Home care for seniors: Is it right for you?

Table of Contents

• What is home care?
• Benefits of home care
• When to get home care
• Services provided by home care
• Types of home care providers
• Cost of home care
• Paying for home care

What is home care?

Home care describes the support services and assistance with daily living activities that are provided to you at your home.

Also called in-home care, at-home care, or domiciliary care, “home care” typically refers to non-medical care, while “home health care” refers to medical care or therapy that is prescribed by doctors and provided by health professionals.  Sometimes, “home care” may be used as an overarching term that includes both non-medical and medical care, but this article uses it to mean non-medical only.

Benefits of home care

With home care services, you can live more safely and securely, maintain greater independence, and enjoy a higher quality of life.  Meanwhile, you get to enjoy the comfort of your own home, remain in a familiar environment, and stay close to people in your neighborhood and community.

Many seniors use home care as a way to “age in place” – an alternative to (or transition before) moving into a senior care home.  Depending on how much assistance you need, home care also can be more affordable than a senior community that makes help available around the clock.

When to get home care

Home care is a good fit for people who need some help with activities of daily living, whether as a result of aging, illness, disabilities, surgery, or a health condition.  Signs include having difficulty with:

• Walking and moving around at home, balancing, navigating stairs
• Grooming, getting dressed
• Using the toilet, bathtub, or shower
• Cleaning and maintaining the home, doing laundry
• Preparing food
• Driving safely
• Remembering to take medication and pay bills, keeping organized
• Staying interested in previous hobbies and activities

While mobility aids and home modifications can help seniors accomplish some ADLs and IADLs, home care can go further and provide more personalized assistance.

Home care is not a good fit for people who need medical care or have advanced cognitive impairment.  For those situations, home health care would be appropriate.

Services provided by home care

There are two categories of home care: personal care and companion care.

Personal care, also called personal attendant services or custodial care, provides non-medical assistance with the activities of daily living (ADLs), which are considered basic, self-care tasks.  This level of support is typically provided by assisted, but not independent, living communities.

1. Bathing, showering
2. Grooming, oral care, personal hygiene
3. Dressing
4. Toileting (including transfers on and off the toilet, cleaning up afterwards)
5. Transferring, ambulating (i.e. moving from one place to another, which includes getting in and out of bed and chairs, changing positions)
6. Eating, feeding (excludes managing feeding tubes)

Companion care, also called homemaker services, provides help with the instrumental activities of daily living (IADLs). These are considered not fundamentally necessary, but needed for living independently.  This level of support is typically provided to some extent by both assisted and independent living communities.

1. Cooking and preparing meals
2. Cleaning and maintaining the home, laundry, trash removal
3. Shopping for groceries and other supplies
4. Driving you to medical appointments, errands, and social activities
5. Reminding you to take medication
6. Reminding you to pay bills, helping to fill out forms
7. Communicating with others by phone, mail, email, etc.
8. Socializing with you, engaging in hobbies and activities

This article, Home Care For Seniors: Is It Right For You?, has been written and published by Senior Wing.

Types of home care providers

There are a few different providers of home care: independent providers, agencies, and the Village Movement.

Keep in mind that not all independent caregivers or agencies may provide all types of home care services.  Be sure to check if the provider you’re considering offers personal care, companion care, or both.

The Village Movement

The Village Movement is a nonprofit organization consisting of local villages that provide senior services that include companion care, but not personal care. They charge membership fees, but the cost is far lower than what you’d pay a caregiver or agency because the services are provided by volunteers.

Combine different care approaches

Some people use a combination of caregiving approaches to meet their specific needs:

• If you have a family caregiver, but that person is not physically strong enough to lift you when needed, supplement with a paid caregiver for tasks involving transferring
• If you have a family caregiver, but that person holds another job, bring in a paid caregiver during those specific times
• To keep costs down, hire an ongoing caregiver for select tasks.  Then hire someone to implement home modifications to make your surroundings safer and more secure, and set up an alert system for overall monitoring as well.
• If you and your spouse need different levels of care, bring in a caregiver to help fill the gaps

Note that home care providers do not include social workers, nurses, doctors, therapists, or other medical professionals, as they are considered home health care.

Cost of home care

According to the U.S. Bureau of Labor Statistics, personal care aides are paid a median rate of $14/hour, with 80% of people earning an hourly rate between $10.72 and $17.79.

Meanwhile, the Genworth Cost of Care Survey finds that home care agencies currently charge a median rate of $26/hour nationwide.  Enter your ZIP code into their site to see how the cost will vary for your location.

Note that costs will vary not only by location, but also by the type of service desired, with companion care at the lower end and full personal care at the upper end.

Compared to senior care communities, home care will be more affordable if you need limited hours of assistance that can be scheduled in advance.  If you are looking for care that is available at all times or on-demand, then a senior care community will be the more economical choice.

Paying for home care

What are your options for paying for home care?  Check all of your insurance plans to see if any cover home care.

• Private pay:  Most people pay for home care out-of-pocket.
• Tax credits for family caregivers:
  • If a family caregiver qualifies to claim you as a dependent on their tax return, they may be able to receive up to a $500 credit as a result of the Child Tax Credit being expanded to include “Credit for Other Dependents.”  Additionally, if the family caregiver has a Dependent Care FSA through their employer, they may be able to pay for your home care expenses using pre-tax dollars.  Check with your CPA for details.
  • Alternatively, even without claiming you as a dependent, family caregivers may be able to claim the Child and Dependent Care Credit if they paid for caregiving costs in certain situations.  Again, check with your CPA for details.
• Medicaid:  Some states may have a Medicaid Consumer-Directed Personal Assistance Program, sometimes called a “cash and counseling program.”  These can include Home and Community Based Services (HCBS), some of which cover ADLs and/or IADLs.  Check on your state’s specific policies.
• Medicare:  Home care is not covered by Medicare Part A or Part B.  Some Medicare Advantage plans (Medicare Part C) may cover some home care services; check with your provider.
• Veterans:  Veterans who need help with ADLs and/or IADLs may be eligible for additional funds through two programs:
  • VA Aid and Attendance or Housebound benefits
  • Veteran-Directed Care program, which is comparable to the Medicaid Consumer-Directed Personal Assistance Program 
• Long-term care insurance:  Some policies may cover home care services once the client qualifies by needing help with at least 2 ADLs.  Check with your insurance provider.
• Life insurance:  Some policies may pay for home care services.  Check with your insurance provider.
• Health insurance:  Most private health insurance plans do not cover home care.  Check with your insurance provider.
• Worker’s compensation:  If you were injured at work and qualify for worker’s comp, then your home care costs may be covered if prescribed by a doctor.  Check with your doctor and insurance company.
• Reverse mortgage:  If you have equity built up in your home, you may be able to take out a reverse mortgage to get cash that you can use toward home care and other expenses.
• Area Agency on Aging:  Find your local agency using the Eldercare Locator.  Then check on what home care services it provides, sometimes at no cost for lower income seniors.