How Does In-Home Care for Aging Adults Work?

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

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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:

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
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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 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.

Pros

  • 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.

Cons

  • 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.

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.

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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