Services to Help Seniors Stay At Home

We're living longer—and healthier—lives than ever before in human history. However, if a time comes when help is needed, questions about living arrangements that include assistance or care often arise. Because so many seniors wish to remain in the home and community that holds a lifetime of memories, a wide variety of home care services have evolved in recent years to make this feasible.

What is home care?

Home care typically refers to non-medical services that assist individuals with activities of daily living. Home care is an increasingly popular choice for care because it enables individuals to remain in their own environments, and can also be a lifesaver for caregivers.

For example, simple tasks such as housekeeping, shopping, meal preparation, opening a jar, or driving to appointments can become increasingly difficult for many older adults. Personal tasks such as bathing, dressing, grooming, toileting and even transferring from the bed to a chair can became unmanageable alone. Many types of individuals, including those who are trained and supervised by agencies, provide such services. In general, home care providers are available 24 hours a day, seven days a week. They may work by themselves or as a team on a shift, part-time, hourly, live-in, or on an as-needed basis.

While some home care agencies provide health-oriented services, it is important to understand the difference between non-medical home care and home health care. Home health care is more specialized medical care, such as that provided by nurses or physical and respiratory therapists. Care providers are trained medical, health care and psychiatric professionals, or certified nurses' aides. Home health services are usually ordered by a physician and may be covered by insurance.

Types of services available for seniors living at home

• Homemaker Services – Can include help with cooking, light cleaning, laundry, grocery shopping, and other household chores.
• Personal Care – Assistance with a variety of daily living activities such as bathing, dressing, toilet use, grooming and eating.
• Companionship – From daily telephone calls from a "buddy," to a daily "friendly" visitor, to round-the-clock paid companions.
• Home Health Care – Skilled care that can include nursing; speech, occupational, physical, or respiratory therapy; home health aides, and social work or psychiatric care.
• Adult Day Care – Daily, facility-based programs in a community center setting for seniors who need monitoring or companionship during the day. Please refer to Helpguide's Adult Day Care Centers: A Guide to Options and Selecting the Best Center for Your Needs for more information.
• Activity Groups – Games, trips, shopping outings, and other stimulating group activities.
• Respite Care - A trained volunteer or para-professional stays with your loved one and takes over your caregiving role, whether for several hours or several days. These brief reprieves from a caregiving situation are healthy for the caregiver and also for the care recipient…a change of daily routine for both. Helpguide's Respite Care includes tips for caregivers' self care.
• Live-in Help - Home care best suited to long-distance caregiving or other situations in which the primary caregiver can't be there in person and the senior needs round-the-clock support. Room, board and, in many cases, a salary, is provided in exchange for meal preparation, light housekeeping, and other non-medical services.
• Hospice Care – Medical, social, and emotional services for the terminally ill and their families. Helpguide's Hospice Care explains how to best utilize this service at home or in a facility.
• Caregiver Support Groups – Support for issues about aging, peer companionship, illness-based support, groups for caregivers, grief support and many others to help people experiencing life challenges with a family member. Learn more about caregiver support groups available for different needs, and how to locate them in Helpguide's Help and Resources for Caregivers.

In addition to consulting with your senior family member and any relevant medical or therapeutic professionals, consider a "needs assessment," which can be conducted by a care manager or home care specialist—or you can do it yourself.

Considering using home care services

For many caregivers, there don't seem to be enough hours in the day. It's difficult to care for all of the needs of a family member and still have enough time and energy left for your own family, a job and yourself. Exhaustion and stress can become overwhelming. If this description fits you, it's time to consider home care services.

Seniors who become home care recipients most often would rather stay in their own homes than move into residential care. And economically, except for round-the-clock nursing care, home care can be less expensive than most board and care homes, skilled nursing homes and assisted living facilities. However, this is not always the case, and prices should be compared.

If you or your loved one has the living space and financial resources (since the cost will most likely be out-of-pocket), you might consider hiring a live-in care provider (see below for more details.) This type of home care is very well suited for long distance caregiving situations in which the primary caregiver can't be there in person and the elder needs full-time assistance or monitoring.

Locating home care providers

You can research and hire home care providers privately or go through a home care agency. To locate agencies or private providers, check with any or all of the following resources:

• Yellow Page listings for Senior Services, Home Care, Home Health Care and similar subject areas
• Area Agency on Aging (Call 1-800-677-1116 for the AAA in your area)
• Local community and senior organizations
• Religious affiliations including churches and synagogues
• Doctor or hospital referrals from your care recipient's medical affiliations
• Agencies. These agencies may or may not be state licensed, but they select and supervise their own personnel, and are liable for any staff or care problems that arise.
• Registries. These are employment agencies for home health care providers. Typically, you will pay a fee (if not, then the employee will), and you will be responsible for payroll (including tax withholding) and all other employment regulations. You'll also be responsible for selecting and supervising your provider. The registry will not be liable for any problems such as no-shows, tardiness or quality of care.
• Newspaper ads. In addition to word-of-mouth, this is the way you're most likely to find independent home care providers. Hiring an independent provider is like hiring any other employee without going through an agency. You will be responsible for payroll, as well as for selecting and supervising your provider.
• The Internet. The World Wide Web allows you to do vast searches for a number of home care services. Links to helpful web sites are listed in references & resources below.
• Friends and acquaintances. Referrals from people you know who have used an agency or individual for their relative are one of the best sources of trusted help. Ask around.

The Eldercare Locator, a service of the U.S. government, has an online database of senior service agencies. To get more detailed information, call the Eldercare Locator toll-free at 1-800-677-1116 (Monday through Friday, 9:00 a.m. - 8:00 p.m. Eastern time). You will speak to an Information Specialist who can provide more specific and useful help.

Tips for hiring agencies and independent home care providers

Agencies will typically be the most expensive; independent providers will be the least expensive. However, home care agencies are also easier to use, since the agency finds and places the provider, handles payroll and any problems that may arise, and usually provides coverage for sick or absent providers. Agencies that are licensed and bonded are generally a good choice, although there are always exceptions. You have avenues of recourse (complaints, legal action) when dealing with agencies that are liable for problems. There is no real recourse (except firing) when dealing with independent providers or ones found through registries.

Before hiring an independent provider:

• Conduct an in-depth interview with each candidate, preferably in person rather than on the phone;
• Be specific about all of the tasks that the provider will be expected to take on;
• Discuss salary and offer to pay wages either weekly or bi-weekly. Do not pay wages in advance;
• Request both work and personal references, and check them carefully. Ask the references about reliability, trustworthiness, and punctuality as well as the care provider's ability to handle stress.
• If possible, consider a background check. For around $100-$150 you can have this done professionally. Check with your local police department, legal aid service or your attorney for referrals to individuals or companies that do this or search for "background checks" on the Internet.

Be sure to include the potential care recipient in the screening process if he or she is able to participate, to ensure that both parties are comfortable, and that your loved one's needs are respected.

Once you've hired a capable home care provider, should a problem develop, discuss it with the care provider first. If that does not resolve matters, talk to the agency (if you've hired the provider through this route). If the provider is independent and you cannot resolve the problem after repeated discussions, you may need to find a new care provider. If you suspect fraud or other criminal behavior, report it to your state's Department of Health and the Better Business Bureau. Remember to read contracts carefully, check all references, and consult with someone you trust before signing on the dotted line.

Costs of home care

A number of factors affect cost, including location, competition and the general economy. In addition, what you'll pay is based on the skill level of service you need and want. Homemakers, personal care assistants and companions will all cost less (typically $7.50 - $15.00 per hour) than home health aides or skilled nursing care ( typically $16-$25 or more an hour). Live-in care is usually priced by the day or week rather than hourly, and can run as high as $200 per day or more through agencies in some parts of the country.

If you are considering adult day care, know that Medicaid will pay most or all of the costs for a licensed adult day care setting, as well as for Alzheimer's oriented centers, for participants with low income and few assets. Private medical insurance may also cover a portion of adult day care costs when licensed medical professionals are involved in the care. See Helpguide's Adult Day Care Centers: A Guide to Options and Selecting the Best Center for Your Needs for more detailed information.

Helping your parents or loved one with daily money management

With your parent’s help or permission, review his or her checkbook, bank statements and canceled checks. Look for:

• Inappropriate payments, such as payments for medical bills that already have been paid;
• Numerous payments to credit card companies, home shopping networks, sweepstakes or other contests;
• Unusually large donations to charitable or fraternal organizations;
• Failure to list or otherwise track deposits and income;
• Failure to record checks or otherwise track expenditures;
• Lost checkbooks or bank statements;
• Numerous transfers from savings to checking accounts;
• Consistent or unusual payments to a person unknown to you, a possible sign that your parent is being exploited financially.

Then review bills and correspondence, watching for letters from creditors or past-due notices. The review may indicate that a daily money manager is needed.

Money management programs available at no cost

The Center for Healthy Aging offers a Daily Money Management program that has become a model for similar programs around the country. Trained and closely supervised volunteers provide in home assistance with:

• Budgeting and bill paying
• Medical insurance claims
• Financial and legal planning
• Income tax preparation
• Handling government benefits

The program is designed to help maintain the highest possible level of independence for persons who are having difficulty managing their daily financial activities.

A program similar to the Center for Healthy Aging program may be offered in other communities by a senior services or other non-profit agency. Some agencies provide the service free, based on financial need, others on a sliding scale or flat fee. Be sure the organization has a good reputation. Ask friends, neighbors, religious or spiritual group members, chamber of commerce, better business bureau and the local area agency on aging what they know about the organization and whether they know of any problems. Before signing up with the program, ask the head of the money management program the following questions:

• What can I expect the volunteers to do for me?
• Who will actually work with me?
• How are these individuals screened, trained, and supervised?
• Is there a financial professional overseeing the program?
• Are the volunteers insured?
• What is the cost of the service?
• Who do I contact if there are any problems?

The senior must feel comfortable and safe with this service. If a non-profit program is not available, consider a reputable bookkeeper or accountant for these tasks.

References and resources for home care services

General resources for home care services

Independent Living: Resources That Can Help Seniors Stay In Their Own Home – Provides a variety of links with resources that can help seniors stay independent in their own homes, including Lifeline Medical Alert systems information and Senior Corps Senior Companions program. (Aging Solutions)

American Association for Home Care – Discusses important questions to ask when choosing a home health agency and presents vital Medicare benefit information. (American Association for Home Care)

Home Care Agency Locator – An extensive home care/hospice agency locator database that you can search by service, payment type, and location. (National Association for Home Care)

Household Employers Tax Instructions (PDF) – What you need to know about employment taxes when you hire household help. (Internal Revenue Service)

Find Homecare Providers – A nationwide non-profit searchable database for all types of private home care services. (National Private Duty Association)

Senior Home Care & Home Healthcare Providers/Agencies – Provides a definition of senior home care, home care agencies and home healthcare agencies with searchable database by state for both home care providers and assisted living facilities. (Senior Magazine)

Additional online resources for home care services

Hiring Home Care On Your Own - Evaluation – Describes how to hire home care providers. (National Organization for Empowering Caregivers)

Caregivers – A detailed explanation of the wide variety of assistance caregivers are available to provide seniors to help them remain at home, from companionship to chores, transportation to moving, and more. (WithALittleHelp.org)

References and resources for daily money management

DMM's and You – Gives information about daily money management and offers tips on locating and choosing a daily money manager. (The American Association of Daily Money Managers)

Amara Rose and Monika White, Ph.D. contributed to this article. Last modified on: 3/14/07.