Understanding In-Home Care

Home Care vs. Home Health Care

Home care is non-medical assistance with activities of daily living provided in the comfort of a senior’s home. Seniors who are resistant to making the move to a senior living facility, or who need minimal support to maintain their independence, can benefit from the added support of an in-home caregiver. In-home caregivers are sometimes called professional caregivers or private-duty aides. A professional caregiver’s role can include assistance with household and personal tasks as well as support to family members so that a senior can continue living at home as they age. As a senior’s needs increase, in-home care plans can be updated to provide increasing levels of care. Caregivers can also provide supportive services in an independent retirement community or assisted living facility to delay the need for a move to a nursing home for as long as safely possible. Non-medical in-home care providers provide support with basic tasks, offer companionship and provide personal care; personal care aides, companions and private duty aides cannot provide skilled medical services.

Companion Caregiver Duties

• Respite for Families
• Companionship
• Assistance with Shopping and Errands
• Transportation to Appointments
• Meal Preparation or Planning
• Light Housekeeping and Laundry
• Socialization
• Assistance with mobility
• Medication Reminders
• Support for someone living with long term illness such as Alzheimer's disease, Dementia or Parkinson’s disease

Personal Care Services

There often comes a time when a senior’s personal hygiene declines and they need a more intimate level of care. Family caregivers often draw the line at providing help with bathing or toileting a parent or grandparent. For the comfort and safety of all involved, hiring a personal care aide can ensure professionally trained, high quality care that preserves an aging loved one’s dignity. Adding personal care services to the care plan will include more hands-on assistance.

Personal Care Aide Duties

• Feeding
• Oral care
• Toileting
• Bathing or Showering
• Dressing
• Grooming
• Skin care
• Incontinence Care

Home Health Care

Home Health Care is prescribed by a physician to treat illness, injury or aid in recovery at home. There is some overlap between home care and home health care; all of the services that a professional caregiver or personal care aide provides can be provided by an in-home care agency, however the medically necessary components of care can only be provided by a licensed home health provider. Companion or personal care services can be added to the skilled care an individual receives if it benefits their overall health and well-being. Home health care services are provided by skilled physical, occupational and speech therapists, registered nurses, CNAs, or home health aides (HHAs) under the supervision of an RN. Most home health care is only provided over a short-term, but it has proven to be highly successful in preventing re-hospitalization and improving quality of life for individuals living with illness or disability.

Home Health Aide Duties

• In-home care for illness or injury
• Post-operative rehab
• Assistance with the Transition from Hospital to Home
• Dispensing Medication
• Monitoring vital signs
• Assistance with medical equipment like portable oxygen, blood glucose monitors and ostomy bags
• Health education
• Wound care
• Physical, occupation or speech-language therapy
• End-of-Life Care and Hospice Support
• Private Duty Nursing

As parent’s age, their abilities change. It is natural to expect some decline in functioning while what were once previously easy tasks become more challenging. There may come a time, however, when an adult child notices that increased difficulties in managing everyday life are causing risk to a parent’s health and well-being. These warning signs don’t necessarily mean that a parent needs to leave their home, but they may warrant starting the discussion about enlisting some help at home. Whether that be an increased commitment from family caregivers or hiring hourly in-home care, it may be time to intervene if you notice any of the following:

10 Signs Your Parent Needs Help at Home

1. Increased confusion
2. Increased memory loss
3. Poor hygiene
4. Changes in weight
5. Neglected household
6. Neglected finances
7. Decreased mobility
8. Increased falls or bruising
9. Behavior changes
10. Loneliness, isolation, and loss of interest in previously enjoyed activities

When parents struggle to complete familiar tasks or become confused by their daily routine, it is time to schedule a physical and cognitive assessment. It is always helpful to have a baseline for cognitive and physical functioning at the start of signs of decline. Additionally, there are some treatable conditions that lead to increased confusion or behavior change, like urinary tract infections, depression, and medication interactions that should be ruled out and treated as necessary.

Activities of Daily Living (ADLs)

ADLs are basic tasks required to live independently- most people are used to doing these things in every-day-life regularly and without assistance. Because these tasks are central to independent living, the inability to complete them is a definitive sign that a senior needs some help. To determine the need for assistance at home, doctors, senior care providers and benefit assessors commonly measure the ability to complete 6 specific activities of daily living to figure out how much help is needed. Generally, the need for support with two or three ADLs triggers the start of care, as well as benefits that pay for care services.

What are the Activities of Daily Living (ADLs)?

Assessing Functional Abilities

• No assistance - Completes tasks completely independently
• Needs supervision
• Needs prompting or direction
• Needs personal assistance
• Needs total care - Dependent on the help of another person to complete tasks

The inability to manage basic physical needs indicates that a senior is no longer safe on their own, and quality of life is likely diminishing.

Senior Needs Assessment

There is general consensus on the activities that are included in scales that assess a senior's level of functioning, however a number of different ADL assessment tools exist for healthcare providers to choose from. The importance of these tools is their ability to provide a standard patient assessment that assists senior care providers in measuring functionality and creating a plan for intervention. Our printable PDF is an example of the information needed to build a thorough care plan for a senior. Printable Senior Needs Assessment

10 Benefits of In-Home Care for a Senior

Most seniors want to age in place. Nearly 90 percent of seniors express the desire to stay in their own home for as long as possible. Hiring a caregiver to support an older adult offers the assistance they need to remain in their home and community as they age.

1. Improved quality of life.
2. Increased comfort in the familiarity of home.
3. Preserved dignity through professional support of activities of daily living.
4. Personalized care and private attention.
5. Companionship and socialization.
6. Connection to community; caregivers can transport clients to social events, local businesses, and community activities.
7. Household help with chores and light cleaning.
8. Support with diet and nutrition through help grocery shopping and preparing meals.
9. Improved safety at home; caregivers can identify and manage safety risks and make recommendations for simple home modifications.
10. Family peace of mind for caregivers who are managing care from a distance or need respite from full time care.

Questions to Ask an In-Home Care Agency

Once you have decided to hire a caregiver, use the following questions when meeting with in-home care agencies to ensure that you receive quality assistance.

Ask about Agency Qualifications

• Does your state license home care agencies? If so, is the agency licensed to provide in-home care services?
• Is the agency Medicare and/or Medicaid certified?
• What type of employee screening is required: background checks, employment history verifications, drug testing?
• What training is provided for employees? Are caregivers required to have CNA training, what certifications do supervisors hold, are their credentials in good standing with state nurse registries? Do you provide agency specific training? How often?
• Is your agency and are the employees bonded and insured?
• Does your agency belong to any accrediting organizations?
• Does your agency maintain a patient bill of rights?
• Who do family members contact with problems, requests or questions?
• Can I speak with current clients, read reviews, or get testimonials from a local professional who would recommend your services?

Ask about Caregivers

• Who will conduct the initial assessment?
• Who will provide and approve the care plan? How often will it be reviewed and updated?
• How does the agency match caregivers with clients? What if we aren't comfortable with the caregiver; what is the process for assigning a new caregiver?
• Are caregivers trained to handle special care needs, like dementia?
• How are caregivers trained to handle difficult clients?
• How do caregivers communicate with family members?
• Are all caregivers licensed drivers? If part of the care plan, whose vehicle is used to transport clients to appointments or errands?
• How soon can you place a caregiver?
• What if a caregiver doesn't show up?

Ask about Costs

• What are the hourly fees? Are there different fee options for round-the-clock, overnight or weekend care?
• How does the agency handle billing?
• Does the agency bill Medicare or Medicaid? Do you accept long-term care insurance? What are the criteria in which I can receive benefits that help pay for in-home care?
• Does the agency pay all social security and payroll taxes?
• Do I pay the caregiver directly?
• What is your policy on tips and gifts to the caregiver?

There are generally three options when paying for in-home care. Medicare, Medicaid, and self-pay, otherwise known as “out of pocket.” The type of care services provided and licensure of the provider determines which method of payment applies.

Medicare

Any care that is not medical in nature ie. companion care or homemaker services are not covered by Medicare. Medicare only pays for home health care, and only if a recipient meets all of the following requirements:

• Care is doctor prescribed as medically necessary,
• Care is limited to intermittent skilled nursing, physical, occupational or speech-language therapy further defined as services that can only be performed safely and correctly by a licensed nurse on a part time basis, hour and day limits apply and cannot exceed 8 hours/day over a 21 day period.
• The recipient is housebound and
• The provider is Medicare certified.

Medicaid

In an effort to help seniors avoid or delay nursing home care, Medicaid pays for some level of Home and Community Based Services in every state however, the programs and services offered in every state differ. In all states, Medicaid pays for basic home health care and medical equipment. Medicaid may pay for homemaker, personal care, and other services that aren’t paid for by Medicare for those seniors who qualify by both income and functional eligibility rules. Medicaid offers standard state plans, HCBS waivers, and the Community First Choice Option to pay for supportive services that help eligible seniors remain in their homes. To learn more about Medicaid in your state contact your State Medicaid Agency.

Veterans Programs

Veterans who are signed up for VA health care have a number of options to manage a disability or health condition from home. The VA provides home-based primary care, homemaker/home health aide (HHA) services, hospice care and respite care for family caregivers depending on a Veteran’s personal eligibility and program availability in the geographic area. All veterans are eligible for services at home and in the community, however there must be a demonstrated clinical need in order to qualify for these services. To learn more about paying for long term care with Veterans Benefits visit the US Department of Veterans Affairs Home and Community Based Services page.

Self-Pay Options for In-Home Care

Options to self-pay for in-home care (also known as private pay or out of pocket) include the use of personal savings, private health insurance and long-term care insurance. Specific policy details will clarify which skilled vs. non-medical services are covered by personal policies, however long-term care coverage generally only pays a benefit to people who need home health care. Fortunately, many states offer resources to seniors who need support at home. As an elder’s needs increase and personal assets diminish, more assistance programs become available. Developing a plan to pay for long-term care is an important step in preparing for the future. Benefits counselors, care managers, and elder care attorneys with specific knowledge as to the programs available in your state can help a family explore long-term care planning options.