You’ve had “the conversation” with your aging parents and they’ve made it very clear that they want to age in place. As time goes by, however, you notice that they’re having increasing difficulty with some basic activities – meal preparation, remembering to take their medication, or housecleaning, for example. You want to honor their desire to age in place, but it’s apparent that they need some additional help to do so. A qualified in-home care provider may be the solution.

Home care is defined as non-medical assistance provided by experienced caregivers.  It includes activities ranging from basic needs such as meal preparation, medication reminders and companionship, to more sophisticated needs such as bathing, grooming and incontinence care.

This type of home care differs from medically required home care, which is prescribed by a physician. Home medical care is provided by Medicare-Certified Home Health Agencies (CHHA), who are certified by Medicare and Medicaid to provide skilled services. They are licensed by the state. They may also provide personal care through their own home health aides or through another agency, usually a licensed agency, with which they have a contract.

There are two main options for non-medical home care: using a full-service agency or hiring a caregiver directly, often referred to as private-pay.

Full-service agency. Caregivers provided through a full-service agency are pre-screened and qualified (background checked and often trained) and paid by the agency. This relieves you of the payroll, insurance and personnel issues encountered with a privately hired caregiver. Also, because the agency has a pool of caregivers, if your assigned caregiver is sick or doesn’t work out, the agency can quickly provide another.  Because of these services, however, you will typically pay more for a caregiver through a full-service agency than when you hire someone directly yourself.

Private caregiver. The cost of hiring a private caregiver will typically be lower than through an agency, and you often have more control over scheduling and activities. Because you are the employer, however, you must adhere to relevant, current employment, wage and tax laws. It is important to have a clear and written employment agreement in place, so there is no misunderstanding about the scope of work, pay, etc.  And unless you’re able to arrange for back up, you may be left without a caregiver in the event of unplanned absences and other disruptions.

Medicare and private health insurance do not pay for non-medical home care. However, Long Term Care Insurance is an option for funding this type of care.  Since home care can be limited to only the hours needed, it may initially cost less than an assisted living facility. Once the care moves to 24 hours a day, the costs become more aligned.

Here are some important steps in choosing a home care provider for your loved one.

Assess needs. What type of help do your parents need – and are willing to accept? Here are some areas to start with:

• Household care: meal preparation, cleaning, shopping, laundry
• Personal care: bathing, eating, dressing, toileting
• Healthcare: medication reminders/management, doctor appointments
• Companionship: activities, outings, conversation

Consider personality/preferences. Spend some time thinking about your parent’s personality, interests, preferences (and, in fact, ask your parent!) so you’ll be able to find a caregiver that will be a good match.  The Family Caregiver Alliance has additional ideas in their fact sheet on Making Choices About Everyday Care.

Perform due diligence. Whether you choose an agency or decide to hire a caregiver on your own, you still need to perform due diligence in making your selection.  Meeting with the caregiver in person will give you a feel for whether they are a personality match for your loved one. But that’s not enough. You need to confirm that it’s a trustworthy person/agency. Ask about proof of workers’ comp insurance, experience, referrals and references. AARP has resources on specific things you should look for in an agency  or when hiring a private caregiver.

Monitor and follow up. Even though you fully research and vet a caregiver, it’s important to check in with your parent and observe the care. Don’t stick to a predictable schedule when “checking up.” And don’t hesitate to share your observations and concerns with the agency or provider.

Providing your senior with the ability to age in their home can extend their independence and quality of life. Doing your homework before making a home care selection, and following up, will provide you with peace of mind.  If you have questions about cost of care and how to pay for it, please feel free to contact me directly!  minda@loveandorder.net or call me at 408-318-0828.