Picture this scenario: Your mom is in her 80s. She lives alone and very much wants to remain in her home as long as possible. However, she really shouldn’t be driving any more because of a decline in her eyesight. She also has some physical issues that put her at risk of falling.
You’ve been pitching in as much as you can—running errands for her, making meals and helping out around her house. However, you’re starting to feel overwhelmed and are wondering whether to hire someone to help care for your mom.
“Caregivers often feel they should take this all on but are juggling so many things,” says Lakelyn Hogan Eichenberger, gerontologist and caregiving advocate at Home Instead, the largest provider of in-home care services. “Having some in-home support can allow them to be a son or daughter again.”
In-home care for aging loved ones can be a great solution for those who can afford it when care needs exceed what family and friends can provide. Here’s what to know about hiring care providers and how to pay for this sort of care.
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What is in-home care?
There are two primary types of home care. Home health care is provided by medical professionals and can involve nursing care, physical therapy or speech therapy. It requires a healthcare provider’s order or prescription and is covered by Medicare.
In-home care is non-medical care that involves assistance with activities of daily living and instrumental activities of daily living. Activities of daily living are bathing, dressing, eating, toileting, transferring (in and out of chairs or a bed) and continence. Instrumental activities of daily living include driving, meal preparation, housekeeping, managing medication and managing finances.
Medicare doesn’t cover the cost of non-medical in-home care. So it’s up to the person receiving the care to pay for it. There are a variety of ways to cover the cost (more on that below).
When it’s time to consider in-home care
Families typically don’t consider in-home care for a loved one until a crisis happens, Eichenberger says. However, you shouldn’t wait for an emergency to seek care. “If you start to notice your loved one needs help, it’s better to have a conversation sooner rather than later,” she says. Here are a key signs that you should consider hiring a home care provider:
- Your loved one can no longer drive (or shouldn’t be driving).
- Your loved one can no longer manage household tasks, such as cleaning and doing the laundry.
- Your loved one needs help with dressing and personal hygiene.
- Your loved one is having trouble preparing meals or eating regularly.
- Your loved one is forgetting to take medications.
- Your loved one is showing signs of memory loss or has been diagnosed with dementia.
- Your loved one has had a fall and is prone to falling again.
“Home care can be a great way to start before making the next step to a facility,” Eichenberger says. It might even be a way for your loved one to remain at home indefinitely.
[ See: Signs Your Loved One Needs Assisted Living ]
How to find in-home care providers
You have several options when it comes to finding home care providers for your loved one.
Home care agency: Agencies such as Home Instead, Visiting Angels and TheKey (formerly Home Care Assistance) employ caregivers then match them with individuals who need care. An agency will screen, train, bond, insure, supervise and handle payroll and taxes for caregivers. It also can provide a back-up caregiver if the one who typically cares for your loved one calls in sick. Hiring a caregiver through an agency can be more expensive than the other options, but it can be worth the extra expense because the agency handles all employment responsibilities, Eichenberger says.
Home care registry: Registries such as Care.com are online platforms or services that connect caregivers with people who need care. The caregivers are not employees of the registry; they are independent contractors. However, registries typically do background checks or some screening of caregivers. Going through a registry to find a caregiver can be cheaper than using an agency. Plus, you can choose the caregiver you want rather than have one assigned, which is what agencies do.
Independent caregivers/privately hired workers: You may be able to find a caregiver for your parents on your own by asking for recommendations from friends or family or placing an ad. The benefit is that you can choose the person who cares for your loved one. You also can negotiate payment. However, it’s also up to you to check references, reach out to local law enforcement to see if a background check can be run on the caregiver, and handle payments and taxes (as a household employee, taxes must be withheld from the caregiver’s pay).
Questions to ask when hiring in-home care providers
Whether you plan to hire a caregiver on your own or through an agency or referral service, you should ask several questions to ensure your loved one will receive quality care.
For independent contractors:
- What sort of caregiving training and experience do you have – and can you provide documentation?
- Do you have specialized training in dementia care (if your loved one has dementia)?
- Do you have CPR or first-aid training?
- What sort of assistance/care services are you able to provide?
- Can you provide references?
- Do you have liability insurance?
- What is your hourly rate, and do you require a minimum number of hours of work per day, week or month?
- Can you provide personal information (name, address, Social Security number and photo ID) so that a background check can be conducted?
If you hire an independent contractor, Eichenberger recommends drafting a written care agreement and asking the caregiver to sign it. Also, keep records of the hours worked, and consider hiring an account to help with the tax implications of hiring a household employee.
- What sort of training do you provide caregivers?
- Do you provide caregivers specialized training in dementia care?
- Have you done background checks, drug screenings and reference checks for all caregivers?
- Are caregivers bonded and insured?
- Is care personalized to meet the needs of the individual?
- Do you require a minimum number of hours per day or week?
- How much flexibility is there in setting a schedule for services?
- Can you provide back-up caregivers if the primary caregiver is unable to work?
- What happens if the person who needs care doesn’t like the caregiver who is assigned?
- How do you communicate to keep families informed?
- What is the cost? Are rates higher for overnight stays? Is a deposit required?
- What is the cancellation policy?
- Can you provide contact information for other families that have used your service?
How to pay for in-home care
Round-the-clock in-home care can be a lot more expensive than an assisted living facility—about $19,000 a month versus $4,500 a month, according to Genworth’s 2021 Cost of Care Survey. However, you can reduce costs by reducing the number of hours that care is provided. For example, the median monthly cost for 40 hours a week of in-home care is about $4,500, according to Genworth.
Medicare does not pay for non-medical care at home. However, Medicaid does pay for long-term care at home for low-income adults in many states if your loved one meets the eligibility requirements. If your loved one doesn’t qualify for Medicaid, he or she (or you) can pay for home care in a variety of ways.
If your loved one has a long-term care insurance policy, it might cover the cost of care at home. Newer policies typically do, but some older policies don’t cover home care, Eichenberger says.
Life insurance can help cover the cost of care if it is a permanent policy (whole life or universal life) with a long-term care benefit or with cash value that could be tapped. A life insurance policy also can be sold to a life settlement company for cash if your loved one is at least 65 years old. Or there might be an accelerated death benefit rider on the policy that can be used to get a portion of the death benefit if your loved one has a life expectancy of 12 months or less.
Of course, your loved one could use savings or investments to pay for care. A reverse mortgage also is an option if your loved one is at least 62 years old and owns his or her home outright or has paid off most of the mortgage.
[ Read: How to Pay for Long-Term Care ]
Consider home care as soon as your loved one starts showing signs that he or she needs help rather than wait for a crisis. Review your loved one’s financial resources and explore care options to determine which is the best fit.
[ Keep Reading: How to Protect Parents From Financial Exploitation by Caregivers ]