Aging is a fact of life — we simply can’t stop the clock, and for most adults, there will come a time when a little extra assistance performing the tasks of daily living would be…
Aging is a fact of life — we simply can’t stop the clock, and for most adults, there will come a time when a little extra assistance performing the tasks of daily living would be helpful. The Home Care Association of America reports that “nearly 70 percent of Americans who reach 65 will be unable to care for themselves at some point without assistance.” For some people, this assistance means moving into an assisted living facility or a nursing home, but for many more, “aging in place” at home is a much more attractive goal that can be achieved with the help of senior home care.
But what does senior home care, also sometimes called elderly home care, entail, and how will you know whether it’s the right choice for you or your loved one? “There is a crazy array of potential services to help people at home — everything from technology to human services,” says Danielle Pierotti, acting president and CEO of ElevatingHOME and the Visiting Nurses Associations of America. A registered nurse with a doctor of nursing degree, Pierotti says ElevatingHOME and the VNAA are trade associations for in-home care services: The VNAA represents not-for-profit home health and hospice providers while ElevatingHOME, “expands that conversation” about care in the home, with the goal of helping Americans stay in their homes as long as possible. “How do we maximize wellness and health and support our communities as we grow older?” she asks. Which is an important question, given that “nine out of 10 Americans 65 and older want to stay at home for as long as possible, and 80 percent think their current home is where they will always live,” according to the HCAA.
With staying at home as the primary goal, Pierotti says senior home care can generally be divided into two big categories. “One of them is what we would think about in terms of personal care, and that might be a homemaker, someone who does light housekeeping, does errands or would assist a senior to do errands. Maybe they help someone get dressed or take a shower — they’re personal care support.” These personnel are not usually licensed, and how these caregivers are trained varies from company to company. The form of care is also typically paid for out-of-pocket by the senior or the family. “Although some Medicare Advantage plans are beginning to explore these options, mostly right now that’s a service that people contract for privately and pay for directly and not through an insurance company,” Pierotti says.
The second big category of care is what Pierotti calls “professionally-driven care — that’s care that’s going to involve a licensed professional and a physician’s order,” and may be thought of as “more traditional home health care that will involve a registered nurse or a physical therapist. There may also be personal care support that is being done in coordination and under the oversight of a registered nurse as part of a plan that a physician or other licensed provider is making.” The key distinction is whether a physician is involved in this form of care, and health care services delivered this way are usually covered by Medicare or a private insurer. “That is included as part of a physician’s plan,” and the patient may have to pay copays, “but usually those are very low if there are any at all,” she says.
Lakelyn Hogan, gerontologist and caregiver advocate for Home Instead Senior Care, an international in-home care agency with 650 locations in the U.S. and Canada, adds that “when we refer to ‘home,’ it could be a residential or a community setting,” and is not strictly limited to an individual’s private residence, although that’s typically where this type of care takes place. No matter in which version of “home” the care transpires, “the idea of home care is to help older adults remain safe and independent as much as possible by helping with activities of daily living,” such as eating and bathing, “and what we call the instrumental activities of daily living,” such as driving or housework.
What services are offered by senior home care organizations?
The menu of options offered by senior home care organizations is virtually limitless, but is often dictated by the family budget. Services for seniors receiving in-home care may include:
— In-home nursing care, such as wound dressing, IV therapy, health monitoring, pain control and other nursing duties
— In-home physical, occupational or speech therapy
— In-home doctors’ visits or telemedicine check-ups via video conferencing or phone
— Medical social services, such as counseling and identifying community support and other resources
— Medication management or reminders
— Light housekeeping — cleaning and laundry services
— Personal services, such as assistance with bathing, dressing or walking
— Assistance with shopping and other errands
— Companionship and social interaction
— Volunteer services, which can run the gamut from simple companionship to transportation, personal care, emotional support and more specialized skills such as assisting with paperwork or other needs.
Different organizations offer these services using one of three models, Hogan says. “There’s the neighbor down the street that you could hire independently,” which is known as the independent caregiver. “Then there’s registries where it’s kind of a list-serv of home care providers that the registry helps connect the family with.” In both those cases, the family would likely be responsible for handling payroll and taxes. “And then there’s the agency model, where the agency employs the professional caregivers,” who are sent into clients’ home to care for them. She says that agency organizations can range in size from “mom and pop operations that are local, or they could be regional or national franchise organizations.”
The Centers for Disease Control and Prevention report that in 2014 (the most recent year for which data are available) there were 12,400 home health agencies in the United States that cared for nearly 5 million people at some point during the year. Some of these individuals needed short-term assistance after coming home from a hospital stay or recovering from an illness or injury, while others needed ongoing assistance due to chronic conditions, advanced age or cognitive decline.
Hogan notes that some agencies offer specialized memory care services for older adults who want to remain in their home but are dealing with cognitive decline, dementia or Alzheimer’s disease. Agencies offering these types of services typically train their caregivers on signs and symptoms to watch out for and what to do when the individual’s health starts to change.
What can I expect from senior home care?
As the name implies, the care is delivered in the home, so first and foremost, it’s important to recognize that means you’ll be inviting people into your or your loved one’s home. When considering whether elderly home care is right for your situation, Pierotti recommends “being very honest with yourself about what you’re comfortable with and what you’re seeking.” She likens the search for the right mix of services to completing a home renovation project.
“If you think about it in terms of how you would work with any contractor coming into your home — are you the type of person who’s comfortable hiring the plumber, the electrician, and the lawn person all by yourself? Or do you want to hire a contractor who’s going to manage all those people. It’s a similar sort of situation,” and it’s important to consider “where your comfort zone is.”
This can be a confusing and difficult aspect of finding the right solution, which is further compounded by the fact that the services a senior needs are likely to change over time. Aging is not a static thing, and it’s hard to predict exactly what assistance will be needed at a given time. “The situation keeps evolving. Unlike the bathroom project that probably has an end point, when you’re talking about a person who’s aging, they’re going to keep aging, and those needs are going to continue to evolve over time,” Pierotti says. Coping with this dynamic process takes patience and an honest assessment of needs versus wants in light of the family’s economic situation.
Again, using the analogy of home improvement, Pierotti explains the process. “If you were looking at your bathroom and thinking, ‘I have to get the leak under the sink fixed, but I’d really love to rip the whole thing out and put in a whole new bathroom,’ you have a wide array of options.” That same thought process can be applied to home care, she says, where you separate the ideal from the reality. “‘What I really need is someone to make sure dad gets a shower twice a week, but what I’d really love is someone who comes in every day and makes sure he has lunch and is dressed.’ And then you can begin to break down and think through the things you really want compared to the things that you’d love to have and process those decisions along the way. What are you comfortable with? What can you afford? Where can you get people?” As you make each decision, the path forward should become clearer.
Hogan agrees, saying “it’s important for families to really assess the need of their loved one,” and use that careful assessment to guide the services they select. She says it’s also important to conduct a thorough home safety assessment to determine whether any modifications need to be made to the home for the senior to remain there without risk of injury. Home Instead offers an online checklist for assessing home safety.
How much does senior home care cost, and will Medicare cover it?
Estimating how much in-home senior care will cost can be challenging, given the wide range and variable combinations of services available. “There’s going to be several factors that play into the cost of service,” Hogan says, including the level of care needed and geographic location. “The cost of care in a city like San Francisco tends to be higher than Omaha, Nebraska,” she says. However, according to the 2018 Cost of Care Survey by Genworth Financial, a financial services firm offering long term care insurance, the median annual cost for homemaker services is $48,048. The national median for a home health aide is $50,336. (By comparison, the national annual median cost for assisted living facilities is $48,000.) The survey offers an online tool where you can get a localized cost estimate for different care options by entering your zip code.
However, Hogan notes that most in-home care companies charge by the hour, not on an annual or monthly basis and that each organization will have its own fee structure and cost ranges. Therefore, it’s important to do your research and ask a lot of questions when considering whether in-home care is the right solution for your situation.
“Sometimes people think that home care is more expensive than it really is, but then they’ll underestimate the cost of a nursing home. Oftentimes, depending on the level of need the opposite is true,” she says. The Genworth survey found that the annual national median cost of a semi-private room in a nursing home is $89,297 while a private room in a nursing home is $100,375, about twice the median of in-home care. Plus, “having care at home can delay the need to move to a facility or community setting in a lot of cases,” Hogan says, which may cut down on cost.
For the most part, home care is covered out-of-pocket by families, although some long-term care insurance options do cover these fees. In April 2018, the Centers for Medicare & Medicaid Services announced that beginning in 2019, Medicare Advantage benefits will include non-skilled home care services, which refers to assistance with things like bathing and dressing, rather than health care delivered by a nurse or other professional provider. Check your plan for details.
Pierotti says many people can avoid moving to a nursing home when the right mix of family and community support is identified and employed. “Nursing home care and services are always going to be needed for a certain group of people, but how do we help folks avoid it until it’s the right thing for them? I think nursing homes offer a lot of safety and security for when someone really needs to have that level of professional care — that involved, 24/7 access to registered nurses and a team of interdisciplinary professionals. But luckily, most of us don’t need that most of the time. Most of us need people who care about us to help fill in the gaps. There’s an awful lot of space for folks to be able to not need that level of care” that a nursing home provides.
Still, this can be challenging for the family caregiver who’s tasked with primary responsibility of coordinating care for the person needing the services. “The key thing is that we’re all in this together. As a national community, we’re going to have to talk about aging and what does it mean for all of us,” Pierotti says, adding that discussions of what we value and prioritize are important to determining how we’ll help each other. “To me, that’s what the conversation about aging is about.” Having those conversations early and frequently is important to finding the right solution for your family.