How to Tell When a Loved One Needs In-Home Care


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

Making the decision to arrange for in-home care can be confusing and stressful. If someone in your family needs in-home care, that means they need professional support and care that you may not be able to provide.

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If you have an aging parent that refuses help, the process can be very challenging. Your family member may feel that they don’t need help and will resist any efforts to arrange for in-home care.

Identifying care needs, understanding how home-care works, and picking a good agency can pave the way for a successful and safe arrangement.

What’s In-Home Care for Aging Adults?

Home care is a term used to describe professional caregiving services for someone who needs support. In-home care can occur at someone’s private home, assisted living, memory care, or any other place where the client lives. There are two basic types of home care, which are as follows:

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Private duty

Private duty or personal care refers to home care provided by certified nursing assistants (CNAs) or unlicensed caregivers. Each state has its own directives with regard to what a caregiver can do for a client. In-home caregivers can provide some of the following tasks: 

  • Help with bathing and dressing
  • Shopping and cooking
  • Light housekeeping
  • Transportation
  • Medication reminders
  • Blood pressure checks
  • Companionship

Home health

Home health refers to medical and therapy services covered under insurance. To qualify for home health, a doctor must write and order the services. There are also other criteria that must be met.

For the most part, home health is for a set amount of time. A home health team consists of:

  • Nursing
  • Physical and Occupational therapists
  • Speech therapy
  • Aide service for help with bathing and dressing

How Do You Know Someone Needs In-Home Care?

It can be hard to know when your loved one needs help, especially if they say they have things under control. Keeping your eyes and ears open for red flags will help you intervene before things get worse.

Here are some things to watch out for:

  • Following an illness or accident. Your family member may have had an accident resulting in a rehab stay or hospitalization. They may need some additional short-term support to return home safely. 
  • A cluttered home. One indication that a loved one may need help is if their home is always untidy or dirty. This may include clutter, accumulations of garbage or recycling, dirty or unfolded laundry, and stacks of dirty dishes. Usually, a cluttered and unkempt home can indicate a problem with home maintenance as well. The grass may be overgrown or snow is not shoveled. Lights or fire detectors are not replaced. Other safety issues are not addressed in a  timely fashion.
  • Poor personal hygiene. Declining hygiene can happen over time. Notice your family member’s appearance and pay particular attention to body odor. Soiled clothing and piles of laundry are red flags. There could be memory or physical issues that make it challenging to stay clean.
  • Problems driving. Driving can be a touchy and difficult subject. Look for signs like traffic tickets, fender-benders, and dents on the vehicle. If possible, take a drive with your family member to observe first hand what their driving is like. Many people drive far beyond the point of what is considered safe because they don’t think they have a driving problem.
  • An extreme change in weight.  A difference of 10 percent or more in body weight could be a warning that your family member is not eating enough. Possible reasons include difficulty with meal preparation or depression. Try to observe a meal so you can assess your family member’s ability to cook. Take a look in the fridge for spoiling food.
  • Confusion or memory problems.  Consider taking your family member in for a complete physical to rule out any medical problem or misuse of medications. Look for signs like getting lost, forgetting routine tasks, wandering, and mismanaging finances.
  • Difficulty managing medications or following doctor’s orders. Mismanaging or neglecting to take prescribed medications can have significant medical consequences. Take a look at your loved one’s medications to see if they are organized in a weekly pillbox. Look for any expired medications. Often, a physician’s office will print out an aftercare summary with specific instructions on home treatment. If these directives are not followed, there may be a deeper problem.
  • Loneliness. Social isolation is a significant problem among older adults. Loneliness can have a profound impact on someone’s emotional and physical well-being. It may also be a consequence of the inability to get out of the house or having no one to talk to.
  • Problems with mobility. Poor mobility can lead to other problems, often resulting in falls. Mobility is not only confined to difficulty walking. It can mean challenges with dressing in the morning, bathing, or transferring from the bed or on and off the toilet.
  • Falls. Frequent falls are a definite sign that something is wrong. Falls are the leading cause of disability for people over the age of 65. Falling can be due to a number of factors. Some of these include weakness, cognitive problems, an undiagnosed medical problem,  or medication mismanagement. 

How Do You Pay for In-Home Care?

Home care can get expensive if your loved one requires many hours during the day or round-the-clock care. There are ways to pay for in-home care, but you may want to check with a financial advisor to ensure that your choice will not adversely affect other care options in the future.

Consider taking a close look at your or your loved one’s medical condition and the likelihood that they will need increasing care.  Let’s explore some possibilities for paying for in-home care.

Long-term care insurance

If you have a long-term care insurance plan, review the policy to see if it includes in-home care. Many policies include a daily rate for private caregivers that can help offset the cost. However, you may want to read the fine print because some plans require a 90-day elimination period. In that case, you will have to pay out of pocket until you meet that requirement. If you don’t have a long-term care policy, then consider the other options below. 


Now might be the time to tap into savings to pay for in-home care. Talk with your financial advisor about this option since most people have savings for an emergency, and there could be other more viable choices.

Tap into the equity of your home

Proceed with caution if you choose this option. If you eventually need assisted living, you might need your home’s equity to pay for it. Discuss ideas with your financial advisor, such as a second mortgage or a home equity line of credit.

Retirement funds

Using retirement funds to pay for in-home care could be a reasonable option. It all depends on what your long-range financial plan is for care. Families often underestimate the cost of long-term care, so you will want to consider expenses associated with increasing needs.

How Does In-Home Care Work?

Many people use a combination of private duty and home health. If your family qualifies for home health, talk with your loved one’s doctor about getting an order to begin those services. When someone is in the hospital or rehab, the managing physician will often write the order before someone returns home. It is important to note that home health is time-limited. 

For private duty, the first step is to select the company you want to hire. They will ask you to sign a contract. After that, you will make a decision about how often you want caregivers to come to the home.

You will probably want to arrange for a caregiver introduction if possible before making a final decision on the person that will be helping your loved one. Costs vary across the country but you can expect to pay between $30 to 40 an hour depending on the number of hours you want. If you have long term care insurance, you might be able to defray some of those costs.

Pros and Cons of In-Home Care

As with any care, there are pros and cons of in-home care. For many families, it can be a challenge to decide between in-home care and senior living options like assisted living.

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  • Aging in place. In-home care allows someone to stay in their home, something most people say they prefer. 
  • Flexibility. In-home private duty care companies offer a great deal of flexibility. You can choose as little or as much care as your family member needs. 
  • Individualized care. If your loved one needs one on one attention and companionship, in-home care is perfect. Senior living communities don’t have the staffing to accommodate that need.


  • Cost. If your family member needs lots of care, costs can soar. At some point, the cost of in-home care may exceed the cost of assisted living.
  • Managing caregivers. You may be thinking, “that is the agency’s job.” That is true, but you may still want to make sure that caregivers are not only doing the job well but that they are a good fit for your family member. 
  • Caregiver turnover. Just when you find the perfect person, they leave. Caregiver turnover is a big problem in the home care industry. You can expect that you will have to change caregivers more than once. 

9 Tips for Selecting an In-Home Care Service

Some communities have hundreds of in-home and home health companies to choose from. Others will have a very limited pool of options. It can be very confusing and time-consuming to find a company you trust to take care of your loved one.

1. Ask for recommendations and references

You may want to ask friends, and/or healthcare providers for recommendations. After having done that, call the company and request references you can call.

2. Assess your in-home care needs

Making a list of exactly what your loved one needs help with will guide your decision about how to choose a company. Depending on the state where you live, a home care company may not be able to perform all the tasks required. Some home care companies have a nurse on staff for an additional fee. 

3. Determine a budget

If finances are tight, you may want to think about how to maximize caregiver hours before making those arrangements. Consider augmenting, at least temporarily, with home health or family caregiving. If you arrange for in-home health that exceeds your budget, it might be more difficult to pull back those hours later.

4. Is the agency licensed, bonded, and insured?

Choosing an agency that is licensed, bonded, and insured will protect you against lawsuits. Ask about the monetary limits of their liability insurance.

5. Caregiver background checks

We recommend choosing an agency that does criminal background checks on all caregivers. Ask about the method they use for doing those checks. Some agencies also provide drug screenings.

6. Inquire about caregiver replacement

If a caregiver is a no-show or quits, or you want to make a change, how will the agency handle this? How long will it take to find a replacement?

7. Caregiver introductions

Ask about caregiver selection. Is it possible to arrange for a “meet and greet” before making a final decision? This can be done before the caregiver meets your family member, or you may prefer a meeting before the introduction.

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8. Caregiver training

Caregivers have to deal with a wide variety of medical and cognitive problems. You may want to ask to see a schedule of yearly training and ask if training is mandatory. Are there caregivers that specialize in certain conditions such as dementia?

9. Supervision process

A good agency will have a consistent supervision process. This means one of their senior staff schedules supervisory visits with the client to see how things are going.

What Are Other Alternatives to In-Home Care?

There are the above listed pros and cons of in-home care, including cost, the complexity of managing several caregivers, and increasing medical needs. At some point, any of these factors could precipitate consideration of other alternatives. With any number of factors, there are no right answers as to which option is best. Cost, personal preference, and safety are guiding principles in making a decision.

Family caregiving

Family caregivers provide more care to loved ones than any other source. That said, family caregiving comes with a cost to those providing the care. The loss of employment, caregiver burnout, and family conflict are all possible consequences of this alternative. However, it is possible for family members to provide safe care to a loved one with careful planning.

Independent senior living with family caregiving

Many independent senior living communities have some of the same amenities as assisted living but for less cost. Standard features are housekeeping, meals, transportation, activities, and in-home doctor’s visits. The missing pieces in independent senior living are the medication management and aide service. So depending on your loved one’s needs, it is possible to get many day-to-day tasks covered by independent senior living and augment with family or private caregiving. 

Assisted living

Assisted living is a commonly used and reasonable alternative to home care. Many of the duties that in-home care provides are part of the menu of services in assisted living. For example, assisted living offers meals, housekeeping, transportation, in-home medical visits, activities, and medication management.

If your loved one still requires assistance with bathing, transfers, or getting dressed daily, you can supplement what assisted living provides with private pay in-home caregivers. 

Adult day care

Adult day care can be an excellent alternative to in-home care at less cost, depending on how much in-home care you need. Some adult day care settings provide personal care, meals, activities, and medical services on-site, typically for a flat daily rate. The challenge could be availability of adult day care centers in your area if you live in a smaller community.

Respite care

Respite care is available in two main ways. The first is through government or state-sponsored programs where you have to qualify for Medicaid or be a veteran. The other respite care is through assisted living. Although most assisted living communities have tight time limits on a respite room, a couple of weeks of care can give you a break and give your loved one an idea of what assisted living is like. If you are already paying several hundred dollars a day for in-home care, occasional respite could be a viable alternative.

In-Home Care For an Aging Adult

If you take the time to arrange for good, reliable in-home care, you will have taken an important set towards providing safe support for your loved one. A patient and flexible approach will help you navigate the inevitable challenges along the way.

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