What you need to know about home care services
Most older Americans want to live at home as long as possible, but finding and paying for the help they need is often not easy. There is a serious shortage of home care workers in many parts of the country. Hiring them is expensive. And most middle-class people will have to pay for home care themselves if they need it in the long term. Here is a guide to finding home care for an older person.
What home care do you need?
After a fall or surgery, some elderly people need short-term care at home from a nurse or therapist to help them recover. Medicare, the federal insurance program for people over 65, typically pays for this type of home care. For example, a nurse can ensure that a wound heals properly, while a physiotherapist can help someone get back on their feet after a knee replacement.
But millions of older Americans need help for months or years to continue living safely at home rather than moving to an assisted living facility or nursing home. They may need help getting out of bed, showering or going to the toilet; going to the doctor; shopping or preparing meals. They need a home health aide or a personal care assistant, who may not have much, if any, medical training.
How do I find help?
There is a wide range of services available, whether it is light housework or hiring a private nurse. Monica Moreno, senior director of care and support at the Alzheimer’s Association, suggests you start by making a simple list of the type of help you or your loved one needs and the number of hours you need to get it each day or week.
To identify agencies and services available in your area, Ms. Moreno recommends using a database of community resources offered jointly by the association and AARP, the nonprofit organization representing older Americans, and which can be searched by location. An overview of the agencies and a brief description of what they provide can be found under the home care category. AARP also has one guide to find a home care assistant.
Should I hire an agency?
While Medicare certifies and gives star ratings home care organizationsthe companies that provide home care services are not subject to federal supervision and are not required to be licensed in any state. But a good agency will do background checks on its employees and provide them with training and support. If an assistant calls in sick or resigns, the agency can provide a replacement. Some companies also connect and insure their healthcare providers.
To choose an agency, Jennifer Battista, the chief operating officer of the Home Care Association of America, suggests inviting several of them to your home to conduct an assessment. Ask them how they vet their employees, whether they conduct background checks, and whether their employees need to know how to perform CPR or administer first aid. Be sure to ask for references for individual assistants and talk to families who have hired them before.
Once you’ve chosen an agency, you may want to try a few healthcare providers before finding the right one. The more information you share about your loved one’s needs, the better the agency can find an assistant who is a good fit for you. “It’s a lot like matchmaking,” Ms. Battista said.
What about finding someone through word of mouth?
Many families manage to find a caregiver by asking people they trust for recommendations, says Nicole Jorwic, an attorney who is director of advocacy and campaigns for Caring Across Generations, an advocacy group. “Speak widely, post on private social media and ask family and friends,” she said, noting that she found caregivers for her grandparents by asking people in her community.
Churches and other religious institutions, local charities and community organizations may also have suggestions. A GP or local medical practice may have experience with specific home care settings or know individual healthcare providers. If you decide to hire someone privately, you should do a thorough background check and talk to families who have previously employed that person. Family Caregiver Alliance, a California-based nonprofit, offers a guide.
Will Medicare Cover the Cost of an Assistant?
Many home health agencies falsely say they cannot send home health care and will tell a doctor’s office or patient that Medicare will not pay for it. “This is a long-standing problem,” said Judith A. Stein, executive director of the Center for Medicare Advocacy, a nonprofit legal organization.
While it’s true that Medicare doesn’t pay for long-term care, it can pay for an aide as part of a patient’s care plan, if that person also qualifies for a home nurse or therapist for a while. Agencies often refuse to provide someone because Medicare pays a flat rate per patient, meaning the agency no longer gets paid for sending an assistant in addition to the nurse or therapist. Discuss with the doctor whether an assistant is needed so that it can be specified in the care plan submitted to the agency.
Medicare patients now receive fewer visits from an aide than they did about 25 years ago, and the center is now appealing a judge’s dismissal. court case alleging that Medicare, under the direction of the U.S. Department of Health and Human Services, has discouraged device use for thousands of people. The judge did that acknowledge that many people did not receive care.
Do other insurance companies pay for an assistant?
Under Medicaid, the state-federal program for the poor that provides long-term care, the cost of an aide is often covered as an alternative to a nursing home. But the shortage of workers can make it difficult to find one, even if you qualify. Families complain of frequent no-shows, and the low wages paid under the program mean agencies often have high employee turnover.
Some private Medicare Advantage plans offer home health care as an additional benefit, and some assistance may be covered by long-term care insurance. If you or your loved one is a veteran, it’s worth checking with Veterans Affairs to see if home care will be covered.
How much does an assistant cost?
If you decide to pay privately, hourly rates charged by agencies vary widely, and some agencies may not be able to fill a position for just a few hours per week. In San Jose, California, half of the agencies charged more than $37 an hour for a home health aide in 2021, according to long-term care insurer Genworth. Across the country, agencies charge about $27 per hour, just over half of which will pay their employees.
There are no good estimates of how much people who work for themselves can charge. You may save some money because there is no middleman to cut corners, but some independent caregivers charge about the same as a staffing agency.
How do I report a problem?
If the agency you use is licensed by your state, you can contact the state agency that oversees it if you encounter a problem. You can also file a complaint with various government agencies, including the state health department.
Where else can I get help?
State or local government agencies that target aging groups or nonprofits can provide information. You can also use the elderly care seeker. The Alzheimer’s Association has some too advice for finding caregivers, and it offers a 24-hour helpline, 1-800-272-3900.
What about respite care?
Caregivers should also consider using respite care to give themselves a break from time to time. Depending on the circumstances, insurance may cover the costs, and there are local authorities and community groups that will also pay for an assistant for a short period of time. Churches and other organizations can also provide respite care.