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Home Care: Everything You Need To Know

For many seniors, aging in place becomes a priority. They don’t want to leave their loving home and move to a senior community. Instead, they want to live close to their children, grandchildren, and friends.

But the inevitable natural aging process can make it difficult over time for elderly to perform their daily chores and take care of their health. Some might need help with their activities of daily life such as housekeeping, cleaning, meal preparation, while others might seek assistance with dressing, bathing, toileting, eating, medication, mobility support etc. As they age, seniors often need more healthcare support to deal with chronic health conditions, cognitive health, malnutrition, sensory impairments, etc.

This is when home care steps in!

You can hire an individual provider for different areas of senior’s needs, including health, house maintenance, companionship, transportation, etc. There are home health agencies that serve an intermediary between professional home care providers and clients.

But before you handle the care of your senior loved one to someone else, it is important to educate yourself with A-Z of home care. Here is your all-in-one guide to home care: types, costs, services offered, how to choose caregivers who best fit senior’s needs and much more.

Let’s have a look before you finalize with a home care service:

What is Home Care?

Senior home care primarily refers to medical assistive care or treatment for older adults who do not want or require hospitalization or facility care but do need additional support to live safely at their home. It is specifically termed as home health care.

Home care can involve medical treatment by medical professionals or assistive health care by licensed nurses. However, the largest segment of in-house care for seniors involves non-medical care such as incontinence care, medication reminders, mobility assistance, and even companionship.

In-home care is carried out professionally trained and certified caregivers ranging from companion caregivers all the way to occupational physical therapists to skilled and licensed nurses.

You can find skilled and professional caregivers through home care agencies. These companies provide home care aides, companion care, homemaker services and may also provide nursing services in the client’s place of residence.

Demographics in the US and Canada

Each day, around 10,000 older adults turn 65 in the United States, and the majority of them prefer aging in their own homes.[1] The staggering number of aging Americans has created a huge demand for in-home health caregivers, from nurses to paraprofessionals and caregivers.

According to the National Health Statistics Reports[2], the most requested type of home healthcare services for seniors aged 65 and older are as follows:

  • Skilled and certified nursing professionals – 84 percent
  • Physical therapy professionals – 40 percent
  • General care professionals to help with daily errands – 37 percent
  • General care professionals to help with homemaker services  – 17 percent
  • Occupational therapy specialists – 14 percent
  • Nutrition and dietary counseling – 14 percent
  • Wound care assistance – 14 percent

Similarly, in recent decades, senior Canadians have been embracing home care regardless of age or ability. The majority of home care recipients in Canada are in their mid-70s or older. 

Statistics Canada predicts that by 2031, nearly one in four Canadian will be over 65, leading to more demand for home care for seniors.[3] Canadian families are increasingly hiring professional in-home health care providers and companion keepers. 

Home Care Types

Seniors, who want to live independently at their home, may need a little extra help. These individuals may benefit from one or more types of home care. Home care ranges from specialized medical care like establishing medical laboratory to generalised care like housekeeping and companionship.

Home care can be divided into three broad categories:

Licensed Medical Professional Care

Licensed medical professionals often include physicians, physician's assistants (PA), physical and occupational therapists, nurses and some specialty home health aides who work under a physician’s direction.

Non-Medical Paraprofessionals Care

Non-medical paraprofessionals include home health aides, personal care attendants, homemakers and companions. Home health aides provide hands-on care and assistance with ADLs (see below). They can also help with cooking, shopping and laundry. Non-medical paraprofessionals include personal care attendants, home health aides, companions, and homemakers.

In-Home Memory Care

In-home memory and dementia care help your senior loved one live comfortably and safely in the home where they feel happy and experience fewer bouts of confusion. At home, the elderly dealing with cognitive impairment or any form of dementia benefit from well-known sights and sounds.

Professional in-home memory care services can include companion services, skilled nursing care, home health aides or even help with household chores.

Live your retirement can provide a list of home care services for your senior loved ones.

Services Offered in Long Term Care Facilities

Depending on the individual patient's situation, home care offers a wide range of services. Caretaker and your doctor determine the care plan and services needed at home.

Non-medical paraprofessionals provide hands-on assistance with activities of daily living (ADL), such as:

  • Bathing
  • Dressing
  • Toileting
  • Oral care
  • Grooming
  • Feeding
  • Walking or using a wheelchair

Instrumental ADLs

The instrumental ADLs are the activities performed by an individual daily that are not essential to basic self-care and independent living but are important for improved quality of life. You can hire a skilled caregiver to help your senior loved one with instrumental ADLs as well.

Instrumental ADLs include:

  • Housekeeping
  • Meal preparations
  • General shopping
  • Managing finances
  • Medication managemen
  • Transportation
  • Laundry

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Home Care Costs

If you want to engage a caregiver for your elderly parent or grandparent, it is advised to note the difference between the cost of home health care, nursing and caregivers who provide non-medical assistance.

You can find a non-medical care provider for a moderate pay rate. However, medical professionals cost more because they provide additional medical care.

Factors influencing the cost of elderly home care are as follows:

  • Local cost of living
  • Amount of care required
  • The expected level of skills
  • Senior’s current health status
  • Senior’s financial assets

According to Genworth, national median cost is about $3,865 monthly for an in-home aide or $3,810 monthly for homemaker care. Genworth assumes 44 hours per week of home care in its calculations.[4]

The median cost countrywide for 44 hours of care per week is about $125 per day. Most companies combine medical and non-medical home care services, which cost about $21 an hour.[5]

The following table ranks the US cities from least expensive to most expensive to give you a clear picture of what the cost of home care is.

The most expensive states in terms of senior in-home care cost:

US State Cost Per Hour
North Dakota $27
Alaska $26
Hawaii $25
Massachusetts $25
Minnesota $25
Rhode Island $25

The least expensive states in terms of senior in-home care cost are:

State Cost Per Hour
Louisiana and West Virginia $16
Alabama, Arkansas and Mississippi $17
Georgia, North Carolina and Tennessee $18

In Canada, hiring a personal care worker through an agency can cost between 20-50$ per hour. Registered nurses cost between 40$ to 100$ an hour. A full-time, live-in caregiver can cost, ranging between 2 000$ to 4 000$, plus the cost of plus room and board.[6]

Canadian Province Cost Type of Home Care service provided
Ontario $20 - $30 per hour Home support, basic personal care
Ontario $50 - $60/hour Therapy or nursing visits
Alberta $28/hour In-home meal preparation
Alberta $110/hour Occupational therapy
Alberta $27/hour 24 hour live-in care
Nova Scotia $12.45/hour Basic home care

Home care costs for dementia in Canada:

Province Rate Dementia Care service provided
Ontario $50-$60/hour Nursing visits
Ontario $65/hour adult day program
Alberta 227/hour 24 hour live-in care
Alberta $110/hour Occupational therapy

Does Medicare Cover Home Care for the Elderly?

Fortunately, Medicare covers various types of senior and elder American health care, including home health care services for up to seven days a week and no more than eight hours each day for 28 hours each week.

Medicare covers your home health care if:

  • Senior is homebound and can’t leave his home without help.
  • The care recipient needs skilled nursing services and/or skilled therapy care intermittently.
  • You have a meeting with a doctor within the 90 days before approaching home health care, or the 30 days after the first day you receive care.
  • The doctor signs a home health certification, which confirms that you are homebound and need intermittent skilled care.
  • The senior receives care from a Medicare-certified home care agency (HHA).[7]

Medicare home health doesn’t cover occupational therapy and custodial care that includes personal care, homemaker services, 24-hour care or meal delivery.

Choosing a Home Care Facility

When you search for a caregiver, make sure you keep the recipient of the care involved in the process so you can choose someone s/he feels comfortable with. Live your retirement can provide information on different in-home care agencies in desired locations.

Following these tips when searching for a caregiver for an elderly in your family:

Ask for Credentials of caregiver

A licensed caregiver has undergone rigorous training to provide the best in-home care to your senior. Ask caregivers for copies of their certification, license and other credentials. Also, ask for references and testimonials.

Check Patience Level of caregiver

There come many times when caregivers feel like giving up, but good caregivers never show these feelings to the seniors they care for. Ask questions to test caregiver’s patience level, such as what would s/he do when the care recipient becomes irritated or sad.

Look for Flexibility

 Emergencies may occur without any notice, and you may need the assistance of caregiver outside of the agreed-upon schedule. So, it is recommended to hire a home caregiver can be available on short notice.

Special Skills

If your loved one needs special care, hire someone who is specialized in that area. For example, if your senior has, you will need a home caregiver having experience with dementia care.

Check for Liability and Dishonesty Insurance

 It is recommended to check if your care provider has liability and dishonesty insurance. This helps protect the care recipient and their family. The care provider often provides proof of insurance in the form of an insurance certificate.

24/7 Flexible Live-In Or Live-Out Services

The requirements of care recipients change over time depending upon needs and the availability of family members. Therefore, it’s vital that the agency be flexible and able to provide either live-in or live-out service for the desired period. Ask if the home care agency provides flexible services on a 24×7 basis.

Free Senior Home Care Resources

Private Duty Homecare Association

The Private Duty Homecare Association (PDHCA) is a trade association of home care providers who help the ill and disabled remain in their own homes. It focuses on providing valuable information to all of its members, including help in understanding federal guidelines, financial assistance, networking, certification and accreditation, and new product offerings.

American Health Care Association (AHCA)

AHCA is America’s largest association of long term and post-acute care providers. The organization focuses on improving the quality of care for frail, disabled and elderly Americans. Compassionate and skilled caregivers provide essential care to millions of individuals in around 11,000 not-for-profit and proprietary member facilities.

Program of All-Inclusive Care for Elderly (PACE)

PACE assists seniors in meeting their health-care requirements at home. It provides information on service areas, Medicaid, etc.

Canadian Home Care Association (CHCA)

CHCA is a not-for-profit association dedicated to ensuring the availability of responsive home care and community supports. The organization helps people to safely and happily stay in their homes with dignity, quality of life and independence.

Home Care Ontario

Home Care Ontario association represents providers of quality home care services across Ontario. The organization advocates creating reliable and accessible home care system that supports citizens to manage their health care issues at home.

For more home care resources in Canada, click here.

Questions to Ask A Home Care Facility

There are many questions you may ask when selecting a senior home care agency:

Organizational

  • Is the agency accredited? The agency can be accredited to the Accreditation Commission for Health Care, Community Health Accreditation Program and/or Joint Commission on Accreditation of Healthcare Organizations. In Canada, it is recommended to choose an in-home senior care provider accredited with Health Standards Organization (HSO).
  • What is the experience of a home care agency with serving your community?
  • Is the agency a member of a home care association or a provincial association?
  • Does the agency provide a written agreement outlining the proposed services and their costs?
  • Does the agency accepts insurance policies and/or government funded programs?

Services

  • What type of home care services does the agency provide?
  • Are agency caregivers available 24 hours per day?

Staff

  • Is the staff licensed and qualified?
  • How does the agency ensure the recipient’s confidentiality?
  • Does the agency provide regular training to its caregivers?

Other questions to ask

  • Are the agency’s previous and existing clients satisfied with the services?
  • What is the procedure for resolving issues that may arise between families or home halt care staff?

Senior Care Facilities by State or Province

The Most Affordable Cities For Senior Home Care

Rank City State Cost
1 Wilmington NC $3,692
2 Tucson AZ $3,774
3 Tampa FL $3,812
4 Mesa AZ $3,856
5 Orlando FL $4,132
6 Baltimore MD $3,950
7 Fayetteville NC $4,045

References:

  1. D’vera Cohn and Paul Taylor. December 20, 2010. Baby Boomers Approach 65 – Glumly, pewsocialtrends.org
  2. Adrienne L. Jones, Lauren Harris-Kojetin and Roberto Valverde. April 18, 2012. Characteristics and Use of Home Health Care by Men and Women Aged 65 and Over, cdc.gov
  3. uCarenet. Jul 24, 2018. Are Canadians (Notably Millennials) Ready To Care For Growing Senior Population?, newswire.ca
  4. Richard Eisenberg. May 10, 2016. Americans' Estimates Of Long-Term Care Costs Are Wildly Off, forbes.com
  5. Marsha Mercer. October 4, 2016. You Can Afford a Home-Care Worker, aarp.org
  6. Melissa Leong. May 24, 2014. The unexpected costs of caring for your elderly parents. Financialpost.com
  7. Home health basics. medicareinteractive.org