Home Care

Home care is a lifeline for many aging seniors and helps them age with dignity. About 70 percent of seniors end up needing some form of care as they age, and many would prefer to stay in their homes. Home care allows seniors to stay home as they age and experience mobility and functioning issues by having a professional help them through their daily lives.

1. What is home care?

As seniors age, they experience more difficulty performing the usual routines that keep them healthy and independent. Home care intervenes to enable seniors to remain in their own home by providing a professional caregiver to aid in doing non-medical tasks for them and around their home. Depending on the lack of mobility, home care providers can engage in intensive activities of daily living, such as bathing and toileting, to less intensive instrumental activities of daily living, such as laundry and meal prep. Home care services make home a realistic and safe option for aging seniors.

Home care goes by many different names. These are some of the words that companies use to denote home care.

• In-home care
• In-home help
• In-home assistance
• Homemaker services
• Home-based care
• Personal care
• Private duty home care
• Unskilled care
• Supportive home care
• Home care aide services: Some companies may refer to aide services as medical. If so, they will stipulate their services to avoid conflation, typically be denoting the service through a home health aide.
• Non-medical home care: This term differentiates itself from home health care, which does provide medical services.
• Sitters
• Caregiving
• Companion care
• Senior care
• Assistive care

FAQ: What are activities of daily living (ADLs)?

Activities of daily living are the basic tasks and routines that maintain a person’s function and hygiene. Seniors need to be able to perform these tasks to remain independent. These activities include:

• Brushing teeth;
• Toileting;
• Bathing;
• Getting dressed; and,
• Other basic living tasks.

FAQ: What are instrumental activities of daily living (IADLs)?

Instrumental activities of daily living require organizational, problem solving, and other skills to perform tasks. These tasks contribute to a senior’s engagement with the world. Some examples include:

• Doing the laundry;
• Cooking;
• Driving or navigating public transportation;
• Running errands; and,
• Balancing a checkbook.

FAQ: What is the difference between IADLs and ADLs?

Instrumental activities of daily living (IADLs) are higher-order tasks and skills than activities of daily living (ADLs). ADLs are the basic functions that people perform to stay alive. Those unable to perform ADLs need intensive care to assist with these functions and require institutionalization. On the other hand, people have varying degrees of ability in IADLs. Assistance with these tasks can help maintain people’s independence and avoid institutionalization.

1.1 Home Care vs Home Health Care

Home care provides non-skilled assistance with basic and more advanced tasks that seniors need to do at home or to remain at home. These include activities of daily living and instrumental activities of daily living. Those offering care typically do not have medical training or licensing. They focus on enabling seniors to live as independently as possible.

Home health care involves the short-term or long-term provision of skilled in-home medical care. Services could be just during rehabilitation after an injury, during hospice, or as someone to provide medical at-home care for those with disorders that require more care. These are some of the other names that people and companies use for home health care.

• Private duty nursing
• Private duty home health care
• Home-based nursing care
• Adult nursing care
• Senior nursing care
• Medicare approved home health care
• Visiting nursing care
• Intermittent nursing care
• Home health care aide
• At-home occupational therapy
• In-home rehabilitation care

2. Why is home care important?

Seniors and their families can get a lot out of choosing in-home care. Here are just some of the benefits of selecting home care assistance.

1. Age in place: Moving into a nursing home or other institutional setting can be stressful and daunting for older adults and their families. Residents in long-term care facilities can have trouble transitioning and experience depression. By aging in place in their home, seniors maintain their dignity in older age and a feeling of independence.
2. Relieve strain on the family: Caregiving of a parent or other senior family takes a lot of time and can have negative psychological impacts on the family member giving care. Hiring a professional can relieve this burden and allow family members to manage their professional and immediate family roles.
3. Safety from scams: Seniors are a common target of scams, including wire transfer fraud, email scams, Medicare scams, and more. Caregivers can help their clients avoid these scams by discussing risks and monitoring activity.
4. Fall prevention: More than 36 million seniors experience falls each year, with approximately 32,000 of those resulting in deaths. Home care providers can reduce the likelihood of a fall by examining the home for potential fall zones and creating a plan to make the home safer.
5. Companionship: The lack of social connection common in older adults can facilitate major health impacts, such as depression, heart problems, strokes, and more. In-home caregivers can act as a companion and engage in activities and hobbies they enjoy, hold discussions, and read with them. This gives the senior someone to develop a consistent and personal bond.
6. Personal attention: A persistent staff shortage at long-term care facilities, along with a large demand for services, makes personal attention at a facility difficult. This level of attention is also crucial for spotting early signs of disease progression. An in-home care provider can monitor and report any changes they notice.
7. Access to family: Remaining at home is a great way for family members and friends to have access to loved ones as they age. Facilities often have visiting hours or other restrictions that make visiting difficult. In-home care providers enable seniors to stay at home close to their families.
8. Cost-effective care: Home care tends to be more affordable than nursing homes or other residential care facilities. Families can also select particular hours or services to keep costs down.

3.What is quality in home care?

Home care can vary in quality based on the background, training, and character of the caregiver. It is vital to have all of the information about a caregiver and their credentials before employment. These are some of the determinants for the quality of home care that someone provides.

• Background check
• Reference check
• Pre-employment health tests
• Training in specialties matching client needs
• Supervision of caregivers by company or agency
• Absence policy and the continuity of care plan
• Reporting to the client’s family and notetaking
• Liability insurance compliance
• Tax documents
• State and federal legal requirements

4. Hiring a Caregiver for In-Home Care

Hiring a caregiver for in-home care is a complex process. These are the options, pros, and cons to getting started.

4.1. Home Care Agencies

Home care agencies directly hire caregivers that they then assign to clients. They handle most of the employment process for their clients. These are some of the pros and cons of home care agencies.

Pros:

1. Conduct background checks: Prior to employing caregivers, home care agencies perform background checks to ensure the safety of their clients.
2. Insurance coverage: Caregivers have liability insurance through the home care agency to protect clients against negligence or other issues.
3. Automatic substitute: Since home care agencies have a roster of caregivers ready to work, they can fill-in for someone at the last minute if a caregiver becomes ill or needs to be absent for the day.
4. Pay handled by agency: As a direct employee, the home care agency handles the paycheck and taxes of their caregivers.
5. Supervision: Home care agencies have managers and supervisors with expertise in place to monitor client satisfaction and the quality of the caregiver. Many also provide training.

Cons:

1. Higher expense: Since home care agencies conduct much of the onboarding process themselves, they can have higher overhead costs than other options. This increases the overall costs.
2. Limited range of caregivers: Home care agencies only have the number of caregivers that they directly employ. Clients may also have restrictions in the number available by location.
3. Specific care services: Each agency typically has a range of services that in which their caregivers provide expertise. Thus, they do not allow for flexibility in the types of services they offer.

4.2 Registry or Staffing Agency

A home care registry or staffing agency acts as a liaison between potential caregivers and clients. They do not directly hire caregivers. These are some of the pros and cons of registries or staffing agencies.

Pros:

1. Ease of creating an applicant pool: Registry work with clients to locate potential caregivers. By giving them a list of people to choose from, they do not have to place job ads or source applicants.
2. Employment screenings: While not all registries may conduct employment screenings upfront, many do conduct background checks and reference checks before setting them up with the registry.
3. Matching expertise: Registries can match the training of the caregiver with the needs of the client. This means that registries can pull a list of potential caregivers that meet particular criteria, training, hours available, and more.
4. Assistance in rural areas: If a registry has a large base, then it could be especially helpful for seniors in rural areas who might lack access to a large number of caregivers to interview if they try to hire a caregiver directly.

Cons:

1. Variance in employment screening: It may be difficult to find out the exact employment screening procedures of a registry. Clients need to check beforehand.
2. Lack of oversight: Since a registry acts as a facilitator, it does not provide supervision or quality control check-ins.
3. No training courses: Unlike agencies, registries do not provide caregivers with the option to participate in onboarding training or training to further their knowledge with specialty certificates.
4. Lack of legal responsibility: Since registries do not directly hire caregivers, they do not provide bonding or insurance of the caregivers, which could leave clients at risk.

4.3. Independent Caregivers

Independent caregivers work on their own, typically as independent contractors. They do not have an affiliation with a registry or agency. These are some of the pros and cons of independent caregivers.

Pros:

1. Cost: Since independent caregivers work for themselves, clients do not have to pay overhead to an agency, which reduces the amount that they need to pay per hour.
2. Quick hire: With independent caregivers, hiring occurs directly between a client and the employee. This means that clients can determine the length and rigor of the onboarding and screening process. While this might be necessary for an emergency, clients should exercise such an approach.
3. Increased range of services: Independent caregivers do not have a strict menu of services that they can provide, depending on their company. Instead, clients and families can negotiate for specific tasks to meet the needs of the client.

Cons:

1. Complicated tax and payment process: Clients and their families have to figure out how to legally pay their caregiver and properly document payment for tax purposes. Some states also require health insurance benefits for people who work a certain number of hours.
2. Burden in hiring process: Clients and their families have to perform any background or medical checks on their own.
3. Lack of insurance: Independent caregivers often do not have liability insurance.
4. Lack of training: Some independent caregivers may not have any training in elder care in general or for specific disorders.
5. Absence issues: If an independent caregiver has to miss a day of work for illness or personal reasons, then no other person can take their place. This can leave families scrambling to find last-minute care or to rearrange schedules.

5. What are Home Care services?

Home care services can offer a wide variety of supports. Home care plans are put into place at the beginning of care delivery to determine the unique mix of services that each client needs. These are some of the services people can request, although availability depends on the specific provider.

1. 24-Hour Home Care: Some clients need around the clock care. Home care can provide a rota of caregivers to provide this care, including through the night.
2. Adult Home Care: Clients who are adults living with disabilities and need care or families in need of respite care can avail of home care services to assist with a range of needs.
3. After Surgery Home Care: Many people, especially older adults, need help at-home after surgery. Home care services can aid patients by making sure they follow post-operation orders and assist with mobility issues during recovery.
4. Alzheimer’s Care & Dementia Care: Home care services can assist those with a variety of dementia disorders or Alzheimer’s. Caregivers can provide memory care services and personal care services depending on the progress of the disorder.
5. Arthritis Care: Arthritis cares services often involve assistance in manipulating objects, mobility care, and transportation.
6. Diabetes Care: At-home caregivers assist diabetes patients by reminding them to take their medications and check their blood sugar, preparing diabetes-friendly meals, and engaging in walking with them.
7. Companion Care: Companion care provides different types of social care and interaction with seniors, such as assistance with technology, reading, meal companionship, and light housekeeping.
8. End of Life Care (Hospice Home Care Support): While at-home end of life care does not involve the administration of medication, it does provide emotional support, respite care for family members, and assistance with personal care and daily needs.
9. Live-in Care: A live-in caregiver can provide someone with particular or companionship needs someone to live at the home with them. The caregiver still works a restricted number of hours, but they live in the home with the client.
10. Overnight Home Care: Overnight home care services include assistance getting in and out of bed, getting dressed for bed, check-ins throughout the night, and more.
11. Palliative home care: Palliative home care services do not include the administration of any medicines or treatments, but caregivers can aid in the provision of personal care, help around the home, companion care, and respite care for family members.
12. Parkinson’s Care: Caregivers with training for clients with Parkinson’s can provide supervision, fall prevention services, transportation, meal prep, and more.
13. Senior Home Care: Senior home care or elderly home care provides support for seniors to remain at home. These services range from intensive, basic functions, such as bathing, to light housekeeping and companionship.
14. Respite Care: Respite care is when a caregiver provides relief for another caregiver, typically a family member. This allows the regular caregiver time to relax and reset their batteries from the demands of caregiving.

5.1. Who is Home Care for?

If someone has never used a professional caregiver, it can be difficult to know when home care is needed. Although there are many people who could benefit from at-home care, here are some of the most common types.

• Many seniors end up needing help with activities of daily living and instrumental activities of daily living as they age. Seniors who need this can get assistance and stay in their homes longer with supportive home care.
• Seniors and older adults can suffer from isolation as they age, especially if they live alone. People in this group can benefit from the companionship at-home care provides.
• People with neurological disorders, such as dementia and Alzheimer’s, need a high level of care to ensure they can meet their daily needs and stay safe, which at-home care can provide.
• As people age, they face an increased risk to their health from falls. Those at-risk can use the fall prevention plans and safety initiatives of at-home care.
• Adults who face challenges moving about their home or driving can use at-home services to help them move about their home safer and assist with running errands.
• Many patients need at-home assistance after surgery, such as a hip, knee, or shoulder replacement surgery. Home care can assist with non-medical tasks, such as meal preparation and taking care of the home.
• Those at the end of their lives, such as those with terminal cancer, can benefit from at-home assistance for taking care of daily needs or providing emotional or companion support.
• Some adults require assistance with activities of daily living or instrumental activities of daily living due to disabilities or physical limitations. These adults can benefit from assistance with the issues that are unique to them.
• Seniors who have difficulty remembering to take their medication or have trouble organizing all of their prescriptions can benefit from at-home care through personal reminders and systems to make taking medications easier.
• As seniors age, their weight can fluctuate to unsafe levels. Seniors who gain or lose too much weight may need encouragement to exercise, a walking partner, a healthy meal plan, or assistance with meal preparation through home care services.
• Seniors whose family members live out-of-state can benefit by having a trusted professional providing at-home care and reporting back to the family.
• Older adults who need help using technology to stay in touch with friends and family members can use at-home care for assistance.
• Adults with family members as regular caregivers can avail of respite care services from professional caregivers.
• Long-term care facilities are expensive, and people who cannot afford a facility can benefit from the lower rates and flexibility of hours in at-home care.
• Older adults suffering from depression can utilize the monitoring support of at-home care, along with the social interaction and assistance getting to therapy or medical appointments for treatment.
• Adults with difficulty communicating physical symptoms can rely on caregivers to track and alert family regarding changes in behaviors, pain symptoms, and more.

5.2. What does Home Care include?

Differences do exist between home care providers, but these are the tasks that each commonly includes as home care:

1. Accompaniment for Walks: A caregiver can go on walks as part of home care services. They provide supportive encouragement to get the socially isolated or seniors to go outside for a walk. In addition to moral support, caregivers provide additional safety while engaging in physical exercise by monitoring them for signs that they are exerting themselves too much or looking out for fall hazards.
2. Accompany to Doctor Appointments: Some people, especially seniors, may have difficulty getting to doctor appointments or advocating for themselves when they are there. Caregivers can provide transportation to doctor appointments and remind clients of their appointments. If the client wishes, the caregiver can accompany the client with appointments to make sure that the client and doctor understand one another.
3. Bathing: People with a mobility difficulty or at-risk of falling, especially seniors, need assistance getting in and out of the bath, washing their hair, and washing their bodies. Home care providers can safely ensure that people get in and out of bathtubs and shows. They can even directly bathe those who need it so that clients can safely maintain adequate hygiene.
4. Companionship: Seniors and those who may be homebound can lack adequate social interaction. Companionship services provide social interaction and intellectual stimulation for clients. Caregivers may engage in hobbies, such as gardening or knitting, with them, hold discussions on various topics, play board games, or plan outings, such as a trip to the zoo.
5. Dressing: Adults with dementia or other neurological disorders, arthritis, vision problems, or other disorders may have trouble dressing. Home care providers can assist clients with picking out weather-appropriate outfits, putting clothes on, or helping with faceting difficult buttons or zippers. This can keep older adults in clean, fresh clothing to support their hygiene.
6. Eating: Especially as people age and encounter issues with fine motor skills through joint or neurological disorders, it can be difficult for them to feed themselves. Caregivers can cut up food for clients and directly feed them. This ensures that they receive an adequate amount of food each day and helps them stay at home instead of at a facility.
7. Errands: Seniors and those with certain disorders can have trouble leaving the house or organizing the errands that they need to run. Caregivers can plan out the errands that a client needs, take them on errand runs, or complete their errands for them. This allows an organized and accessible approach so that everything gets done and the home continues to run.
8. Grocery Shopping: Grocery shopping can be difficult for people who have trouble getting around. In addition to mobility issues, grocery shopping can involve repetitive lifting and carrying heavy items. Caregivers can go with their clients to the grocery store or go for them to alleviate these burdens. They can carry their groceries, assist with finding the right items, and put the groceries away at home.
9. Grooming: Seniors can experience problems engaging in basic grooming, such as brushing their hair, brushing their teeth, putting on makeup, and other basic tasks, due to mobility or neurological issues. Home care grooming services allow seniors to maintain good health and hygiene with assistance in these tasks. It can also give them the confidence to greet their day or go outside.
10. Fall prevention: Seniors are prone to falls and the serious complications from falling while at home. Home care providers can isolate potential causes of falls and danger points within the home, monitor mobility while on medications that induce drowsiness and accompany those at-risk around their home. Fall prevention through home care can reduce falls and keep seniors healthier or out of the hospital from accidents.
11. Hydration: Seniors often have problems noting when they are thirsty and should drink water. Caregivers can provide reminders to drink fluids throughout the day. This can ensure they receive an adequate amount of hydration to support proper organ and bodily function.
12. Incontinence Care: Incontinence care involves both assistance in prevention and cleaning up after accidents. This involves assistance getting to the bathroom, assistance with using devices to help seniors stay dry, and mopping floors or washing fabrics to clean up from any accidents.
13. Light Housekeeping: People with disabilities or seniors may find it difficult to perform basic cleaning tasks around the home. Home care providers can make the bed, dust, do the laundry, mop, wash dishes, sweep, take out the trash, and vacuum. This care enables seniors to remain at home in a clean environment.
14. Transportation: Seniors can have trouble driving and may no longer have a driver’s license due to mobility issues or vision issues. Caregivers can transport seniors to medical, dental, physical therapy, or other appointments. This ensures they receive all of the medical care they need outside of their home.
15. Meal Preparation: Seniors and those with disabilities can struggle to prepare meals for themselves. Caregivers can cut vegetables, cook meals, plan out menus, and wash up afterward. By doing so, seniors can remain safe from getting assistance in fine motor skills tasks while ensuring that they eat.
16. Medication reminders: Whether someone has a lot of different medications or has difficulty with memory, it can be easy to forget to take medications. Caregivers can remind patients to take their medication. They can keep a schedule of when the client needs to take each medication. This way, they do not forget.
17. Oral Hygiene: Brushing teeth can require fine motor skills that are difficult to use with arthritis or other disorders. Home care can assist clients in maintaining oral hygiene by helping them brush their teeth, floss, or use mouthwash. They can even assist with the purchasing of those items or remind them when they run low.
18. Organizing Incoming Mail: Seniors can have a difficult time keeping up with their mail, especially if they have dementia or other memory issues. While caregivers do not open someone else’s mail without explicit permission, they can examine the envelopes or open them if appropriate. Then, they can alert the family to legal, financial, or health-related mail so that legal matters do not slip through the cracks.
19. Pet Care and Feeding: Having a pet can benefit seniors and the socially isolated but taking care of a pet requires many skills. Home care providers make sure that pets receive an adequate amount of food and water and have their needs met. They can also clean up kitty litter, or any smells around the home. Some can wash the animals to keep both the owner and the pet healthy and clean.
20. Picking up prescriptions: Picking up prescriptions requires both organizational skills and the physical ability to pick them up. Home care providers can either go with clients to pick up prescriptions or pick up their prescriptions alone. Prescription pick-up care means that older adults do not have to worry about running out of a prescription or accessing their medication.
21. Post Office Visits: Seniors can have difficulty getting to the post office or conducting business while there due to mobility, neurological, or motivation issues. Home care providers can drop off packages and letters, buy stamps, or pick up mail at the post office. This helps keep seniors in contact with the world and up to date with correspondence.
22. Recreational Activities: For those who need assistance or a companion to engage in recreational activities, a home care provider can help. They can facilitate engagement and participate with them. A home care provider could take a client swimming, lounge at a nearby beach, or engage in other activities with them to keep them active.
23. Respite/Relief for Families: Families who provide care to aging parents or relatives with disability often have trouble balancing their own needs with the needs of their family members. Home care provides respite services that allow family members to take a break from caretaking duties. This even helps the client as their family member can return refreshed and emotionally restored.
24. Safety: Many dangers from scams to accidents make seniors vulnerable. Home care providers can create a safer environment for their clients by assisting with riskier activities, looking out for safety hazards, and keeping abreast of any scams a senior may encounter. Keeping their clients safe can support the health and happiness of their clients.
25. Toileting: Older adults or people with mobility issues can have trouble going to the bathroom alone. Home care providers can help people on and off the toilet, assist with wiping, and help them take their clothes on and off. This helps them maintain their hygiene.
26. Transferring and Positioning: Adults who do not have the ability to properly move into place can benefit from transferring and positioning services. Home care providers can help clients in and out of chairs or beds. By ensuring proper positioning techniques, they can keep them at optimum positions for their muscles, skin, and digestion.
27. Transportation (Non-medical): Older adults often need transportation assistance beyond trips to medical appointments. Medical and non-medical transportation are different services, and potential clients should check to see if a provider has both services. This allows transportation for errands or to attend events and activities to keep seniors engaged in the community and independent.

5.3. What Does Home Care Not Include?

Common misconceptions exist about what home care does or does not include. These are services that people often associate with home care but are not a part of the services.

• Wound care: Wound care requires medical training and is a part of home health care instead of home care.
• In-home infusion or IV: IV services require knowledge to access appropriate blood vessels and inject the body with a substance. Since it requires medical licensure, it is a service of home health care only.
• Indwelling catheter care: Indwelling catheter care is care for a medical device, which means that this service falls under home health care with a qualified provider.
• Medication management: Medication management, including the administration of medication, is a service of home health care.
• Deep cleaning: While home care providers engage in light housekeeping, such as doing the laundry or washing the dishes, they do not engage in deep cleaning. For that service, a client would need to contact a professional home cleaning company.
• Taxi Service: Although many home care providers do have transportation services, these are a part of the other caregiving services that they offer. A client cannot just use home care for errand running alone or on-call.
• Physical therapy: Physical therapy is a rehabilitation service that only licensed professionals provide. Home health care with this specialty may offer this service.
• Occupational therapy: Occupational therapists are professionals that operate through home health services.
• Social work services: Social workers have specific registration, licensing, or other requirements to work with at-risk populations to help them obtain services.

6. Which Professionals are Involved in Home Care?

Below are the primary jobs of people involved in-home care.

• Home health aides (HHA): Home health aides mainly perform activities of daily living. This includes assistance with personal care and basic functions. They can also engage in light housekeeping and social interaction.
• Certified nurse assistant (CNA): CNAs have knowledge of basic issues in care with particular common disorders, such as Alzheimer’s. This knowledge and training can help them understand and adjust for the particular care needs of patients with these issues. While they do not provide medical care within home care, they can use their knowledge to approach the client more effectively.
• Personal Care Assistant (PCA): A personal care assistant or a personal care aide has training specifically to work within people’s home to provide care. They assist with activities of daily living and light housekeeping duties. They also provide companion care.
• Nurses: While nurses typically work for home health care providers, they may also provide non-medical in-home care. In this capacity, they would perform duties for activities of daily living, instrumental activities of daily living, and companionship. Their medical knowledge makes them uniquely qualified in the event of an emergency.
• Caregivers: A caregiver is an umbrella term for any home care provider. Caregivers perform activities of daily living, instrumental activities of daily living, or any other at-home service. This is a catch-all term for service providers.
• Live-in caregiver: A live-in caregiver is someone who assists with activities of daily living, companionship, and instrumental activities of daily living. Unlike regular caregivers, these live in the home with the client. This arrangement allows them to develop a bond and be present for emergencies. Like a general caregiver, the specific duties include the use of an umbrella term for home care.

7. How to Pay for Home Care?

Few options exist when it comes to paying for home care. Since home care is typically long-term and does not provide medical services, it limits the ways to pay for it. Clients can always pay out-of-pocket (private pay) for services. Some long-term care insurance policies will cover services, but clients need to examine each policy individually to decide. If a veteran can meet eligibility requirements and provide evidence that they need assistance with ADLs, then they may qualify to use veterans benefits for home care.