In-home care is a broad term that covers a range of supportive services, from non-medical assistance to medical care. The idea of providing as much care as possible at home is gaining traction due to cost savings and patients' and their families' preferences.
You may also have heard about the Hospital at Home programs that offer in-patient-level care in someone’s home. However, until those programs become more widely available, families will depend on other in-home care services to assist a loved one after an illness or surgery.
We will review the in-home care options, what each covers, and how to pay for support when health insurance doesn’t cover it. Understanding the available in-home care services will prepare you to respond to your loved one’s care needs with less stress and more confidence.
Understanding In-Home Care
The definition of each in-home care service will differ slightly depending on where you live, your insurance coverage, and available service providers.
What is In-Home Care?
In-home care is any supportive medical and non-medical care allowing someone to remain safely at home. There are significant benefits to in-home care.
- Less exposure to infections
- Reduces or eliminates the need for transportation to providers, which can be a barrier for many older adults
- Provides care in the familiarity and comfort of home
- Facilitates visits from friends and family
- Allows patients to stay connected to their community
- Can offer family caregivers respite from the responsibilities of caregiving
Types of In-Home Care Services
There are three primary in-home care services: Homemaker (also called in-home care or personal care), Home Health, and Hospice. Let’s examine each in the context of benefits, length of service, and payor source.
In-home care (Homemaker or personal care services)
In-home care is the foundation of much of the care someone needs after surgery, general decline, or an illness. Since in-home care is typically private pay (unless you have long-term care insurance or Medicaid), there is no time limit on services. In-home care is best provided by qualified professional caregivers, like those listed on Clara's caregiver matching service.
Home Health
Home health is a skilled medical service covered by insurance when specific criteria are met. Home health is typically time-limited except under particular circumstances.
Hospice
Hospice is end-of-life care. To receive hospice care, a physician must certify that you have a terminal illness and that you will likely die within six months. Hospice is also covered by both Medicare and Medicaid.
Benefits of In-Home Care
Very few people want to move to institutional care as they age. A setback such as surgery, worsening of a medical condition, or general age-related decline can disrupt everyone’s life, especially with hospitalization. The goal is to return or remain at home as long as safely possible, and to do that, in-home care is necessary to improve health and promote independence.
Comfort and Familiarity
The benefits of receiving care at home can’t be underestimated. A familiar home environment has these advantages.
- The comfort of home enhances well-being and can reduce stress and anxiety.
- Being at home surrounded by memories and personal items can improve mood.
- Caregivers can offer flexible scheduling that is compatible with personal preferences.
- When people are at home, they typically feel more confident and in control.
Personalized Care
Caregivers can offer care that accommodates personal preferences and goals. Caregivers can encourage clients to re-engage with familiar routines. Other benefits of personalized care:
- When people are involved in decisions about their care, they are more motivated to improve.
- In-home care can flex to the client’s changing needs and goals
- Care in the home can expose potential problems, such as the need for adaptive equipment or other assistive devices.
Family Involvement
Family involvement is a critical piece of recovery and well-being. Simply put, family visiting a loved one at home is easier and more convenient than in the hospital or assisted living. Other advantages include:
- The ability for the family to be closely involved in tracking progress, identifying problems, and making suggestions to care staff
- Family members can communicate their loved one’s preferences to care staff.
- Family can coordinate and facilitate visits from friends.
- In-home care encourages increased family involvement. It is common for family members to be unaware of growing problems until a crisis occurs.
Who Typically Needs In-Home Care?
People who typically need in-home care cover a wide range of conditions and situations.
Older Adults with Chronic Conditions
Approximately 95% of older adults have at least one chronic medical condition. Any chronic condition requires careful monitoring and can affect daily functioning. Typical age-related medical conditions include:
- Heart disease
- Diabetes
- Arthritis
- Hypertension
- Obesity
- Chronic kidney disease
- High cholesterol
- Heart failure
- Alzheimer’s and dementia
- Depression
Home care can have significant benefits in managing and treating these conditions by:
- Ensuring adequate dietary and fluid intake
- Checking vital signs
- Encouraging healthy habits such as exercise and proper nutrition
- Medication management and oversight
- Assisting with diabetic blood checks
- Monitoring for any significant physical and cognitive changes and reporting those to family
- Assisting with activities of daily living for clients who need it
- Assessing fall risk by clearing clutter, standing by for transfers, and recommending adaptive home additions
- Providing respite to family caregivers
Individuals Recovering from Surgery
Surgery for an older adult can be a traumatic experience. Recovery time is slower, and the effects of anesthesia can be long-lasting. Some patients opt for skilled nursing stays, which are time-limited, while others go directly home. In-home care can mean the difference between remaining at home during recovery or returning to the hospital.
Benefits include:
- Reinforcing discharge orders such as activity/rehab and dietary recommendations
- Monitoring for physical changes
- Stand-by assistance for bathing, dressing, and walking to ensure safety and prevent falls
- Communication with family about progress and any potential problems
- Shopping and meal preparation
- Transportation to outpatient follow-up visits with health providers
People with Disabilities
Disabilities affect people of all ages. Disabilities can be acquired, but many are lifelong and include:
- Hearing and vision loss
- Intellectual disabilities
- Cerebral palsy
- Traumatic brain injuries
- Attention Deficit Hyperactivity Disorder
- Autism
- Mental health conditions
For some families, in-home care is a permanent situation that helps relieve the burden of the family caregiver. Depending on the disability, in-home care can help with the following:
- Ensuring safety by monitoring the client and the home environment
- Communicating changes or problems to family
- Reinforcing treatment goals
- Managing medications and any dietary recommendation
- Engaging in appropriate activities to improve mood and motivation
- Providing companionship to reduce loneliness and isolation
Patients with Dementia or Alzheimer’s
Patients with dementia or Alzheimer’s have unique challenges, and their struggles can be heartbreaking for families. In-home care can provide valuable support for families and ensure safety. In-home care can assist with:
- Activities of daily living such as bathing, dressing, and grooming
- Meal preparation and cooking
- Monitoring medication compliance
- Engaging in cognitively appropriate activities to reduce agitation
- Communicating changes to family and healthcare providers
- Decreasing loneliness
Types of In-Home Care Services
In-home care services continue to evolve with one goal: keeping people at home for as long and as safely as possible.
Personal Care Assistance
Personal care assistance covers much of what we do daily without giving it much thought until we have an accident or illness. Personal care services include:
- Assistance with bathing, dressing, and grooming
- Shopping, meal planning, and preparation
- Medication reminders
- Assistance with transfers
- Oral care
- Using the toilet and incontinence care
- Help with daily tasks such as bill sorting, shopping lists, medication pick up, etc.
Companionship Care
Companionship care is a service that can be provided as a stand-alone option or in conjunction with personal and medical care. Companionship care can have significant benefits, such as:
- Helping people feel less alone and isolated
- Improving mood by facilitating preferred activities
- Engaging in stimulating conversation
- Encouraging independence and increasing motivation to recover and gain independence
- Providing respite for family caregivers
Skilled Nursing Care
Skilled nursing care is a service that is typically administered through insurance. Sometimes, home care companies contract with nurses to offer nursing as a private pay option. Most states require a licensed nurse to provide any medical care, which can include:
- Managing, monitoring, setting up and administering medications
- Wound care
- Catheter care
- Injections
- Monitoring vital signs
- Recommending durable medical equipment
- Patient education about managing conditions
- Coordination with the primary care physician and other health professional
Specialized Medical Care
Specialized medical care is tailored to specific conditions and diseases and may require advanced expertise and technology. Examples are cancer care, Alzheimer’s and dementia, cardiology, and neurological disorders such as Parkinson’s disease.
When someone requires specialized medical care, personal care services can tailor their assistance to support patient and nursing goals.
Costs of In-Home Care
Let’s examine in-home care costs and the factors that affect costs.
Average Costs
- In-home Personal Care: Monthly median cost is $30.90. With Clara, this cost is usually 20-30% lower.
- Skilled Nursing Through Home Health: Typically covered by insurance
- Specialized Medical Care: This could be covered by insurance through home health or palliative care benefits.
Factors Influencing Costs
For in-home personal and companion care, many factors can influence cost:
- Where you live. Some more rural areas will charge much less than the median cost due to fewer customers. Caregivers in larger cities with a higher living cost will generally charge more per hour.
- The higher the number of hours of care, the higher the cost
- If you require a CNA (Certified Nursing Assistant), you will pay $33.99 per hour, depending on your location.
Cost Comparison: In-Home Care vs. Other Care Options
The cost of in-home care depends on the number of care hours needed. Assisted living costs depend on the level of care someone requires. Assisted living costs typically start with a base rate and then add additional costs the more care someone needs.
For example, the highest level of care in assisted living entails assistance with all activities of daily living along with on-demand assistance 24/7. So, consider the pricing below in the context of all the factors influencing costs.
- In-Home Care Costs: The hourly median cost in the US is $30.90.
- Assisted Living Costs: The monthly median cost in the US is $5,511
- Nursing Home Care Costs: The monthly median cost in the US is $8,929 for a shared room.
Financial Assistance and Payment Options
There is financial assistance for in-home care, and some services are covered by insurance.
Medicare and Medicaid
Medicare pays for skilled nursing home health and hospice care. Home health has specific qualifying criteria and is time-limited. As part of the service, you can expect a home health aide to assist with bathing and dressing up to three times a week.
Medicaid is a medical program for low-income individuals, and in-home services vary by state. However, most states have programs that can assist in paying for in-home care if you meet the criteria.
Private Pay and Long-Term Care Insurance
Many families pay privately for in-home personal care using savings or retirement funds. Most long-term care insurance policies cover in-home personal care once you have met the required criteria.
There is typically a maximum per day rate, and you may have an elimination period in which you will pay out of pocket until benefits become effective. The Clara team can help you identify and navigate these details with a free 30 minute consultation.
Veterans Benefits
For veterans and their spouses, benefits may include VA pension benefits and or the Aid and Attendance program. Both programs provide a cash benefit that can be used towards in-home care costs.
Nonprofit and Charity Assistance
Local nonprofit or faith-based organizations may be able to provide in-home care. Contact your Area Agency on Aging to find resources in your area.
Choosing the Right In-Home Care Provider
Choosing the right in-home care provider can take some time as you vet different agencies and get recommendations.
Assessing Care Needs
Assessing care needs involves a detailed review of functional and physical requirements.
Some specific areas to evaluate:
- Ability to perform activities of daily living
- Assessing mobility and fall risk
- The need for someone to do meal preparation
- Assistance with toileting
- Medication management and compliance
- Any skilled nursing needs
- Respite for family caregivers
- Any cognitive issues like dementia or Alzhiemer’s disease
Evaluating Care Providers
If you live in a larger urban area, you could have many in-home care providers to choose from.
Some factors to consider:
- Qualifications and required training
- Are care providers experienced in working with various client issues and conditions?
- Recent references from several families
- Any emergency training, such as CPR
Questions to Ask Potential Providers
Here are some key questions to ask any potential care provider:
- Do you provide liability insurance for your customer and the caregiver, and do your caregivers have to pass background checks?
- What do you do if a caregiver misses a shift? Do you have replacement caregivers to fill in?
- Specifically, what training do you require of your caregivers?
- How much input do I have regarding the caregiver we choose?
- How often is the plan of care updated?
- Who do I communicate with regarding concerns or problems?
- How is information from the care provider communicated to the family?
Clara's care team provides a complete service offering and is available to discuss these questions, and any others 7 days a week. Schedule a free consultation here.
Tips for a Smooth Transition to In-Home Care
Introducing a care provider to a loved one can be challenging and requires sensitivity and transparent communication. Try to involve your loved one as much as possible through the transition so they feel empowered to help make decisions.
Preparing the Home
Consider what a caregiver needs to serve your loved one best.
- Ensure that supplies, such as wipes or continence care supplies, are readily available.
- Shop for foods that you know your loved one prefers.
- Set up medications for medication reminders.
- Have clean clothes ready for dressing and undressing
- Clear any clutter that might interfere with safe caregiving
- If grab bars are needed for safe bathing, install those before caregiving begins
Communicating with Caregivers
Communication with a caregiver will ensure quality care by setting expectations and clarifying misunderstandings.
Try to be respectful, considerate, and clear in your communication. The vast majority of caregivers want to provide the best care possible.
Involving Family Members
Family members typically want to be as involved as possible in care planning, and they should be.
As a family, try to reach a consensus with your loved one on goals, preferences, and expectations. Not everyone may agree on everything, but keeping everyone involved will avoid conflict and hurt feelings.
In-Home Care: The Key to Safe and Successful Recovery
In-home care supports a range of ages and diverse needs with the goal of safe and effective recovery. In most cases, home is where people feel most comfortable and able to regain as much independence as possible.
This article was reviewed and fact-checked by Megan Jones, MSW, LSWAIC.
Sources
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The National Council on Aging. (n.d.). https://www.ncoa.org/article/get-the-facts-on-healthy-aging
Cost of long term care by state | Cost of care report. (n.d.-c). Genworth. https://www.genworth.com/aging-and-you/finances/cost-of-care
Home health services. (n.d.-c). Medicare. https://www.medicare.gov/coverage/home-health-services
VA pension benefits | Veterans Affairs. (2024, July 19). Veterans Affairs. https://www.va.gov/pension/#get-va-pension-benefits
VA Aid and Attendance benefits and Housebound allowance | Veterans Affairs. (2024, July 18). Veterans Affairs. https://www.va.gov/pension/aid-attendance-housebound/
Eldercare locator. (n.d.-d). https://eldercare.acl.gov/Public/Index.aspx
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