What’s Domiciliary Care? Definition, Pros & Cons

Updated

Certified Care Manager, Aging Life Care Professional, and National Master Guardian Emeritus

You may or may not have heard the term “domiciliary care,” but the term will make perfect sense once you understand the definition.  When it comes to taking care of a loved one, the array of services can be confusing and overwhelming. Insurance can pay for some assistance under specific circumstances, but some other services require families to pay privately.

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The other critical part of receiving care is where it occurs. Survey after survey shows that most older adults prefer to age in place, which means their home. For many people, home is where they have lived in some cases for decades, and that is where they prefer to stay.

Unless someone has the good fortune to age independently, many seniors will require assistance to remain at home. Domiciliary care is a particular type of assistance that provides the foundation for aging in place. 

Definition and Purpose of Domiciliary Care

The word domiciliary comes from the root “domicile,” which means home. Home doesn’t always mean your original place of residence as in a single-family home. For some, a home might mean independent senior living or board and care. But, for our purposes, the purpose of domiciliary care can be defined as keeping someone in their preferred community—which is usually their house.

Another more familiar term is “in-home” or “personal care,” which is generally non-medical but necessary to sustain independence. Some of the typical tasks of domiciliary care are:

Household assistance

  • Help with cleaning and laundry
  • Assessing and arranging for home maintenance and repair
  • Lawn care
  • Organizing and decluttering the home to make it safer

Food preparation

  • Planning nutritious or special medical meals 
  • Shopping for groceries
  • Preparing meals

Personal care

  • Help with bathing
  • Selecting clothing and assistance with dressing
  • Hygiene

Mobility

  • Reinforcement of physical therapy exercises
  • Assistance with transferring from bed or chair to standing or a wheelchair
  • Support while going up or up or down a flight of stairs

Companionship

  • Provide socialization and comfort
  • Facilitate engagement in preferred hobbies
  • Help someone get to valued activities like church or other social groups

Transportation

  • Transport someone to doctors appointments 
  • Provide rides to social meetings or groups

Medications 

  • If permitted by the state, assist the person with taking medications as prescribed
  • Note any discrepancies with medications and report to family or healthcare providers

The purpose of domiciliary care is to support your loved one in ways that are safe and meaningful for them. Hopefully, domiciliary care can motivate your loved one to recover and recuperate to the point where they regain enough function to be independent again. But, in cases where that isn’t possible, domiciliary care can also help prevent hospitalization or institutional care. 

The benefits are dependent upon the caregivers themselves, the cost involved, and the management of different professionals coming into the home. 

Are There Different Types of Domiciliary Care?

Domiciliary care is usually considered personal care, but if the definition is broadened, there are other types of in-home care. The primary distinction is that domiciliary care is non-skilled care.  The main types of in-home care are:

Home health

Home health is a time-limited medical/skilled service ordered by your doctor. Most insurance covers home health if you meet the qualifying criteria. Services under home health are nursing, physical, occupational, and speech therapy and aides.

Under insurance rules, aides cannot offer the types of assistance that domiciliary care can provide. Aides under home health can only assist with bathing, dressing, mobility, and minimal medical tasks in some states.

Personal care or private duty care

Personal care or private duty care are other names for domiciliary care. Every state has specific licensing or certification requirements for domiciliary care workers. 

Hospice care

Hospice care is end-of-life care from skilled professionals who help manage pain and improve comfort. Aides are often a part of the hospice team, but they are not allowed to perform duties like housekeeping, transportation, or cooking under insurance rules. Families may decide to engage domiciliary care in addition to hospice to fill in the gaps of care.

What’s Domiciliary Care for Veterans?

Domiciliary care for veterans is a specific category of care that differs from that of the general population. Domiciliary care through Veterans Affairs focuses on homeless and disadvantaged Veterans who need assistance to remain independent. The Domiciliary Care program for Veterans is a clinical rehabilitation and treatment program for male and female Veterans. Domiciliary programs are now part of the Mental Health Residential Rehabilitation and Treatment Programs (MH RRTPs).

The Domiciliary Care program is a long-term rehabilitation program that provides veterans a chance to live in the community while learning skills to remain out of institutional care.  Veterans participate in rehabilitation services such as addiction counseling, spiritual, behavioral, physical, psychosocial, dietary, vocational, and occupational therapy.

The other VA program that more closely resembles community domiciliary care is the VA Aid and Attendance Program. Veterans and their spouses who qualify receive a monetary amount for help with bathing, dressing, hygiene, toileting, eating, medication management, and transferring.

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Who’s Domiciliary Care Typically For?

Domiciliary care is for individuals who need non-medical assistance to stay safe in their homes. Families may prefer to provide hands-on care to a loved one themselves or use a combination of domiciliary care and family caregiving. How and when to start domiciliary care is an individual decision, and your loved one may resist the idea of a stranger coming to their home to help.

Others will want help sooner rather than later and may be open to starting domiciliary care when they struggle with their activities of daily living (ADLs). As a concerned family member, these are some things to look for.

  • Resistance to senior living like assisted living or memory care
  • Problems with getting up and getting dressed in the morning
  • Not being safe in the shower without someone to stand by or provide hands-on assistance with bathing
  • No longer driving, which limits accessibility to doctors visits and other critical services
  • Cognitive impairment that impairs judgment and safety
  • Loneliness and social isolation contribute to mental health problems like depression and anxiety
  • Inability to shop or cook meals
  • Problems with managing medications and taking them correctly 

How Much Does Domiciliary Care Cost?

The cost of domiciliary care depends on a few factors. Your living situation, location, and preferences can all play a big role.

Where you live

Every part of the country and, in some cases, counties within the same state will have variable pricing. If you reside in a rural area, your costs might be influenced by the limited availability of caregivers.

Agency vs. private hire

When you hire someone privately, you can negotiate pay. But consider other costs such as payroll, liability insurance, and background checks. An agency will also have pricing that varies according to your area, but nationally, the hourly median cost for homemaker services is $23.50 an hour.

Number of hours

Generally speaking, the higher the number of hours of care, the higher the cost. Most agencies will discount the hourly rate if you contract for several hours in a row. Also, overnight rates can be slightly lower. 

Pros and Cons of Domiciliary Care

No in-home care option is perfect and domiciliary care is no different. As a family, you will want to weigh the pros and cons, and in time, you may change directions based on your loved one’s needs. That is normal and expected. However, understanding the pros and cons of domiciliary care will help you make the best choice now, accepting that conditions could change later. 

Pros of domiciliary care

  • It is flexible. You can increase or decrease hours as needs change.
  • Care is provided in the home. Home is where most people feel most comfortable, and your loved one probably feels the same way. Community and familiarity are valuable aspects of remaining at home.
  • Domiciliary care relieves family caregiving. Caregiving is stressful and can have consequences such as decreased employment and caregiver burnout.
  • Depending on the cost, domiciliary care could be much less expensive than other senior living care such as assisted or memory care.
  • A good caregiver can help your loved one stay socially engaged, motivated, and happier.

Cons of domiciliary care

  • If hours of care increase over time, the cost could become prohibitive. This is especially true of 24 hours or round-the-clock care. 
  • Unless you have a long-term care policy or Medicaid, you will pay privately. 
  • You could have multiple caregivers coming in each week and may not be able to have your preferred caregiver.
  • Domiciliary care is non-medical. If your loved one needs medical care in the home, you will have to arrange for that through a home health agency or privately.
  • Turnover plagues the industry, so finding the right fit could be challenging.
  • You might live in a community with few agency or caregiver choices, which could mean the possibility of substandard care.

How to Find Domiciliary Care Near You

Finding domiciliary care in a large city could be overwhelming. It is not unusual for some places to have over a hundred agency choices. And then there are online companies that pair caregivers with families.

To sort through all of the options, you can try to find domiciliary care with these methods:

  • Look at online reviews of agencies to determine their reliability and staffing.
  • Check with your loved one’s healthcare providers who might have patients with experience (good and bad) with specific companies.
  • Talk to friends and neighbors about any caregivers or companies they recommend.
  • Contract for a consultation with a geriatric care manager. These professionals can do an in-home assessment, determine the care needed, and make recommendations of companies or caregivers. 

Domiciliary Care for You and Your Loved One

The demand for domiciliary care is growing as our population of older adults increases. Finding the best fit for your loved one is a process of trial and error. With flexibility you can find compassionate and stable support for you and your loved one.

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