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Your guide to in-home care

by Maryalene LaPonsie

Just because a loved one needs extra help, that doesn’t mean they need to leave their home. In-home care is one option for aging parents and other relatives.

For adult children, one of the most difficult decisions to make is determining the appropriate level of care for aging parents. While we all want our parents to have the dignity of independent living, that must be balanced by a need to protect their health and safety. Fortunately, in-home care can provide the best of both worlds in many situations. Seniors can remain in their home while getting the health care they need.

Types of in-home care

Just as the name implies, in-home care involves health care professionals coming into a home to provide services.

According to Gina Kaurich, a credentialed Professional Geriatric Case Manager and Executive Director of Client Care Services for FirstLight HomeCare, there are two distinct types of in-home care: companion care and personal care. These are also sometimes referred to as custodial care and skilled care.

Companion, or custodial care, includes transportation services, meal preparation, household chores and medication reminders. Personal, or skilled care, can be more involved and may include bathing and hygiene needs as well as assistance with mobility and eating.

Who should consider in-home care

According to the National Association of Home Care & Hospice, in-home care is best when an individual wishes to stay at home but needs ongoing care that cannot be easily administered by family or friends. In addition, in-home care can be used on a short-term basis for individuals recovering from an acute illness or surgery.

"This is going to be an option for someone who can stay home with some assistance," said Kaurich.

For example, some individuals or caregivers may only need help with certain tasks such as bathing or meal preparation, and an in-home worker can assist with those tasks. Kaurich notes companion care can be combined with skilled care as well. While skilled care workers only come to a home for as long as a procedure takes, companion workers can stay for longer periods as needed.

Selecting the right in-home care provider

In-home care is provided by a number of private agencies and organizations. Selecting the right program can be essential to ensuring a positive experience for you and your loved one.

The American Association for Homecare recommends discussing your options with a hospital discharge planner, social worker or physician who may be familiar with the agencies operating in your area. Some of the questions caregivers should ask include inquiries into patient satisfaction and complementary services:

  • Is the agency Medicare-certified?
  • Will same caregiver be sent to the home for each visit?
  • What are the training requirements for caregivers? How are they screened for employment?
  • How are emergencies handled?
  • Does the agency conduct any customer satisfaction surveys? Are the results available for review?
  • Will the agency connect families with other resources such as Meals on Wheels as needed?

Medicare and in-home care

While Medicare Part A pays for home health services, caregivers should be aware there are specific limitations on the type of care covered by the program.

"Many people think Medicare pays for long term care. It doesn't," said Laura Rossman, a member of the Board of Directors for the American Society on Aging and Chief Marketing Officer for iQuote.com. "Medicare pays for medical care."

Specifically, Medicare will pay for in-home care only when a doctor certifies an individual needs one or more of the following services:

  • Physical therapy
  • Continued occupational therapy
  • Speech-language pathology services
  • Intermittent skilled nursing care

Individuals must be homebound, and Medicare pays for up to 60 days of skilled care. Personal care such as bathing and dressing are not covered if those are the only services your loved one needs. In addition, Medicare will not pay for 24-hour in-home care or companion care services.

Other ways to pay for in-home care

Rossman suggests families consider personal resources such as reverse mortgages or accelerated life insurance benefits to pay for needed care. However, she cautions that caregivers not jeopardize their own financial stability when paying for long-term care services.

Other options may include long term care insurance or Medicaid programs.

"Some state Medicaid programs have 'money follows the person' programs which allow the individual to remain in the community rather than go to a nursing facility," said Rossman.

The 2011 Market Survey of Long-Term Care Costs conducted by MetLife found the national average hourly rates for home health aides was $21 in 2010 while homemakers earned $19 an hour. Still, Kaurich says in-home care is a bargain compared to other options such as nursing homes.

"The cost for in-home care is significantly less than that for other forms of care out there," she said.