In-home care: What are your options?
Perhaps you or a loved one is starting to have trouble with everyday tasks, such as grocery shopping, cooking, or bathing and personal care. Or maybe you need help with specific medical needs. That's when an in-home care provider can help.
Hiring in-home help can allow you or your loved one to stay at home instead of moving to assisted living or a nursing home. It can also give family and friends peace of mind.
In-home care comes in all shapes and sizes:
- Home health care can include a range of health services administered in your home by a skilled provider (such as a nurse or other medical professional) for wound care, giving injections, occupational therapy, or monitoring serious illness.
- Non-medical home care can include personal care (grooming, bathing, toileting), helping with household tasks like cooking or laundry, or simply providing companionship.
“You really need to look at what does the person need help with? What’s difficult for them to do? And who can best fill those needs?” explains Christina Irving, LCSW, Family Consultant at the Family Caregiver Alliance. Here’s how to figure out what kind of in-home care might be right for your situation.
Types of in-home care and cost
Besides determining what type of care you need, you’ll also want to determine how much help you need. Do you need the care provider 24 hours a day, or are you looking to hire someone to come in for a few hours on a daily basis or a few days a week?
In some cases you may need a combination of services. For example, you may need a personal care assistant to live with an elderly family member or friend around the clock, but you may only need to hire a nurse to come in once or twice a week to help manage that person’s medical needs, Irving explains.
You might also be able to use a combination of in-home care and various types of respite care. For example, adult day care programs can provide care and companionship for your loved one during all or part of the day.
Below are some of the different types of home care services available. Costs are national medians from the 2017 Genworth Cost of Care Survey, which includes data collected from all 50 states across the U.S. Cost and availability of services can vary widely based on the geographic region where you live, Irving adds. (You can see average costs in your state or city from the Genworth survey here.)
Companion care is one of the least intensive levels of care. It’s frequently used by people who do not require assistance with medical, health, or personal care, but who may benefit from a care provider who can provide social interaction. In addition to companionship, some care providers may also help with meal preparation, light housekeeping, and errands or shopping, depending on the type of assistant you hire.
Depending on where you live, companion care workers may be available for shifts on a daily or weekly basis. Religious-based organizations may offer companion care assistance, too.
Who pays: Neither Medicare or Medicaid cover companion care. Some long-term care insurers may cover some or all of this type of care depending on the plan. Uncovered costs fall to the person receiving care or their family members.
Average cost: $18/hour
Personal care assistants help an individual with everyday living tasks, such as bathing, dressing, light housekeeping, running errands, meal preparation, and (in some cases) transport, as well as providing companionship and social support.
This is typically not a licensed field of work (though licensure requirements can vary by state), so the experience and training of care providers can vary.
Personal care can be available for continuous, 24-hour coverage or it may be an option to have someone come in for a few hours at a time either daily or weekly, Irving says.
- If you’re eligible for Medicaid, the program will typically cover personal care services that allow individuals to stay in their home. Benefits vary by state, and sometimes costs are covered through waivers rather than being paid for directly.
- Medicare may contribute to personal care when it’s medically necessary, which means directly after a hospitalization or if such care is prescribed by a doctor. Typically coverage only happens in instances where someone requires both personal care and skilled nursing care (see below). If Medicare does contribute, such benefits are typically only for a limited amount of time.
- Long-term care insurance plans typically do cover personal care, but the amount of coverage depends on your specific policy.
- Uncovered costs fall to the individual receiving care or their family.
Average cost: $21/hour
Also known as: non-medical home care, homemaker care
Home health care
Home health care can include a wide range of health care services that are administered in your home after you suffer an injury or illness—or to provide personal and health care on a regular basis. When home health care is temporary, the goal is to get you back to a status where you can live independently again. In other cases, home health care is long-term and intended to help an individual manage their health on a routine basis. For example, this might include assistance taking medications, testing blood sugar, or giving insulin injections.
Home health care aides should be helping you manage what you’re eating and drinking; checking vital signs; checking that you’re taking prescriptions or other treatments according to your doctor’s orders; monitoring pain; and helping you re-learn how to take care of yourself.
When home health care is medically required by your doctor, part or all of it may be covered by Medicare or Medicaid.
- If you qualify for Medicaid, the program does typically cover home health care needs.
- Medicare may pay for some or all home health care when it is medically necessary, but typically only on an intermittent basis or for a limited amount of time.
- Long-term care insurance plans typically cover home health care, but as with personal care, the amount of coverage depends on your specific policy.
- Uncovered costs fall to the person receiving care or the family.
Average cost: $22/hour
Skilled nursing care
If you or your loved one’s needs require more than simply monitoring a health condition and helping manage medications, you may require skilled nursing care. This type of home health care may include wound care, injections, intravenous or nutrition therapy, or more comprehensive monitoring of a serious illness or unstable health condition. Some nurses are also trained to provide occupational, speech, or physical therapy.
Generally, home nurses only provide the nursing and medical care services they specialize in. They do not provide other personal care services a person might require, such as help with personal hygiene, housekeeping, cooking and meal preparation, and running errands and shopping.
- If you qualify for Medicaid and the skilled nursing care you need is medically necessary and ordered by your doctor, Medicaid may cover some or all of the costs.
- Medicare may pay for some or all skilled nursing care when it is medically necessary (meaning typically the program only covers such care on an intermittent basis or for a limited amount of time).
- Long-term care insurance plans typically do cover skilled nursing care that is medically necessary, but again, the amount of coverage depends on your specific policy.
- Uncovered costs fall to the individual receiving care or the family.
Average cost: $13-30/hour
When and why to consider in-home care
Deciding when you need in-home care is a matter of looking at the needs of both the person needing care and of the person acting as their primary caregiver (such as a spouse, grown children, or a friend).
“If there is already a caregiver in place (such as a family member or friend), it’s a question of looking at that person’s health and wellbeing and what is their capacity to provide care,” Irving adds.
When considering the needs of the person who requires care, consider:
- Do they need help with personal care? Are they struggling with eating, bathing, using the toilet, or other daily activities? Are you worried about falls?
- Do they need help with household care, such as cooking, shopping, cleaning, laundry, and running other errands?
- Do they have health and medical care needs that are going unaddressed? To continue living at home, do they need help managing prescriptions and medications they need to take? Do they require physical therapy?
- Do they need companionship? Are they lonely? Would they benefit from more conversation and someone to socialize with?
If you are a family member or friend who is primarily responsible for meeting the needs of the person requiring care, consider the following:
- Is providing care cutting into the demands of your job or career?
- Are you struggling to meet a loved one’s medical needs, such as administering medications or helping with therapy?
- Are you facing challenges that are a result of their dementia, such as keeping them from wandering or preventing dangerous behaviors (such as leaving water running or using sharp knives or appliances without you around)?
- Do you have time to manage your own household chores and responsibilities?
- Do you have time to manage your own health and wellness (whether that means exercising, cooking, reading, seeing friends, practicing meditation or other forms of stress relief)?
- Are you able to take care of that individual without physically harming yourself? When you help lift a person needing care so they can bathe or use the toilet, are you damaging or risking damage to your back?
How to find in-home care
To get started finding an in-home care provider, ask for recommendations from family, trusted friends, doctors, social workers, your faith community, or others you know. This can help make the transition go a lot more smoothly. “Sometimes that makes it easier to feel more comfortable with the whole process,” Irving says. You can also search for home care providers here.
Written by Sarah DiGiulio