Deciding to get extra care for a senior at home is often a great relief for you as a family caregiver. If your family member does not need full time home nursing care or really wants to stay home, help is available from a variety of sources.
Involving the senior in the decision from the start often helps make the transition easier. It is important to have good open communication about this type of decision before you start introducing new people into the care team. Good communication methods can help make tough conversations easier. Many elderly people welcome home care because they can have more variety in their day and often feel like they are giving a family caregiver a break.
So, which kind of home care is right for you and your loved one? It depends to some extent on how comfortable you both are with other types of help - and also on what is needed. The more help you can get, the better off you both may be in the long run. Some senior services will be funded by Medicare or Medicaid – but only up to a limit or for a limited amount of time after a hospitalization. You may as well take advantage of these home care services when you can - since many of these are limited.
A social worker will often talk to you both during discharge from a hospital event about eligibility for home care options. You may also want to talk to your family member’s doctor. Some kinds of help are obviously not appropriate for everyone - like hospice for instance - and some will potentially require transportation, which may or may not be included with the service.
Before beginning any service at home, it may be a good idea to talk with and visit at least 2-3 different agencies. Comparing before you commit is a good idea. Some people and places will simply feel like a better fit and/or offer key services that others do not (like transportation – which can make a huge difference). So, shop around and ask lots of questions first!
Sometimes, people use the terms for different types of elderly services incorrectly or interchangeably - and that can cause a little confusion. The following list attempts to clarify the different types of senior home care available:
Government Aging Services
- Area Agencies on Aging (or AAAs), often offer many services for seniors and family caregivers. The types of services vary from region to region, but at the very least, most offer some form of information and referral as a starting point to access senior care services. The national website has a way to find your local AAA.
- In addition, many local AAAs will be able to guide you toward local "family caregiver programs" – which also vary from state to state. These programs sometimes offer financial assistance to you as an informal family caregiver or will offer one-time cash assistance for personal emergency response devices or other home medical equipment. The National family caregiver support program website offers more information.
- The Eldercare Locator: A web-based system to finding senior care services in your area.
- Medicare and Medicaid also offer a lot of information and resources online at www.medicare.gov -including a way to compare what services are offered at your local home health agencies.
What to Expect from a Home Care Worker
Adult Day Care
This is a service for seniors who wish to remain at home, but who need supervision during the day either due to mental or physical limitations. This service allows an elderly person to have a safe environment to go to during the day to interact with others, exercise, learn, and receive some medical services. Transportation, meals, occupational and recreational therapy, personal care, and health services are also usually available. Adult day care is usually during the work week and work hours. Many centers allow for guests to be enrolled full time or for just a few hours per week depending on the needs of the family. Sometimes, Medicare or Medicaid will cover these services and often, they are also offered on a sliding fee scale based on ability to pay. Transportation is a consideration.
PACE Services (Program for All-Inclusive Care for the Elderly)
This is an all-inclusive program for those aged 55 or over who qualify in their state for nursing home residential care, but wish to stay at home. It was developed to save money by delaying the need to enter full-time nursing home residential care as long as possible. The program includes adult day care, home care, and all the medical care – including prescriptions - that one would receive in a nursing home, except they are at their own family home overnight. Medicare and Medicaid partially cover this for qualified individuals. This service is not yet wide-spread – but growing as the demand for it rises. Only in 29 states currently. See the PACE website for more information on this type of care service.
Geriatric Care Management
Typically, paid for out of pocket by the family, a geriatric care manager is hired to provide an assessment of your elderly loved one’s needs and then create a comprehensive care plan involving the senior’s emotional, physical, and mental needs. The care manager is also knowledgeable to coordinate all the paper work and administrative tasks of finding funding for services and enrolling your family member in any programs he or she may be eligible for receiving. This person also assists as needs change and a new care plan is needed. A GCM acts as an advocate for the family in making complex home care decisions and ensures the best fit between the senior’s needs and the facility. Costs vary and some private insurance may cover some of the costs. Most of these case managers work independently rather than with an agency - to find one near you, see their trade association website, National Organization for Geriatric Care Managers.
Hospice is a comprehensive home care service for patients who are not expected to recover and want to live the rest of their lives in comfort at home. Typically, a referral or approval by a doctor is needed to begin hospice services. These services are often provided by home care agencies and include medical and personal care services to help the patient be as physically and emotionally comfortable as possible. While these services are offered in residential and hospital settings, most often, hospice is a home-based service. Medicare, Medicaid, and most major insurance companies usually cover hospice services. Hospice services do not include “cures,” but rather, comfort.
For more Information:
- Hospice Education Institute 800-331-1620 provides information and referrals for hospice care.
- Hospice Foundation of America 800-854-3402 provides education and information on hospice care and offers teleconference series "Living with Grief," newsletter for bereaved families and audiotapes for clergy.
Meals on Wheels
In almost every community across the US, there are variations of affiliated programs called “Meals on Wheels.” Some are run by churches and others by non-profit organizations. Many use volunteers as well as paid workers to make and distribute meals to seniors in their home and/or offer group meals at a central location. The mission of the larger organization is to end senior hunger. Often, there is a sliding scale of fees associated with the program and offerings vary from location to location. Find a Meals on Wheels program in your area.
Home Technology Services
Electronic tools like Personal Emergency Response Systems (PERS) and the SageMinder offer peace of mind. The PERS units are worn as a bracelet or necklace and allow a person to call for help if they cannot reach the phone or have fallen. SageMinder is an automated phone call check-in service to ensure that a person is okay at a pre-scheduled time of the day. SageMinder can also be scheduled multiple times throughout the day to remind a senior to take prescribed medication. Live Operator Care Calls are also available.
Area Agencies on Aging (AAAs) through the Administration of Aging Department, offer a variety of services. Located in most areas, AAA centers usually offer some assistance to seniors and families from information and referral to programs and services like adult day care. These offices are often knowledgeable about local services and qualification for funding. Find a AAA in your area.
Senior Home Care Agencies
Many agencies that fall into this category offer a wide variety of services such as day care, hospice, home care and home health care. Sometimes it is helpful to work with an agency that has a variety of service offerings so that you can stay with the same provider and as your home care needs change over time. Some online sources, such as "seniorhomes.com," offer a greater understanding and listing of local home care agencies.
Home Health Care
This refers to state licensed nurses or other health care professionals who visit the patient at home to perform medical or health related tasks like assistance with medications, dressing wounds, evaluating health status, etc. It can also refer to a doctor, occupational therapist, mental health worker, physical therapist, speech therapist, or other medical specialist visiting the patient at home. Typically, Medicare, Medicaid, and/or insurance will cover a certain amount of home health care visits based on the patient’s needs. These services are provided by individual licensed professionals or are affiliated with a medical clinic, hospital, or home nursing agency.
Home care in general refers to many different types of non-medical or informal aspects of elderly care in the home. It can include home maker services like house cleaning or cooking, companion services, running errands like grocery shopping, and general personal care. Often, homecare agencies employ “certified nursing assistants” or others to perform what is termed as “activities of daily living.” These activities include 6 broad areas: bathing, dressing, transferring from one place to another, using the toilet, eating, and walking. Different agencies will provide a different mix of services. These services can be covered by insurance and/or Medicare, but often are paid for by the family. These services are provided by individuals or home care agencies. Some forms of these types of services are licensed by the government and some are more informal like individuals who offer companion services. The more licensed and regulated the agency or worker, the more you can rely on certain standards being met. Ask questions about certification when you interview for these types of home services.