In-Home Care Costs for Older Adults: Breaking It Down

When choosing in-home care services, it is important to have an awareness of what you may need for help.  Questions to ask yourself or to discuss with your family and loved ones are:
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1. What activities do you need the most help with?  For example, is it bathing, dressing, cooking, cleaning, going out in the community, or something else?
2. Do you already have help for these activities through family or loved ones?
3. Are you or your family financially prepared to hire in-home care?
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Having these conversations will allow you and your loved ones to make informed decisions about the care you want and need and the best way to pay for this type of care. 

In this article, we will discuss different types of in-home care services as well as the associated costs so that you and your loved ones can plan accordingly.
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Overview of In-Home Care Costs

When considering in-home care, it is important to know what services may or may not be available and the average hourly cost of these services. 

Here are some examples of commonly used in-home care services and the average cost of care:
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• Nurses (RN): $41-42/hour
• Home Health Aide (Licensed): $18-19/hour
• Home Health Aide or Personal Care Assistant (Unlicensed): $16-17
• Homemaker: $30-34/hour
• Meal Preparation or Delivery: $8-30/hour
• Companion Care: $20-30/hour
• Volunteer Care: No cost
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Factors that can impact these hourly rates include but are not limited to:
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• Education and licensure: These can determine what a provider is able to do legally and medically.  The more education and licensure an in-home provider has, the more they may be able to do for you.  This will, however, drive up the hourly cost of care.
• Location: Each state has fluctuating costs that can depend upon whether you are in a major city or an outstate area as the cost of living and average wage will vary.
• Inflation: As the cost of care has risen in hospitals and clinics, it has also risen in the private pay sector.
• Part-time work versus full-time work: Purchasing more hours can give a slight discount versus asking for one hour at a time. This is not always the case, but it does happen.
• Level of care needed: The more complex your medical care needs are, the higher your hourly rates may be.  You may also be told that your medical care needs are too complex for a health aide or PCA because they are not skilled enough or properly licensed/ trained for your needs.
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Using the Genworth Cost of Care Survey tool is one of many tools available to give you a starting idea of in-home care costs in your area.  It is advised to inquire with at least 2-3 agencies or service providers like Clara after using any cost forecasting tool to confirm what the cost of in-home care will be in your area.
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Types of In-Home Care Services

Now that we’ve discussed the average costs of care, what do these hourly rates get you?  It is important to know what each care team member does so you can ask for the appropriately trained and or licensed care person.
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Personal Care Assistance

Personal care assistance entails assisting with activities of daily living. These activities include but are not limited to: 
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• Showering or bathing and grooming, bed baths
• Repositioning in bed
• Dressing
• Toileting
• Changing bed linens
• Supervision and companionship
• Assistance to leave the home safely
• *Giving medications only if certified and allowed in your state and allowed by the agency that is providing the care.
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Nursing Care (RN, BSN, BSRN)

In-home care nurses can assist with several activities based on their licensure and training level. These include but are not limited to:
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• Taking vitals
• Giving medications
• Activities of daily living
• Wound care or dressing changes
• Tube feeding care and cleaning
• Trach or ventilator care and cleaning
• IV line care
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Companion Care

Companion care is hiring someone to provide supervision, emotional support, or companionship to you or your loved one.  Some companions assist with mobility to leave the home, while others may stay in the home with you to converse, play music, read a book, or assist with light chores.
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Live-In Care

Live-in care describes hiring a PCA or health aide to live with you or your loved one in the home for 24 hours per day, 7 days per week.  The cost of care depends whether the agency or individual hired has an hourly, daily, weekly, or monthly rate. 

While a live-in care aide can assist with activities of daily living and chores, there are still limitations to their ability to provide medical care (i.e. the activities listed under nursing care). 

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If you and your family choose to pay for a live-in nurse who is an active nurse and who is medically licensed, then more services are possible.  Please note that there will be a significant cost difference between a 24/7 PCA and a 24/7 licensed nurse due to the different skill sets, education levels, and medical care that can be provided.
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Specialized Medical Care

Specialized medical care includes hiring providers who have knowledge and expertise on medical devices (i.e. trachs, ventilators, tube feedings, etc.) or knowledge of dementia and Alzheimer’s care.
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Costs of specialized medical care will be determined based on the medical care needed.  This can include cleaning wounds, dressing changes, suction, supplies provided, and hourly time. 

Because these costs are incredibly variable and medical complexity is hard to sum up in a blog, it is recommended to speak with at least 2-3 home care agencies to get a sense of what the hourly cost would be in your area for your unique type of medical care.
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Respite Care

Respite care means having an in-home provider for anywhere from 1 hour for one day to 24/7 care for days or weeks.  
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Respite care is intended to be short-term to allow the main caregiver, be it a family member, loved one, friend, or neighbor, a break from their caregiving routines.  Respite care can be provided in a home and will typically have similar hourly or daily costs as live-in care. 

The type of staff needed to provide respite will be determined based on medical needs, so the cost of respite care may be increased if the medical care needs are higher.
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How to Budget for In-Home Care

The next question is how to budget for in-home care.  In the next section, we will discuss financial strategies to assist with paying for in-home care services.
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Assessing Your Financial Situation

When creating a budget (if one is not already created), it is important to know your monthly income (money you are receiving each month) and your monthly expenses (i.e. bills, food, rent, monthly payments, debt payments, etc.).  
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Once you have subtracted your expenses from your income, you will know how much you have remaining to spend on your care needs each month.  This is only the first step in assessing your financial situation.  You will also need to evaluate your savings, including assets, and how long your savings will last.
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Exploring Payment Options

When exploring payment options, it is good to know that a variety of payment options may exist.  It is worthwhile to explore these options to see if they are a fit for you and your family.  Payment options are varied and differ from state to state and agency to agency. 
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Here are a few examples of payment options for care:
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• Home health agencies may offer deals, bundled packages, or discounts based on buying higher amounts of care.  For example, an agency may have a weekly rate or monthly rate that includes a set number of hours that is less expensive than buying those hours individually.
• Depending on your financial situation, in-home care agencies may offer payment plans or have their own financial assistance programs.
• If you meet your state’s income and asset limits for Medicaid, it may be worthwhile to explore if Medicaid is the right insurance plan for you. If you are over the income or asset limit for Medicaid, you may encounter what is called a spend down.  An example of a spend-down plan is, if you earn $1500 per month, and the Medicaid income limit is $1400 per month, you would pay $100 per month as a “copay” or a “spend down” to Medicaid. You may also need to “spend down” your assets.  In other words, you may need to spend/reduce your assets to support your care until you meet the set asset limit for Medicaid eligibility.  If you are unsure whether or not you meet the criteria for Medicaid, it is recommended that you meet with a financial worker in your home county.
• If you do not qualify for Medicaid, Clara is typically the most affordable, legal private-pay option for non-medical care.
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Tips for Reducing In-Home Care Costs

Now that you’ve made your budget and have started to plan for the cost of in-home care, here are some tips to find additional savings on in-home care services.
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Using Community Resources

Community programs through senior centers, religious institutions or places of worship, or local neighborhood centers may offer volunteer care services. 
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It is important to evaluate if a volunteer has the right skills and experience to help with activities of daily living.  Most volunteers are not medical providers and should not be expected to render medical aid or be used as a replacement for a nurse to avoid paying the cost of a nurse.
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Hiring Independent Caregivers

Independent caregivers operate their own businesses either by themselves or as an independent group and are thus able to independently set their rates. 
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You can often find people like off-duty nurses or independent PCAs who are looking for work, be it full-time, part-time, or just a few hours for additional income.  Using social media outlets (i.e. a neighborhood group) can be a good way to get started on finding independent caregivers. 

Please note that when hiring outside of an established agency, you may want to consider doing your own background check and interview process before hiring the caregiver.

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Clara makes finding and hiring independent caregivers easy, through their unique full-service marketplace model.
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Negotiating Rates

You will often find that independent caregivers have more flexibility to negotiate rates since they control their rates rather than an agency.  You can also negotiate care costs by shifting some medical care to family or loved ones. 
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Care to complete activities of daily living are often less expensive tasks, and they do not require a nursing license to complete.  Please be mindful when shifting care responsibilities or negotiating rates that you are not putting your safety or your loved one’s safety at risk to save money.
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Evaluating and Comparing In-Home Care Providers

Once you have decided what you want to do for in-home care, the next step is evaluating and comparing in-home care providers.  This section will explore tips to assist you in the evaluation and comparison process.
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Key Factors to Consider

When researching either an agency or a freelance care provider, it is important to keep these key factors in mind:
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• What is their license and what are they legally qualified to do based on that licensure?  Also, is their license active with no complaints, violations, or pending legal action?
• What are their working hours?  Are they exclusively daytime? Do they offer overnights?  If they offer overnights, are they awake or sleeping?
• If the caregiver calls in sick, misses a shift due to inclement weather, or no-shows, who is responsible for covering that shift?  Does the agency send another staff member?  Are you required to cover that shift?  And do you still have to pay for that missed shift (especially for weekly or monthly rate plans)?
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Questions to Ask Potential Providers

When interviewing the provider themselves, it is important to ask the following questions to ensure they are a fit for you and your family:
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• What is your experience with my or my loved one’s [insert medical condition or mental health needs]?  For example, what is your experience working with persons with dementia?
• What activities are you licensed or certified to provide?  Are you CPR / AED certified?  Are you certified to assist with a choking incident?
• How long have you been with your agency?
• What are your comfort levels with working with someone with [insert political orientation] or [insert religious affiliations]?  This can be especially important if you or your loved one prepares meals according to a religious teaching or tradition.  It is important to ensure your care provider is willing and able to work with your or your loved one’s needs.
• Are you bilingual other than English?
• How do you communicate concerns or even daily progress?  Even though a provider may be independent, they are still required to maintain documentation of their encounters as they are providing a service to you and your family.  The exception to this is volunteers as they are not paid providers.
• How do you communicate disagreements in care or compatibility if the care relationship does not appear to be working after a few weeks or months?
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Asking these types of questions will help elicit an idea of who you are hiring and whether or not they will be a fit for your family.  Leaving care up to someone outside your trusted circle can be stressful, so it is important to know who is in your home and who is providing your care.
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Checking Reviews and References

Once you feel you have settled on a caregiver, ask for reviews and/or references.  This is especially important if they are a freelance provider who is not affiliated with an agency.  Understanding who they have worked for, how recent was their last employment, and how satisfied their last client was with care are all important factors to know.

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Clara simplifies this process by background checking, vetting, and getting to know every caregiver they work with. While it's always a good idea to establish your own relationship with any caregiver, Clara can provide a trustworthy foundation for your care.
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Navigating the Costs of Care

Deciding on in-home care is a time-intensive process.  Even though the need to find care may feel imminent and you may feel pressured to get it done now, it is recommended to take your time and make decisions the best you can with the information you have. 
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You can always change your plans, and you should allow grace for yourself as in-home care planning is a learning process.

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This article was reviewed and fact-checked by Megan Jones, MSW, LSWAIC. 
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Sources 

Bureau of Labor Statistics, U.S. Department of Labor, Occupational Outlook Handbook, Registered Nurses,

at https://www.bls.gov/ooh/healthcare/registered-nurses.htm. Accessed 5 August 2024.

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Bureau of Labor Statistics, U.S. Department of Labor, Occupational Outlook Handbook, Nursing Assistants and Orderlies,

at https://www.bls.gov/ooh/healthcare/nursing-assistants.htm. Accessed 5 August 2024.

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Bureau of Labor Statistics, U.S. Department of Labor, Occupational Outlook Handbook, What Registered Nurses Do,

at https://www.bls.gov/ooh/healthcare/nursing-assistants.htm. Accessed 5 August 2024.

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Bureau of Labor Statistics, U.S. Department of Labor, Occupational Outlook Handbook, Home Health and Personal Care Aides,

at https://www.bls.gov/ooh/healthcare/home-health-aides-and-personal-care-aides.htm. Accessed 5 August 2024.

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Genworth Financial Inc. "Cost of Care Survey." Gentworth, 22 Feb. 2024, www.genworth.com/aging-and-you/finances/cost-of-care. Accessed 5 Aug. 2024.

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Genworth Financial Inc. "Genworth Releases Cost of Care Survey Results for 2023: Twenty Years of Tracking Long-Term Care Costs." Gentworth Investor Relations, 12 Mar. 2024, investor.genworth.com/news-events/press-releases/detail/972/genworth-releases-cost-of-care-survey-results-for-2023. Accessed 5 Aug. 2024.

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National Council on Aging. "What Is Medicaid Spend Down?" NCOA, 20 Feb. 2024, www.ncoa.org/article/what-is-medicaid-spend-down. Accessed 5 Aug. 2024.

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Stanley, Maureen, and Matthew Clem. "How Much Does Companion Care Cost?" Senior Living.Org, 25 Jun. 2024, www.seniorliving.org/companion-care/costs/. Accessed 5 Aug. 2024.