Home is where most people would prefer to be if they are sick or recovering from an accident or illness. The benefits are significant—the comfort of familiar surroundings, the ease with which friends and family can visit, and a sense of dignity and control.
We will review how the types of in-home care services work and which are most appropriate for your situation. The goal is to design a safe and effective plan to help you recover and regain your independence.
Overview of In-Home Care Services
In-home care services can seem complicated and overwhelming. Part of the confusion comes from terminology, insurance coverage, and the types of tasks that each discipline can provide.
1. Personal Care Services
Personal care services are at the heart of in-home care. If you think about a typical day, you perform scores of tasks without thinking about them. However, when you cannot do those simple tasks due to an accident or medical event, your independent functioning is compromised. If you have ever broken a leg, wrist, or shoulder, you know how hard it can be to take care of yourself.
Personal care service providers assist with the following:
- Dressing and undressing
- Bathing
- Hygiene and grooming such as shaving, hair cutting, etc,
- Assistance with transfers
2. Companionship Care
Companionship care is an underappreciated service that can significantly impact mood. When people feel supported, stimulated, and engaged, their mood improves, which in turn helps with recovery.
Companionship care is tailored to the individual’s preferences and cognitive functioning:
- Reminiscing can help people with dementia improve their quality of life and reduce symptoms of depression.
- Engaging in mentally stimulating activities keeps people interested and motivated. Activities include games, conversation, crafts, trips to cultural events, and being read to.
- Reinforcing healthy habits like hydration, good nutrition, and approved physical exercise.
- Facilitating social interactions with others to reduce isolation and loneliness. This could involve assisting with technology and helping plan visits with friends and family.
3. Homemaker Services
Homemaker services are all those household tasks that could become challenging due to age or disability. They include assistance with:
- Shopping
- Meal planning and cooking
- Laundry
- Light housekeeping
- Running errands
- Picking up medications
- Sorting mail
Homemaker services ensure that someone gets proper nutrition, maintains a safe household, and gives family members peace of mind.
Medical and Health-Related Home Health Care Services
The previous in-home care services we described are nonmedical and, therefore, not covered by most insurance plans. However, medical care may be required following a hospitalization or exacerbation of a medical condition.
4. Skilled Nursing Care
Skilled nursing care through home health is an insurance-covered benefit ordered by a physician. Nursing services are typically time-limited and do have qualifying criteria.
Nurses provide these medical home health care services:
- Health monitoring, such as blood pressure, oxygen, and temperature
- Wound care
- Tracking and administering medications
- Giving injections
- Coordinating and ordering any durable medical equipment
5. Physical Therapy
Physical therapists are licensed professionals who diagnose and treat a range of injuries, disabilities, and health conditions due to general decline, accident, or illness.
Physical therapists take an individualized approach to recovery by:
- Developing a treatment plan that works with patient goals and needs
- Assisting with increasing mobility, strength, and endurance
- Assessing pain and recommending exercises to reduce pain and discomfort
- Educating patients about safe movement and posture
- Recommending mobility aides such as walkers or canes
6. Occupational Therapy
Occupational therapists work with people who experience physical, cognitive, or emotional challenges that affect their ability to engage in everyday activities or occupations. There may be some overlap with physical therapy.
However, here are some ways occupational therapists help patients regain function:
- Improve fine and gross motor skills
- Practice techniques to improve thinking and memory
- Provide recommendations for home or work modifications to improve accessibility and safety
- Make recommendations for assistive devices such as eating utensils and grab bars
7. Speech Therapy
Speech therapists focus on two main areas: evaluating and treating communication disorders and swallowing problems. Speech therapists use a variety of techniques, such as:
- Mouth and tongue exercises
- Improving motor skills through facial movements
- Reading out loud to improve speaking
- Playing word games
- Provide instruction on how to chew and swallow safely
- Recommendations for modified diets
8. Medical Social Services
Medical social workers help patients and families deal with the emotional and social consequences of medical conditions.
Their role is to assist families with navigating the healthcare system and coping with illness by:
- Providing emotional support and counseling
- Advocating for patients with health providers
- Assisting with connecting patients and families to additional support resources in the community
- Educating patients about insurance benefits and helping them apply for any benefits they are entitled to
- Helping patients complete documents such as advance directives, living wills, and power of attorney.
Specialized In-Home Care Services
Many people requiring in-home care services have specialized needs that necessitate specific training and approaches.
9. Alzheimer’s and Dementia Care
Alzheimer’s and dementia care is complex due to the diverse and unique needs of people who suffer from cognitive impairment. Some people may be at the beginning of the disease, and others may be in advanced stages.
In-home care services respond to changing priorities and goals but, in general, assist with the following:
- Ensuring safety by monitoring activities and recommending safety features
- Keeping people stimulated and active to reduce agitation and improve sleep
- Assisting with activities of daily living such as cooking, dressing, bathing and housekeeping
- Reinforcing healthy habits such as hydration and proper nutrition
- Monitoring medication compliance
- Communicating with family members about any changes or healthcare needs
10. Palliative and Hospice Care
Hospice and palliative care are not round-the-clock unless someone is in a hospice facility. Most people with a terminal or serious illness have many hours of uncovered care needs. In-home services can fill the gaps in care by:
- Changing briefs or helping to the toilet
- Assisting bed-bound patients with eating and drinking
- Grooming and bathing
- Companionship
- Running errands
- Keeping families informed of changes and needs
11. Respite Care
Many families provide at least some care to a loved one, and some devote many hours of caregiving daily. Caregiving is more than just stressful, it also affects people’s work and social lives, taking an economic and emotional toll. Respite care, temporary relief for family caregivers, give family time to attend to obligations, engage in preferred activities, and connect with other friends and family. Respite care is flexible and tailored to family caregivers' changing needs.
Choosing the Right In-Home Care Service
If you live in a larger city, you could have scores of in-home care service providers to choose from. Let’s examine the steps to finding the best fit for your family.
Assessing Care Needs
Assessing care needs is a multi-step process that requires patience and flexibility. Care needs change, and part of the process involves anticipating what your loved one needs now and in the future.
Here are some questions to answer that will help guide you:
- Does your loved one have complex medical needs? If so, you may need to augment with home health.
- What are your loved one’s functional limitations? Consider dressing, bathing, mobility, transportation, shopping, and cooking.
- Does the person needing help have dementia or other cognitive problems that require specialized training and safety monitoring?
- Is medication organization and compliance an issue? You may need a nurse or a family member to assist with setting up medications, and caregivers can give reminders.
- Is loneliness and social isolation caused by your loved one’s inability to access friends and family a cause for concern?
- Are long-term medical issues likely to worsen over time, requiring additional care hours?
- Does someone need to assist with household maintenance tasks such as snow shoveling, lawn care, and general repairs?
Evaluating Care Providers
Evaluating in-home care providers should be a careful and thorough process- after all, you are entrusting someone you love to a care professional. These are some factors to consider when deciding.
Qualifications and Training
When evaluating care providers, ask about specific caregiver training. Some examples include dementia, transfer, safety, and emergency response training.
Experience
Ask about how many and what kinds of clients a care provider has worked with. If a care provider has no experience working with someone with dementia, it doesn’t necessarily mean they won’t do well with them. However, having experience with safety issues and behavior challenges can be beneficial.
References
Always ask to speak with other clients that the care provider has worked with. Prepare a list of questions.
Compatibility
Compatibility can be tough to predict, but there may be specific personality styles you think would work better with a loved one.
Financial Considerations
Most insurance plans cover home health services, but in-home personal care services are private pay unless you have long-term care insurance.
Call your local Area Agency on Aging to inquire about resources to assist with payment, including Medicaid and Veterans' benefits. Consider meeting with a financial planner to discuss leveraging your assets to pay for in-home care.
Benefits of In-Home Care Services
Without in-home care services, families would have to consider institutional care for a loved one or provide that care themselves.
Comfort and Familiarity
Most people want to be home as they age, and approximately 88% of older adults want to remain in their homes for as long as possible.
The reasons are clear: People like the familiarity and comfort of being at home where their community is. Most older adults experience some age-related decline, and in-home care provides the support necessary for people to remain at home.
Personalized Care
It may seem like a cliche to say everyone is different, but it is true. Every person has unique needs, personality styles, likes and dislikes, and goals for recovery and care. In-home care is person-centered care that tailors care to the individual.
Family Involvement
Family involvement is critical to providing and improving care. In-home care providers communicate changes, problems, and concerns along with improvements.
This article was reviewed and fact-checked by Megan Jones, MSW, LSWAIC.
Sources
Kennard, C. (2022, April 24). Reminiscence Therapy for Alzheimer's Disease. Verywell Health. https://www.verywellhealth.com/reminiscence-as-activity-and-therapy-97499
Area agencies on aging. (n.d.). https://eldercare.acl.gov/Public/About/Aging_Network/AAA.aspx
Older adults’ preparedness to age in place. (2022, April 13). National Poll on Healthy Aging. https://www.healthyagingpoll.org/reports-more/report/older-adults-preparedness-age-place
