What is In-Home Care?

In-home care services can provide companionship, supervision and assistance with personal care in the comfort and convenience of a person’s own home–making it possible for older adults to live at home rather than move into a senior living community. As baby boomers advance in years, come to retirement age and start collecting social security, before they know it their adult children find themselves caring for elderly parents. When routine phone calls or even alert systems are not enough, but the elderly don’t want to spend their retirement living outside the home they are familiar and comfortable with, their loved ones can still assure their health and well-being.

Care in the home may include some combination of skilled health care services, such as nursing interventions, and non-medical or assisted living services, but there is a distinction to be made: the term “home health care” is understood to mean licensed nursing care, while in-home care or home care refers to non-medical care, personal care, custodial care or domiciliary care. These differences are important because they help determine the appropriate level of care provided, which in turn will determine the actual cost of care 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.

What Is Non-Medical Home Care?

In-home, non-medical care services include supervision and help with personal care (see Activities of Daily Living, or ADLs, below), as well as help in the home with tasks such as meal preparation, medication reminders, laundry, light housekeeping, errands, shopping, transportation, and companionship. While there are differences in the terms describing aspects of in-home care or home health care, in reality, most older adults needing one type of care, will eventually need both as they continue to age.

What is the Difference Between Skilled Home Health Care and Non-Medical Home Care?

Skilled Home Health Agency vs Non-Medical Home Care

The most familiar provider of medical home care services is the skilled home health agency. 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 and/or 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

Just as the name states, 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. It can include a wide range of non-medical services, aimed to help make a senior’s life more manageable. To give you an idea, 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. Furthermore, this type of senior 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, while having peace-of-mind knowing household chores, medication management and fresh meals are being taken care of.

Skilled-Nursing Care

As the aging process continues, health-related issues often become more prevalent. Skilled-nursing care helps reduce the stress that both seniors and their family members experience when a loved one is sick, or diagnosed with disease. The clinical care these nurses provide, make the lives of their senior clients easier, and in-turn increase a 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 more!

What are Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs) and Why are they Important?

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

  • Personal hygiene including bathing, grooming, nail care, and oral care.
  • Dressing: choosing appropriate clothing and being able to physically dress and undress oneself.
  • Transferring i.e. being able to move from one body position or location to another.
  • Toileting: the ability to get on and off the toilet and cleaning oneself
  • Eating, meaning the ability to feed oneself.
  • Ambulating: walking or otherwise being able to get around independently (for example with a wheelchair).

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

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 new Medicare benefit for non-medical care available only through Medicare Advantage Plans beginning in 2019 will most likely also require the same.

When is Home Care Needed?

Home care is especially useful in the following scenarios:

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–falls resulting in a broken hip or femur, joint replacements, strokes, etc.–can result in prolonged recoveries, especially among the elderly. Hospital discharge planners and social service personnel are required to ensure that patients have adequate care at home before they can be discharged. Because hospitals are financially penalized if patients are readmitted within 30 days of discharge, they have a strong incentive to ensure that their patients are properly cared for at home. In the past, hospitals focused primarily on the clinical, medical care the patient needed in the home. Today, hospitals and insurers are increasingly focusing on the non-medical services that caregivers can provide. They want to ensure that their patients follow doctors’ orders, take their prescriptions, comply with diet restrictions, follow specific therapy regimens, and avoid falls or other accidents at home.

Short term disability or illness

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

For chronic conditions or illnesses such as:

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

Most elderly, especially the frail elderly, will have co-morbidity diagnoses, meaning they will be diagnosed with two or more serious health conditions. It would be quite common, for example, for an 85 year-old woman who suffered a stroke to also have diabetes, osteoporosis and dementia. She would most likely have multiple prescription medications and have been given important dietary restrictions–often ordered by different doctors. After her 3-5 day stay in the hospital for her stroke, she would go to a short-term rehab facility for 10 days before being discharged home. Without constant, capable care and assistance at home, there is a high degree of probability that she could sustain a serious fall, sending her back to the hospital for a broken hip or femur–where she could in turn catch pneumonia or another infection, worsening her chances of full recovery. Hospital discharge planners, case managers, and professional geriatric social workers face the reality of this scenario constantly. The need for in-home caregivers, especially those experienced in condition specific co-morbidity care for the frail elderly, has never been higher.

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, by far, one of the fastest growing trends in senior living. As enticing as growing old in the comfort of your own 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.

Chart of Advantages & Disadvantages of Home Care

Advantages Disadvantages
  • Allows a person to “age in place” with family
  • Privacy & comfort
  • Independence and control in scheduling & routine
  • Costs of senior care are high: In-Home Care is among the more affordable options
  • Allows a person to stay in the neighborhood they’re familiar with
  • The freedom to hire services that fill in any gaps in your need
  • If you’ve made any updates to your home, you can enjoy them for longer
  • In-Home Care has proven to be effective in preventing hospital re-administration
  • Not all senior care facilities allow pets. If you’re aging at home, you’ll be able to keep your pets
  • Family can be more involved in care
  • Can be burdensome or intrusive to other family members
  • Support & supervision limited to hours designated
  • You won’t receive the same level of care as you would in a facility
  • The task of creating a safe and accommodating space
  • A less structured environment can make seniors feel less secure

Does Someone in my Family Need Home Care?

Fearful of losing their independence, aging individuals will often mask or cover-up 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.

Next look for 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.

In addition, look for the following 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.

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 if you are considering this, you must be aware of the additional responsibilities and liabilities involved.

If You Decide to Hire a Caregiver Directly:

Hiring a caregiver independently means:

  • 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.
  • You, as the employer of record, are 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, needs time off or simply abandons you.

Using a Referral Agency:

Home care referral agencies, also called home care registries, can help match you to an independent caregiver. 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. When you hire a caregiver, you will become the employer of record and be responsible, as above, for complying with all federal, state and local labor, tax and insurance laws.

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. Indeed, they lighten the burden of hiring a caregiver and provide peace of mind to the patient’s family.

Benefits of Using 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

You or your loved one is able to continue living 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 your personal care needs and to your personal interests.

4. Cost-Effectiveness

You’ll receive the one-on-one care and attention from your caregiver that you can’t get in a facility. That means greater value for every dollar spent on care. Plus, your caregiver may perform tasks previously handled by an errand service, a housekeeper, a transportation service, etc.–saving you more money and time, too.

5. Security

Having a professional caregiver in your 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

In-home care assures you and your family peace of mind. 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.

Care Needs Checklist:

Non-medical home care agencies provide some personal care that skilled home healthcare agencies do not; conversely there are needs that can only be provided by skilled healthcare personnel. Although these tasks vary by state because of license regulations, the following are some general guidelines:

Chart of Advantages & Disadvantages of Home Care

Advantages Disadvantages
  • Allows a person to “age in place” with family
  • Privacy & comfort
  • Independence and control in scheduling & routine
  • Costs of senior care are high: In-Home Care is among the more affordable options
  • Allows a person to stay in the neighborhood they’re familiar with
  • The freedom to hire services that fill in any gaps in your need
  • If you’ve made any updates to your home, you can enjoy them for longer
  • In-Home Care has proven to be effective in preventing hospital re-administration
  • Not all senior care facilities allow pets. If you’re aging at home, you’ll be able to keep your pets
  • Family can be more involved in care
  • Can be burdensome or intrusive to other family members
  • Support & supervision limited to hours designated
  • You won’t receive the same level of care as you would in a facility
  • The task of creating a safe and accommodating space
  • A less structured environment can make seniors feel less secure

Does Someone in my Family Need Home Care?

Fearful of losing their independence, aging individuals will often mask or cover-up 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.

Next look for 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.

In addition, look for the following 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.

How do I Find a Professional Caregiver or