The role reversal that happens as parents or loved ones age and need more help can be a hard to navigate journey. If you are stepping into a caregiving role for a loved one, or considering looking into home health care options to hire an at-home caregiver for assistance, you’ll want to educate yourself on the types of caregiving professionals and the steps you’ll need to take for a quick and smooth transition into care.
[READ: What Is Senior Home Care: Services, Costs and Tips for Aging in Place]
What Are the Signs Your Loved One Needs an In-Home Caregiver?
“Many people experience a gradual decline in their ability to care for themselves” — and may not recognize their need for a caregiver right away, says Corinne Eldridge, president and CEO of Center for Caregiver Advancement, a California-based organization that supports caregiver training, research, policy and advocacy. She adds that at-home care can be an attractive option for many seniors looking to age in place. If your loved one cannot see or voice their caregiving needs, it can be important for you to look out for signs that they need extra help.
Some signs that your loved one may benefit from an in-home caregiver include:
— They are being discharged from the hospital or rehab and have doctor’s orders for additional care or therapy.
— They have trouble managing their medications, or forget to take them.
— They frequently fall at home or are at risk for falling.
— They have challenges with bathing themselves or getting to the bathroom on their own.
— They struggle with cooking or do not cook for themselves.
— They struggle to or cannot dress themselves.
— They have noticeable changes in their cognitive function, such as displaying forgetfulness or confusion.
Perhaps you have already determined that your loved one needs in-home caregiving support, but — rather than hire a professional — you have been providing this care yourself. If you’re already acting as a caregiver for your loved one, consider if hiring a professional supports your needs too. For instance, ask yourself if the tasks you are providing for your loved one feel sustainable — or if these are taking a toll on other aspects of your life.
Additionally, consider if you are equipped to provide caregiving that meets their needs. Are you a health care professional who can assist with medical needs and medication intake? Or if you are not trained in this area, would you feel more comfortable passing this task to someone who is?
[Read: What to Do When You Become the Family Caregiver]
Home Health Care vs. Home Care: Understanding Your Needs
The term home health care refers to skilled care such as nursing or therapy services performed by licensed and trained professionals. Whereas home care or in-home caregivers refers to a wide array of people who tend to and support others in their home — as opposed to in a hospital or a senior living facility — and may include paid workers and friends or family members. There are also various types of professional in-home caregivers you can hire.
Different types of professional in-home caregivers have different skill sets, some which may better suit your or your loved one’s needs than others. For instance, some in-home caregivers offer non-skilled care, which means they do not provide medical assistance but may provide your loved one companionship and support their basic activities of daily living. Others provide skilled care, which means they have medical training and can assist with checking your loved one’s vital signs or help them take medications.
[READ Home Health Care vs. Home Care: What’s the Difference?]
Skilled vs. Non-Skilled Services Comparison
| Home Health Care (Skilled Nursing Care) | Home Care (Non-Skilled Care) |
| Wound & Catheter Care | Light Housekeeping |
| Physical & Occupational Therapy | Meal Preparation |
| Medication Administration (Injections/IV) | Companionship & Grooming |
| Vital Sign Monitoring | Grocery Shopping & Errands |
| Usually covered by Medicare (short-term) | Usually Private Pay or Long-Term Insurance |
Home health care or skilled nursing care services can involve:
— Wound care
— IV therapy
— Medication management
— Occupational therapy
— Speech therapy
Corrie Bly, the director of Home Health, Hospice & AIM at Redlands Community Hospital, explains that “skilled care requires the skills and knowledge of a nurse, physical or occupational therapist to provide the care” and can be “ideal for patients who have been recently discharged from a hospital, ER or skilled nursing facility.”
After a hospital stay, the in-home care may also be covered by Medicare for eligible beneficiaries.
[READ: Does Medicare Cover Home Health Care?]
Home care or non-skilled nursing care services can involve:
— Housekeeping
— Meal preparation
— Personal care assistance
— Companionship
Types of caregivers
Even within the categories of skilled and non-skilled providers, types of caregivers vary.
A few types of home health caregivers you may consider hiring include:
— Home care nurses
— Certified nursing assistants
— Home health aides
— In-home supportive services providers
Home care nurses
Home care nurses, sometimes known as home health nurses, are registered nurses who come to your home to provide treatment or care.
Home care nurses can provide services, such as:
— Administer medicine to your loved one
— Inspect their wounds and change bandages
— Monitor their well-being and vitals
— Work with doctors on personalized care plans for your loved one
Certified nursing assistants (CNAs)
Certified nursing assistants will provide your loved one with essential health care services including activities of daily living assistance as well as limited medical services, such as taking vital signs under RN supervision.
Home health aides (HHAs)
Home health aides are caregivers who offer your loved one essential health care services, which include duties like changing soiled sheets and helping your loved one perform activities of daily living, including bathing or showering, dressing, preparing meals and some types of housekeeping.
In some places, HHAs will shop for groceries for your loved one, remind them about appointments and medications, do laundry, assist with health monitoring and escort them on outings too. Additionally, an HHA can act as a companion for your loved one.
They may also provide limited medical care such as taking vital signs, under a nurse’s supervision.
The job duties of CNAs and HHAs have several similarities. But overall, CNAs are trained more broadly within the medical field while HHAs are focused more narrowly on home care and often elderly care.
Dr. Esiquio Casillas, chief medical officer for the AltaMed Health Services Program of All-Inclusive Care for the Elderly, or PACE, in Los Angeles, explains that being under a nurse’s supervision doesn’t mean that an RN will be joining the rest of you at your loved one’s home. “They just need a nurse to be available and speak to — to guide if there are changes in condition that they note,” says Casillas.
In-home supportive services providers (IHSS)
In-home supportive service providers can help with things like housekeeping, meal preparation and companionship. They are hired individuals from either a home health service provider or independent contractors.
With any worker, the extent of their services can vary based on the individual and their contract with you.
If you are not a health care worker but are interested in becoming a paid caregiver, you can apply to become a IHSS provider. Depending on where you live, becoming an IHSS provider can enable you to receive state payments for taking care of your loved one. Becoming an IHSS provider does not make you a health care worker, but enables you to care for your loved one’s well-being. As an IHSS provider, you assist with their ADLs and other nonmedical aspects of their care.
Casillas says that IHSS can at times act “much more autonomously” than other caregivers, as they are under the direction of an individual patient — or loved one — as opposed to an agency.
[READ: How to Set Up Home Health Care After a Hospital Stay]
Things to Consider When Hiring an In-Home Caregiver
1. What level of care does your loved one need?
If your loved one is in need of care following a discharge after a hospital stay, they are typically in need of skilled care and a doctor will order the types of care needed — including physical or occupational therapy. In the case where you are looking to get additional caregiving help for things like bathing, dressing and housekeeping, you’re looking for non-skilled care.
Types of Caregivers: What to Consider
| Caregiver Type | Best for… | Medical Tasks? |
| Home Care Nurse (RN/LPN) | Complex medical care | Yes (IVs, wound care) |
| Certified Nursing Assistant (CNA) | ADLS and basic medical needs | Yes (under RN supervision) |
| Home Health Aide (HHA) | Daily living (bathing, meals) | Limited (vitals only) |
| In-Home Supportive Services Provider | Housekeeping, companionship, meal prep | No |
“Non-skilled care is often “coordinated between the patient or family and the caregiving agency they choose,” says Bly says. Care “may be covered under some long-term care insurance policies or privately paid by the patient and/or family.”
If you are unsure of what level of support your loved one needs, talk to their doctor about what is recommended for their situation.
[READ: Does Long-Term Care Insurance Cover Home Health Care?]
2. Choose your hiring path
When considering hiring an in-home care provider, it’s important to decide if you want to hire through an agency offering home health care solutions or hiring a self-employed caregiver. To decide which is best, consider level of care needed. Also, keep in mind that agencies handle taxes and background checks. If you hire privately you may save some money, but you will become the legal employer of the caregiver.
3. Vet the candidates
Whoever you choose to be your loved one’s caregiver will become a major presence in their life — and likely your life as well — so it’s in your best interest to be thoughtful about your selection.
“It is extremely important to be selective about the type of caregiver hired for oneself or a loved one because they directly impact quality of life and well-being,” Eldridge says. Caregivers who pay close attention to their consumer’s changes in health and behaviors can provide invaluable information to clinical teams and reduce the risk of medical complications,” which could be lifesaving.
Additionally, some, but not all caregivers, are specialized to work with people who have conditions like Alzheimer’s disease and related dementias. If your loved one has dementia, you’ll want to make sure their caregiver is equipped to care for their condition.
In addition to medical specialties, make sure your caregiver is a good emotional fit for you and your loved one.
Questions to ask a caregiver:
Some questions you may want to ask a caregiver before deciding if they are a good fit include:
— Can you tell me about your medical experience?
— Do you have experience caring for someone with dementia or another condition that my loved one has?
— How willing are you to learn about my loved one and their needs?
— How much do you prioritize emotional support and companionship among your services?
— How do you build trust with your patients?
— How will you communicate with me and my loved one?
— How have you demonstrated reliability with patients?
Caregivers may also provide references from former employers that can help you get a sense of their temperament, personality and work style, Eldridge says.
[READ: How Much Does In-Home Care Cost & How to Pay for It]
How Quickly Can Home Care Start After a Discharge From a Hospital?
Patients who receive a home health order can expect their in-home caregiving services to begin within 48 hours of discharge from a hospital. This is the standard timeframe set by the Centers for Medicare & Medicaid Services, which applies to patients enrolled in Medicare or Medicaid, including many older adults.
The home health care timeline following a hospital stay discharge:
— Hour 0: Hospital Discharge (case manager sends referral).
— Hours 0-24: Family calls agency to confirm receipt of documentation.
— Hours 24-48: First in-home assessment and start of care
— Post-48 Hours: Increased risk of medication errors and rehospitalization
Sonia Sehgal, an internist and geriatrician at UCI Health, says that while 48 hours is the CMS standard, some patients may experience longer delays between discharge and in-home care, stemming from the time of their discharge. For example, missing orders from doctors, issues with insurance companies or people who are discharged on a weekend may experience more delays to their start of care.
Some of these delays can be unavoidable. Nonetheless, Sehgal says it is important for home care to be initiated as soon as possible to best protect a patient’s health.
Among other concerns, Sehgal says that delays in care can lead to increased risks for situations such as:
— Rehospitalization
— Delayed wound care and increased risk of infection
Rehospitalization is perhaps one of the most concerning risks related to delayed care. According to a 2022 study by the Journal of the American Medical Directors Association, when patients wait more than two days for at-home care to start, their risk for rehospitalization or an emergency department visit increases by 12%.
“One of the greatest risks when there is any delay in getting home health care started is rehospitalization,” Bly affirms. “The risk is greater when patients need time-sensitive care such as wound care, drain care or intravenous infusions.”
To avoid rehospitalization and other negative health consequences that can result from gaps in care, Sehgal encourages patients and their families to “advocate for timely initiation of home health services.”
Some steps you can take to help your or a loved one’s home care transition begin smoothly and swiftly include:
— Inquire early about the need for home health after discharge.
— Connect with case managers and social workers to identify home health service providers that are covered by insurance.
— Ask and be transparent about the type of services you will need during home care, such as: wound care, catheter care, medication administration or physical therapy.
— Talk to doctors and care team members about any barriers or hesitations to home care.
— Get a home health order and the contact information for your home health care company in writing.
— To the extent possible, schedule appointments ahead of time.
— Contact your agency to ensure that they have received the required information related to your referral, such as your address, insurance information and documentation of authorization.
If delays do occur, contact your primary care provider so that they can help you coordinate with the home health care company, or so that they can help address your loved one’s unmet needs, Sehgal says.
Patients can also reach out to the home health care agency. Bly recommends contacting the home health agency within 24 hours of discharge if they haven’t initiated contact with the patient.
[READ: How to Set Up Home Health Care After a Hospital Stay]
In-Home Caregiving vs. Facility-Based Support
| Feature | In-Home Caregiver | Assisted Living / Nursing Home |
| Environment | Familiar, private surroundings | Communal, clinical or residential |
| Socialization | Existing networks (family/neighbors) | Daily peer interaction & social activities |
| Autonomy | High; personalized schedule | Shared; subject to facility policies |
| Flexibility | Highly adjustable hours/tasks | Structured care plans & visiting hours |
| Cost Basis | Hourly or daily rates + home upkeep | All-inclusive monthly room & board |
If you are wrestling with the decision of hiring an in-home caregiver or moving your loved one into a caregiving facility, there are some questions you can ask yourself to gain clarity.
— What level of care is required?
— Can this level of care be provided at the home?
— If necessary, can the home be modified to ensure your loved one’s safety?
— What is the cost difference between in-home caregiving and a caregiving facility?
— What is the proximity — of either your loved one’s home or a potential facility — to their friends and family members, including you?
— What is your loved one’s preferred living environment?
— Do you or they have any other emotional or social considerations that may affect your decision?
[SEE: Important Questions to Ask Your Aging Parents]
Calling in Help for Decision-Making
In some cases, you may feel that your loved one needs in-home caregiving support — and they may disagree with you. Such clashes could put a strain on your relationship and take a toll on both of you. To help separate your loved one’s health needs from both of your emotions around the decision, Eldridge says you may consider calling in a professional like a geriatric care manager who can conduct an assessment of your loved one’s health and safety in their home.
“It can be challenging to accept the judgment of a family member or loved one, so professional assessments are helpful and available at no cost upon the recommendation of a primary care provider,” Eldridge explains.
Depending on where you live and what services are close to you, you may be able to preview what these types of in-home assessments will look like online. For example, if you live in California, Disability Rights California provides an online worksheet that explains that service workers are looking for an IHSS assessment.
Prioritize Your Loved One’s Preferences in Caregiving Discussions
If you are hiring an in-home caregiver for your loved one, chances are you are taking on a couple of different roles for them already. And while it may be necessary to make some choices for your loved one, it’s important to respect their preferences.
“The patient’s preferences should be prioritized, especially if they are mentally capable of making decisions,” says Dr. Khaliq Siddiq, chief medical officer of Clever Care Health Plan, who practices in Seal Beach, California. “Person-centered care is a priority. However, loved ones often have to make these decisions if the patient’s health condition impedes their ability to make informed choices.”
Above all, he adds that empathy and understanding the emotional and physical challenges faced by the individual receiving care is crucial to providing compassionate and effective support.
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Hiring an In-Home Caregiver: What to Consider originally appeared on usnews.com
Update 01/14/26: This story was published at an earlier date and has been updated with new information.
