met specific federal guidelines and criteria.

Many are also accredited by independent third-party review organizations such as JCAHCO, CHAPS, or HHC. Services are generally paid for by Medicare, Medicaid, and private health insurance and patients must meet strict criteria for participation and payment authorization. However, some medical agencies also offer their medical home care services on a private duty or private pay basis. There are approximately 14,500 licensed home health agencies operating nationwide.

While the main focus of these agencies is medical care, some also offer a dedicated non-medical, in-home care service. Individuals often have ongoing personal care needs even though skilled home health care services are no longer required. With this home care component, the same agency can continue to provide personal and custodial care to their patients, but it will usually be on a private pay basis.

What are the main types of senior care?

Companion Care

Companion care offers seniors the comfort of companionship. The primary focus of this type of care is to provide emotional support and companionship for seniors who are healthy, generally speaking, but would prefer to to remain independent at home. Here are some of the most common companion care services: Medication reminders, assistance with Activities of Daily Living (ADLs), light housekeeping, cooking and meal prep, transportation, and help with planning, scheduling, and keeping appointments. In addition, companion care often includes encouraging exercise and planning social activities.

Personal Care

Personal care services essentially provide seniors with assistance in completing everyday tasks, such as eating, bathing, dressing, grooming, and oral hygiene. Personal care generally entails performing home safety evaluations to prevent avoidable accidents.

Transitional Care

Transitional care refers to the care provided following hospitalization, or a stay in a rehabilitation facility. This type of care plays a key role in optimizing the health and well-being of the senior, all while significantly reducing the risk of hospital readmission. Once released from the hospital, a caregiver will tend to the recovering senior, relieving them of many day-to-day responsibilities. The senior can rest and recuperate, knowing that household chores, medication management, and fresh meals are being taken care of.

Skilled-Nursing Care

Health issue become more prevalent with age. Skilled-nursing care helps reduce the stress that both seniors and their family members experience when a loved one is sick, or diagnosed with a disease. The clinical care these nurses provide increase seniors’ quality of life. Skilled Nursing Care services include:

high-tech nursing, assistance with medical machinery (including ventilators), administration and maintenance of catheters, PICC line dressing changes, drawing blood, performing injections, and other vital tasks.

What are ADLs and IADLs?

Activities of Daily Living (ADLs) refer to six specific tasks of basic self-care:

1. Personal hygiene: Bathing, grooming, nail care, and oral care.

2. Dressing: choosing appropriate clothing and being able to physically dress and undress oneself.

3. Transferring: moving from one body position or location to another.

4. Toileting: getting on and off the toilet and cleaning oneself.

5. Eating: includes preparing and eating meals.

6. Ambulating: walking or otherwise getting around independently (Ex: with a wheelchair).

Instrumental Activities of Daily Living (IADLs) are advanced activities related to independent living:

  • Managing personal finances.
  • Transportation, by driving or by organizing other means of transport.
  • Shopping for food, clothing, and other necessities.
  • Meal preparation (cooking and safely using kitchen equipment and utensils).
  • Home maintenance to keep a tidy and hygienic place of residence.
  • Managing communication, such as telephone and mail.
  • Taking medications in accurate doses and at appropriate times.

The number and severity of a person’s ADL and IADL needs are used to determine the level of assistance required, as well as to determine eligibility for long-term care insurance benefits. Insurance companies require justification and documentation that the insured individual needs help with at least two (sometimes three) ADLs in order for the benefit to be effective. The Medicare benefit for non-medical care available only through Medicare Advantage Plans will most likely also require the same.

When is home care needed?

Support for daily activities

When an individual needs assistance with ADLs and IADLs. Also when general supervision is needed for persons with Alzheimer’s disease, dementia, or other cognitive deficiencies.

Respite care

When regular in-home care is provided by family and close friends, respite care through a professional agency is a convenient and safe option for giving them a break from the emotional and physical demands of daily caregiving.

After a serious medical episode

Some medical episodes can result in prolonged recoveries, especially among the elderly. Hospital discharge planners and social service personnel ensure that patients have adequate care at home before they can be discharged.

Short term disability or illness

Including situations such as a difficult pregnancy, or after a complicated childbirth.

Chronic conditions or illnesses such as:

  • Cancer
  • Alzheimerʼs & dementia
  • Parkinsonʼs
  • Chronic obstructive pulmonary disease (COPD)
  • Heart disease
  • Diabetes
  • Multiple sclerosis
  • Osteoporosis

Most elderly people will have co-morbidity diagnoses, meaning they will be diagnosed with two or more serious health conditions. In these cases, in-home care may be necessary to improve the person’s safety and comfort.

Does someone in my family need home care?

Fearful of losing their independence, aging individuals will often mask or cover the signs and symptoms indicating they might need assistance. Younger adults and children with disabilities or who are recuperating from acute illness may also benefit from in-home care.

Knowing the ADLs and IADLs and looking for patterns of behavior and neglect within those areas can help pinpoint whether a loved one needs in-home care. The IADLs are usually the earliest to suffer, so look for difficulties with those first:

  • Unpaid bills, irresponsible spending, susceptibility to scams.
  • Inability to drive safely or to access other means of transportation.
  • Low supplies of fresh food and other necessities; spoiled food in the fridge; evidence that only canned food is being consumed.
  • Messes left untidied, laundry piled up, home care and maintenance neglected.
  • Telephone calls unanswered, mail unopened.
  • Unfilled prescriptions; medications not being taken as directed.

Evidence of trouble with ADLs:

  • Infrequent bathing, unusually sloppy appearance, bad body or mouth odor.
  • Inappropriate clothing choices or not being able to physically dress and undress oneself.
  • Difficulty standing up, sitting down, or getting in and out of bed.
  • Incontinence or difficulty cleaning oneself after using the toilet.
  • Weight loss, appetite changes, difficulty swallowing, dehydration.
  • Inability to walk or otherwise be able to get around independently.

Additional warning signs:

  • Burns or bruises.
  • Hearing loss.
  • Spilling or dropping things.
  • Fatigue; sleeping too much or too little.
  • Isolation; lack of interest in friendships, hobbies, or activities; curtains drawn day and night.
  • Change in attitude; sadness or feelings of depression and despair; abuse of alcohol or drugs; paranoia; refusal to communicate or unusual argumentativeness; verbal abuse.
  • Diminished cognitive abilities; forgetfulness about where things are, getting lost walking or driving, confusion, loss of reasoning skills, difficulty answering questions, inability to find the right word or complete a sentence, repetitive words or phrases, wandering, loss of sense of time or season, forgetting how to use ordinary things, consistently forgetting to turn off the stove, close windows, or lock doors.

With the advent of professional in-home care agencies, families can easily help their elderly or disabled loved ones to stay in the comfort and security of their own homes, while still receiving the care and assistance they need to be safe.

Benefits of a licensed home care agency

1. Convenience

InHomeCare.com makes it simple and easy to find a reputable in-home care company serving your area. You’ll work out a schedule and the list of duties your caregiver will perform when you meet with your selected company. The company will choose the best caregiver for you to ensure that the care you receive is personalized to meet your exact needs.

2. Comfort

Patients live as independently as possible, in familiar surroundings and in the comfort of home.

3. Companionship

In-home care services can also provide something that we all need: companionship. Most in-home care companies will match a caregiver to the patient’s needs and interests.

4. Cost-Effectiveness

People receive one-on-one care and attention from caregivers that they can’t get in a facility. That means greater value for every dollar spent on care. Plus the caregiver may perform tasks previously handled by an errand service, a housekeeper, a transportation service, and other expensive agencies.

5. Security

Having a professional caregiver at home can provide an additional level of security. However, when contacting an in-home care company, be sure to ask how the agency screens caregivers and manages their staff. Make sure your selected agency is properly licensed and insured, and that its caregivers are fidelity bonded.

6. Assurance

Many adult children of aging parents can’t regularly pop-in to check on their loved ones or tend to their every need. With a caregiver in the home, families are regularly updated as to the well-being of their parents. Having a personal, caring, professional caregiver in the home provides everyone peace of mind.

How do I find a professional caregiver or home care agency?

Traditionally, much of the care in the home was provided by families and friends or by independent or freelance caregivers, even though there are significant labor and liability risks associated with directly hiring a caregiver. That course is changing due to the emergence of widely available, capable, and affordable in-home care agencies.

Many people looking to hire professional care for a loved one will ask a relative or trusted friend, advisor, or clergy if they know of any caregiving services and options. Some families would rather hire a caregiver privately. There may be some potential cost savings in going this route, but you must also consider the additional responsibilities and liabilities involved.

Hiring a caregiver independently

You must do a substantial background check to ensure that the employee has no record of criminal activity or abusive behavior and that they, in fact, have the experience and training necessary to meet your care needs.

When you hire a caregiver, you become the employer of record and are responsible for complying with all federal, state, and local labor, tax and insurance laws. You’re also responsible for all the employment paperwork (payroll taxes, proper withholdings and filings, worker’s compensation insurance, etc.) necessary to comply with all federal, state, and local labor, tax, and insurance laws.

You will need to arrange for a suitable substitute or relief caregiver if your caregiver is ill or needs time off.

Using a referral agency

Home care referral agencies match independent caregivers to the patients who needs them. These agencies do not employ caregivers; they simply collect a referral fee if you hire someone from their registry. Referral agencies vary widely in the quality of the screening they do, and they do not generally offer professional liability or workers’ compensation insurance.

Using a licensed home care agency

Full service, licensed home care agencies (also called home care organizations) specialize in recruiting, hiring, and supervising their caregivers. They are responsible for performing background checks, handling all payroll taxes, withholdings and filings, worker’s compensation insurance, and arranging replacement and back-up staff for time-off, sick-time, and emergencies. They lighten the burden of hiring a caregiver and provide peace of mind to the patient’s family.

Pros & Cons of In-Home Care

According to extensive research conducted by the American Association of Retired Persons (AARP): More than 90% of seniors want to stay in their own homes as they age.

“Aging in place” is one of the fastest-growing trends in senior living. As enticing as growing old at home may sound, seniors often find themselves struggling to perform some of the basic Activities of Daily Living (ADLs) on their own. Others may find that, as time goes on, it becomes increasingly difficult to remember when medication needs to be taken, or what time their scheduled doctor’s appointment is. In-home care for seniors can help solve these issues, and many more common problems that may arise as we get older.

The chart below summarizes both the pros & cons of in-home care for seniors. We know that each and every situation is unique, as every person has their own set of needs. That said, this chart provides a basic overview of the advantages and disadvantages associated with senior home care.

Advantages & Disadvantages of Home Care

Advantages Disadvantages
  • Allows a person to age in place with family
  • Privacy & comfort
  • Independence and control in scheduling & routine
  • In-home care is more affordable than other senior care
  • Allows a person to stay in the neighborhood they’re familiar with
  • The freedom to hire services that fill in any gaps in the patient’s need
  • Enjoy home renovations
  • In-Home Care has proven to be effective in preventing hospital re-administration
  • Not all senior care facilities allow pets. Aging at home lets the patient keep them
  • Increased family involvement
  • Can be burdensome or intrusive to other family members
  • Support & supervision limited to designated
  • Not the same level of care facilities provide
  • The task of creating a safe and accommodating space
  • A less structured environment can make seniors feel less secure

Care Needs Checklist

Non-medical Care Skilled Healthcare
Household Tasks
Light Housekeeping: clean and keep tidy all living areas
Laundry: wash and change bed linens and launder clothing, etc.
Meals: cook, grocery shop, prepare food ahead for later meals
Organization: schedule daily tasks and appointments, sort mail, etc.
Transportation, Companionship, General Safety
Drive and escort on errands, shopping, and doctor appointments
Encourage social participation, escort on outings and to recreational events, everyday stimulating conversation, phone call assistance
Supervise in home to avoid falls, household accidents and ensure easy access to emergency contacts
Personal Care
Eating: assist feeding, provide nutritious meals and adequate fluids
Bathing: assist bathing, transferring in/out of tub/shower, bed-baths as needed
Dressing & Grooming: assist dressing, glasses, hearing aids, special orthotics (i.e. braces), hair care, shaving, oral hygiene
Ambulation: assist walking, safe use of assistive devices, range of motion, and strengthening exercises
Toileting: assist to bathroom, bedside commode, urinal, bedpan usage
Incontinence: assist changing diapers, undergarments, pads, related skin care
Communication
Therapy: assess, plan, implement and evaluate therapy to regain speech, breathing, and swallowing function
Teaching: instruct speech therapy regime, evaluate technique and compliance
Assistance: help to perform prescribed exercises, report progress to supervisor
Support
Referrals: identify and arrange local resources for home care services, adult daycare, respite, financial assistance, and support groups
Intervention: identify and arrange local resources for family and individual counseling and crisis intervention
Wounds and Bedsores
Assess wound, incision, or bedsore; evaluate signs and symptoms of infection and monitor response to treatment
Teach Care: instruct wound or bedsore regime, evaluate technique, compliance
Treatment: perform wound/bedsore care per prescribed regime; report signs & symptoms of infection
Alzheimer’s and Dementia
Home Safety: closely supervise for safe environment, secure area with use of monitoring alarm devices to avoid wandering
Emotional Support: provide structured activity at appropriate cognitive level to minimize confusion
Diabetes
New Diabetic: teach specialized skin care, insulin injection technique, blood glucose monitoring, hypo/hyperglycemia symptoms, and related emergency protocol
Glucose Monitoring: remind to check blood glucose per orders, report results to supervisor
Insulin: remind to inject insulin per prescribed regime, follow-up, and report compliance to supervisor
Diet: prepare special prescribed diets, encourage compliance with restrictions
Ostomies: Colostomy, Urostomy
New Ostomy: teach ostomy care, preventive skin care, troubleshooting
Care: assist with ostomy changes, monitor peristomal skin blood work, and report results to physician
Feeding Tubes: G-Tube, NG Tube
New Tube: teach proactive skin care, dressing changes, and troubleshooting problems with blockage, tube placement, skin infections
Tube Changes: insert new tube per authorized plan of care and as needed
Feeding: teach tube feeding regime, evaluate competency and compliance
Care: perform daily and as needed dressing changes and skin care to tube site
Catheters: Foley Indwelling and External
New Catheter: teach drainage bag changes and cleaning, securing tubing, troubleshooting dislodged catheters, placement, blockages, drainage amounts
Catheter Changes: insert catheter per authorized plan of care and as needed
Care: perform daily and as needed catheter care including emptying drainage bag, monitoring intake and output, cleaning and securing tubing and bags
Basic Health Monitoring
Skin: monitor for signs of breakdown, apply pressure reduction measures
Nutrition: monitor weight, nutritional intake, adhere to dietary restrictions
Intake/Output: encourage adequate fluids, monitor fluid intake and urine output
Vital Signs: take blood pressure, temperatures, pulses, and report changes
Lab Monitoring: perform prescribed blood work and report results to physician
Medication Management
Remind to take medications and follow-up
Administer oral medications
Teaching: instruct new medications or monitor changes in regime per plan of care, assess response, side effects, and adverse reactions
Injections: administer prescribed injections per authorized plan of care, report side effects, adverse reactions
Supplies: manage supply of prescriptions to have all meds on-hand
Mobility
Home Assessment: evaluate home safety needs, arrange for adaptive equipment
Therapy: assess, plan, perform and evaluate physical therapy to regain strength and maximal activities of daily living plan
Teaching: instruct prescribe exercise regime and safe ambulation with/without assistive devices
Assistance: help perform prescribed exercises, report progress to supervisor

Paying for home care

The cost of care varies widely. Factors include the type and number of hours of care needed and the geographic location. On average, the cost of light companionship care is between $17-$21 per hour. The cost for total care can range from $28-$40 per hour. Someone needing a moderate amount of in-home care services could expect to pay around $22-$28 per hour.

The rates, terms, and types of programs offered by agencies vary when it comes to paying for home care. Rates may be priced on an hourly, per day, or per shift (including a “live-in”) basis. Some determine their charges based on the level of care needed, while others charge a flat rate per hour or day regardless of the care needed. Paying an upfront deposit is common in the industry. Agencies usually bill twice each month or on a monthly cycle. Payment by check is still the most common form of payment although many agencies are set up for automatic debit payment. More and more accept major credit cards as an additional form of payment.

Private Pay

Where does the money to pay for care come from? There are several sources of funding for non-medical, in-home care services. However, the vast majority of care is paid from the savings, retirement accounts, and resources of the individual receiving care or from their family. This type of payment is commonly referred to as private pay, or out-of-pocket payment.

Medicare

Medicare does not presently cover non-medical care except when certain custodial services are part of a doctor-authorized plan of care. In this case, the licensed home care agency must be approved and, of course, the patient must be Medicare-eligible and meet Medicare’s definition of “homebound.”

Long-Term Care Insurance

Long-Term Care Insurance (LTC) carriers currently pay for about 20% of the in-home care in the U.S. LTC companies generally pay a fixed benefit per day and have a maximum benefit they will pay for in-home care. Most home care agencies will assist you in complying with the requirements of your LTC carrier. They will usually verify policy benefits, perform a pre-evaluation, obtain a doctor’s order, complete daily care notes, and itemize bills for services rendered. It is generally your responsibility to pay the care agency and then to submit the claims to your LTC insurance carrier for payment on your policy. Some agencies do accept benefit assignments, meaning they do all the paperwork and get paid directly by your LTC carrier.

Other Options

There may be other options to consider which might assist in paying for care including:

  • Paid Family Leave
  • Medicaid & State Assistance Programs
  • Veterans Administration
  • Grants

In-home care costs vs Continuing care in a facility

The cost of care in a facility, as with most medical expenses, depends on many factors including the type of facility (Short-term Skilled Rehab vs Chronic Long-term Care Facility, or Skilled Nursing vs Assisted Living), the health and care needs of the patient, private room vs semi-private, the quality and location of the facility, etc. Cost varies widely: anywhere from $350 to $1,200 per day.

Because a patient does not receive one-on-one care in a facility, a patient or resident in a facility may also elect to hire, at additional cost, an outside care agency or caregiver to supplement the care provided by the facility. In these cases, the agency and caregiver must comply with all rules and regulations of the facility.

Alzheimer’s Disease & Dementia home care

What are the symptoms of Alzheimer’s Disease?

The most common symptom of Alzheimer’s is progressive memory loss. Here are the symptoms associated with memory loss:

  • Forgetting appointments and/or prior engagements
  • Losing objects – and storing them in illogical places
  • Experiencing feelings of confusion, or loss, even in familiar areas
  • Forgetting the correct name of basic objects and/or household items
  • Forgetting the names of familiar people – such as family members

What are the signs of Dementia?

  • Apathy
  • Withdrawing from social situations
  • Inhibition loss
  • Suffering from a sleeping disorder(s)
  • Delusions, such as believing a theft has taken place when it hasn’t
  • Losing trust in those close to them

Can in-home care help seniors with Dementia?

In-home care services include both medical, and non-medical, assistance with a variety of daily activities. From safe and reliable transportation to medication management and bathing. If you or a loved one are suffering from the effects of memory loss, it may be time to look into home care. Many seniors who have had to live alone with Dementia, say their quality of life has increased significantly – ever since hiring a home caregiver to help them with day-to-day affairs.