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Aging in place has become a priority for many older adults. According to a 2018 AARP survey, 3 and out 4 Americans over the age of 50 hope to remain in their current home as long as possible. Some may want to age in place due to an emotional connection to their home or community, while others do so out of a desire to keep their independence. In other cases, it may be a financial necessity to age in place rather than move to a residential senior community.
But, there can be some disadvantages to aging in place, especially for seniors living with chronic health conditions, acute injuries or illness, reduced mobility, and other ailments. For people in these situations, it can be hard to decide whether to age in place and risk their health or safety, or give up their independence to live in a community where assistance will be available.
Home care can be essential for seniors who find themselves in this challenging situation. Obtaining the services of a home care aide or home health care aide can enable seniors to retain their independence and age in place while still having access to the assistance and care that they need. Home care can make aging in place more manageable and safe for older adults of all ability levels.
There are many home care providers for seniors and their families to choose from, as well as different types of home care. In this guide, we explain what services are available with a home care aide, the different types of home care, the cost of home care, and financial assistance options. At the bottom of this page, you’ll find frequently asked questions about home care and a directory of home care providers in your area.
What is Home Care?
Home care is non-medical caregiving and assistance provided in the client’s home. Care may include assistance with activities of daily living (ADLs) such as bathing, transferring, and meal preparation; transportation; companionship; and more. It does not include medical care or therapies. Depending on the client’s needs, they may receive assistance from a home care aide anywhere from one hour a week to 24-hours a day.
Many seniors and their families choose home care as a way for the senior to remain in their own home as their needs and abilities change, rather than moving to a residential care community. Home care, combined with any necessary home modifications or assistive technology, can enable seniors to live out their Golden Years in the comfort of their own homes. Family caregivers may also seek home care services as a respite to make caregiving more manageable.
Who is a Good Fit for Home Care?
Home care oftentimes serves as an alternative to assisted living for seniors who wish to live independently. It can be a good care option for those who meet the following criteria.
- Seniors who struggle with mobility and need assistance safely moving throughout their home
- Seniors with impaired motor skills who need assistance with daily household tasks
- Seniors who no longer drive and need transportation to appointments, the grocery store, friends’ houses, and more
- Seniors who are isolated and desire the companionship of a caregiver
- Seniors who need assistance with ADLs including meal preparation, bathing, and more
- Seniors in need of housekeeping services such as cleaning and grocery shopping
- Seniors in the early stages of memory impairment
Who is Not a Good Fit for Home Care?
Though a good care solution for many, home care is not right for everyone. Below are some reasons why a senior may not be a good fit for home care. Note that this list refers to standard home care services, not home health care. Some seniors included in this list, such as those in need of therapy services, would be a good fit for home health care rather than home care.
- Seniors seeking the companionship of their peers rather than an aide or caregiver
- Seniors who need nursing care, or other regular medical care
- Seniors who want an all-inclusive lifestyle like those offered in many residential care communities
- Seniors who want physical, occupational, or speech therapy services in the home
- Seniors with advanced memory impairment who require a secure environment and around-the-clock care
How Do I Know If My Loved One Needs Home Care?
Many older adults eventually reach a point where they can no longer care for themselves the way that they used to. Home care is an appealing option for many seniors and their families because it can be used for just a few hours a week or on an as-needed basis for those who are having some difficulties, but do not need constant care. It can serve as an in-between for seniors who are struggling to care for themselves or their home completely independently, but do not need around-the-clock assistance. It’s also a good option for seniors who may have been resistant to moving out of their home, but who do need help with some of their ADLs. Though each individual is different, below are some signs that it may be time for in-home care.
- Weight loss or decreased muscle mass
- Decreased mobility
- Increased forgetfulness
- Worsening hygiene practices
- Neglecting to maintain home cleanliness or organization
- Inability to drive or any incidents while driving
- Isolation or signs of loneliness
- The occurrence of accidents and injuries such as falls
Some seniors may also need home care on a short-term basis, such as when they are recovering from a surgery or health emergency like a stroke. In these cases, the senior will be better suited for home health care than standard in-home personal care assistance.
Types of Home Care
Under the umbrella of in-home care, there are several different types of assistance and different roles of those who deliver these services. The type of care one needs will depend on their health, abilities, and, sometimes, budget.
Companion care services, personal care assistance, and home health care are three common types of home care. Keep in mind that as the client’s needs change, they may transition from one type of home care to another.
Companion Care Services
Companion care services are ideal for seniors who live independently and do not need much assistance with their activities of daily living. Those in need of companion care services oftentimes live alone and feel isolated in their day-to-day lives. The aide provides some much-needed social support.
A home care aide providing companion care may simply spend time with the client and engage with them, read to them, participate in the client’s hobbies such as board games or walking, or provide supervision. An elder companion may also provide transportation services and assist in medication management. Though typically companion care aides are not certified to administer medications or otherwise provide any type of medical care.
Companion care services are also a good option for those in the early stages of memory impairment who do not yet need much assistance, but who may not be able to be left alone. These clients may live with family members who cannot be with their loved one full-time due to work or other obligations.
Personal Care Assistance
Personal care assistance is ideal for seniors who need regular help with their activities of daily living. Personal care assistants can provide a broad range of services, including help bathing and toileting, grocery shopping, and mobility assistance to prevent falls.
These aides may not provide any medical care beyond medication management. This type of home care is comparable to the services residents receive in assisted living communities. So personal care assistants can certainly provide help to make the client’s life easier and safer. But it is not suited for those with regular medical needs.
Many families providing caregiving services for a loved one seek personal care assistance to perform the tasks that they are unable to safely or comfortably perform for their loved ones. For example, a wife who cannot safely support the weight of her husband who needs help getting out of chairs and their bed may hire a home care aide to help with her husband’s transfer. Personal care aides can also be used as respite if a family caregiver needs to travel or knows that they will be out of the home all day.
Home Health Care
Home health care differs from the other types of home care in that home health care aides carry certification to provide medical assistance. Unlike standard home care, which a senior or their family can seek out when they feel the time is right for them, home health care is typically recommended by a physician and may require a doctor’s written order to have the services covered by insurance.
Seniors who require frequent medical services, such as injections or infusions, can work with a home health care provider on a regular basis. Others may seek home health care on a short-term or as-needed basis, such as when recovering from an injury or surgery.
The range of services that one can receive from a home health aide is similar to what one would receive in a nursing home. Wound care, IV insertion, and occupational and physical therapy are all available with a home health care aide. Unlike companion care aides and personal care assistance, home health aides must have specialized training and certification, such as a nursing certificate, in order to perform these services. Those who have the proper certifications can even administer skilled nursing care in clients’ homes.
Home Care and Home Health Care Services
Home care encompasses a wide range of services, which expands even further with home health care. Below, you can see the many possible home care and home health care services.
The services each individual client receives will depend on their needs and preferences and, sometimes, the ability of the caregiver. It’s important to always ensure that the hired caregiver is capable of providing the necessary care before establishing a contract with them.
Available Home Care Services
- Housekeeping, including cleaning, washing dishes, and laundry
- Medication management and reminders
- Meal preparation and grocery shopping
- Transferring and other forms of mobility assistance
- Assistance with activities of daily living including bathing, dressing, eating, and toileting
- Cognitive stimulation, including conversation, reading aloud, and playing brain games
- Supervision, especially for those in early stages of memory impairment
- Respite for caregivers
Available Home Health Care Services
- Medication administration, including injections
- Occupational therapy
- Physical therapy
- IV therapy and infusions
- First aid and wound care
- Blood withdrawal
- Respiratory therapy
- Management of chronic conditions, such as monitoring glucose levels for seniors with diabetes
- Maintenance of feeding tubes, colostomy bags, oxygen tanks and tubing, etc.
- Post-surgery care
Paying for Home Care Services
Though sometimes less expensive than comparable residential care, home care can be costly. Below, we explore the cost of in-home care and financial assistance options that can help seniors and their families cover the cost of care.
How Much Does Home Care Cost?
According to Genworth Financial’s Cost of Care Survey, the average cost of in-home care in the United States is $4,957 a month. For home health care, the cost is higher, at an average of $5,148 a month. However, considering that home health care can include nursing services, it is a more economical option than residential skilled nursing care, which costs an average of $7,908 a month for a shared room and $9,034 for a private room.
Keep in mind that the above figures are the national average. Depending on your location, home care can be significantly less expensive or much more expensive than the listed costs.
For example, in Louisiana, in-home care costs an average of $3,623, potentially saving residents over $1,000 a month compared to the national average. However, in Washington, the price for the same services average $6,547 a month.
Regardless of one’s state, home health care will almost always be more expensive than basic home care because of the medical certifications and training required of the caregivers.
How Can I Pay for Home Care?
Many seniors and their families find it challenging to pay for care, whether delivered in one’s home or a residential community. Fortunately, there are financial assistance options available for in-home care. Read on to learn more about the available options and if any of them may be able to lessen your financial burden.
In some cases, an individual’s private insurance may cover some of the cost of in-home care. This typically applies to people with long-term care insurance, as most long-term care services, including home care, are not covered by regular insurance policies.
Long-term care insurance is designed to cover senior care, including in-home care. However, coverage varies depending on the insurance provider, the specific policy, and other factors, including the age of the beneficiary when they signed up for the policy. Often, long-term care insurance will only begin to cover care once the beneficiary needs assistance with at least two ADLs. So those only in need of companion care may not be covered even if they do have long-term care insurance.
Note that purchasing long-term care insurance once you already need care is typically not an option, and if it is, the policy will not cover very much. To learn more about these policies, visit https://acl.gov/ltc.
Aid and Attendance Benefit
Eligible veterans and their spouses may be able to use the Aid and Attendance benefit to help finance their in-home care. The Aid and Attendance benefit is an extra monthly payment that eligible veterans receive in addition to their regular monthly VA pension. While the funds do not directly cover in-home care, the added monthly income is intended for veterans who have care needs.
In order to qualify for Aid and Attendance, veterans must be receiving a VA pension and meet all of the associated eligibility requirements, plus meet at least one of four separate eligibility requirements. One of these four criteria is needing assistance performing one’s activities of daily living, so those in need of home care are likely to qualify. Some veterans may need a letter from a physician stating that they are in need of assistance before they are approved for Aid and Attendance.
The amount of assistance that one receives depends on several factors, including how many members are in their household and the overall household income. To learn more about Aid and Attendance and how to apply, visit the VA website.
Though life insurance is intended to benefit the policyholder’s loved ones following their death, in some cases, it may be used to pay for long-term care, including home care. Some policies, referred to as hybrid life insurance, are designed to cover long-term care, though the specifics of what care is covered will vary.
Even those with standard life insurance policies may be able to transfer their current insurance policy to a cash payment. Depending on the specific case, policyholders may be able to surrender their policy to the insurance provider. Or they can sell their policy to a third-party group. In both cases, the cash value is almost guaranteed to be less than the original death benefit-sometimes significantly so. For this reason, it’s worth having a family discussion about whether transferring a life insurance policy to cash is the right decision. Some people may be better off keeping their life insurance policy as-is. Some may be unable to surrender or sell their policy, depending on the insurance company’s rules.
Reverse Mortgage Loans
Adults age 62 and older have the option of taking out a reverse mortgage to help finance long-term care, or any other expenses. These loans convert part of the value of one’s home to cash, so they are essentially a cash advance on the home’s equity. Oftentimes, the money received from a reverse mortgage loan is not taxed. This can give seniors some liquid cash to pay for long-term care without needing to sell their home prematurely. This makes it particularly useful for those using in-home care services.
There are several kinds of reverse mortgages. But the only one that is federally-insured is the Home Equity Conversion Mortgage (HECM). No matter which type of reverse mortgage you choose, you will need to repay it when the last surviving borrower passes away or moves out of the home. Keep in mind that you will have to pay interest on the loan. And borrowing against the home’s value means that you most likely won’t be able to leave the home or the money from its sale to your heirs. Still, reverse mortgages can be a great way to access liquid cash, so long as the borrower is aware of the above stipulations.
For those with the resources to do so, private pay is always an option. If the client only needs care for a few hours a week, this may be much more doable than for those who need full-time care. For example, those using home care services 20 hours a week can expect to pay an average of $2,253 a month for personal care assistance and $2,340 a month for home health care, according to Genworth Financial.
However, if the client needs more regular care, the cost can become prohibitive. At the 40 hours a week mark, home care becomes more expensive than assisted living, at $4,506 a month and $4,500 a month, respectively. Around-the-clock home care costs an average of $18,972 a month for personal care assistance and $19,656 for home health care. Thus, if the client needs around-the-clock care, it may make more sense financially to relocate to a residential care home.
If moving is not an option and you’ve exhausted your financial resources, try talking to several different home care providers in your area. The costs listed above are the national average, so costs in your area can vary.
Do Medicare and Medicaid Cover Home Care?
Two of the most well-known government-sponsored programs designed to assist in the healthcare costs of Americans are Medicare and Medicaid. If you or a loved one has Medicare or Medicaid, you’re probably wondering if home care services are covered.
Here’s what you need to know about the home care coverage of each program:
Medicare and Home Care
Medicare doesn’t cover standard home care, including companion care services (light housekeeping, meal preparation, grocery shopping, transportation, etc.) and personal care assistance (activities of daily living such as eating, bathing, and dressing).
Only home health care services prescribed by a doctor and deemed necessary as part of a care plan are covered by Medicare, provided that the individual meets a few requirements.
Who’s Eligible for Medicare Coverage for Home Health Care?
As per Medicare.gov, seniors must have coverage via Medicare Part A (Hospital Insurance) and/or Medicare Part B (Medical Insurance) and meet all of the following requirements to be eligible for Medicare coverage of in-home health care services:
You’re certified by a doctor
A doctor or another medical professional certifies that you need occupational therapy, physical therapy, speech-language pathology, or skilled nursing care.
Being homebound means you’re unable to leave home without great effort or due to illness or injury. A doctor must certify that you’re homebound.
You’re under a plan of care
You’re under a doctor’s plan of care that he reviews regularly.
You’ve had a face-to-face meeting with a doctor or healthcare professional
As part of your certification, a doctor or healthcare professional must have had a documented face-to-face encounter with you, and it must be related to the reason you require home care.
You work with a Medicare-approved agency
The health agency that cares for you is approved by Medicare.
Which Home Health Care Services Does Medicare Cover?
For eligible seniors, Medicare covers a range of home health services provided they are reasonable and essential to treat their illness or injury. Below are the home care services covered by Medicare:
- Skilled nursing care: Medicare covers skilled nursing services if they’re reasonable and provided by a Registered Nurse (RN) or a Licensed Practical Nurse (LPN), and given on a “part-time or intermittent” basis. This means agencies can render these services any number of days each week as long as they’re either fewer than 8 hours daily or 28 hours or less per week.
- Skilled therapy services: Medicare covers therapy services including physical therapy, occupational therapy, and speech-language pathology services. A licensed therapist and therapist assistant must provide these services, and they’re reasonable and necessary to your plan of care.
- Medical social services: Medicare will cover counseling for social and emotional concerns related to your illness or injury, provided you’re also getting the aforementioned skilled services above. Otherwise, Medicare doesn’t cover medical social services on its own.
- Home health aides: Personal care aides such as assistance with ADLs are covered by Medicare if they’re necessary due to illness or injury. However, they must be delivered in tandem with skilled nursing or therapy from a Medicare-certified provider.
- Medical supplies: Supplies covered by Medicare include catheters and wound dressings related to your illness or injury and must be ordered by the doctor as part of your care. Durable equipment such as walkers and wheelchairs may also be covered but only up to 80% of the approved cost.
Medicare standards determine the duration and frequency of these services. If the level of care exceeds the part-time or intermittent guidelines, Medicare won’t cover it.
In addition, you may have personal care coverage with a Medicare Advantage plan from private insurance, provided you can find an agency that accepts it. Before starting any home care plan, ensure that the agency provides you with a breakdown of the charges, which services are covered by Medicare, and how much you’ll pay out of pocket.
What Isn’t Covered by Medicare?
Although Medicare can be a huge relief for patients needing home health care, it doesn’t cover everything. Here are several services that Medicare doesn’t cover:
- Round the clock home care
- Meals delivered to your home
- Household services such as grocery shopping, cleaning, and laundry, if you don’t get skilled nursing or therapy
- Personal care or custodial services such as bathing or dressing, if you don’t get skilled nursing or therapy.
NOTE: If a home care agency wants to include services without Medicare coverage, they’re mandated to issue an Advance Beneficiary Notice of Noncoverage (ABN), also called waiver of liability. This notice is issued if, based on coverage rules, the agency believes Medicare won’t cover the service.
Medicaid and Home Care
Medicaid does pay for in-home care for eligible seniors. States administer their own Medicaid programs, so eligibility requirements and the scope of services covered can vary from state to state.
Which Medicaid Programs Pay for Home Care?
Home care services may be covered under the regular state Medicaid but may also be offered under the Home and Community-Based Services (HCBS) Medicaid waivers or Section 1115 demonstration waivers.
- Regular State Medicaid: Also called original or classic Medicaid, regular state Medicaid provides health coverage and mandatory benefits to millions of Americans – including home health services. Although in-home personal care services (help with dressing, bathing, eating, etc.) are not federally mandated, some states may offer them via regular Medicaid. Original Medicaid is an entitlement benefit which means all qualified individuals will receive benefits and not be placed on a waitlist.
- HCBS Medicaid Waivers: Also known as 1915(c) waivers, HCBS Medicaid waivers enable seniors to self-direct their care and best meet their needs. In many cases, this means a patient requiring a nursing home level of care, may opt to receive in-home health care instead and still have Medicaid coverage. However, unlike Medicaid, waiver programs are not entitlement benefits. This means even if you’re qualified, there’s a possibility you won’t receive the benefit or be placed on a waitlist.
- 1115 Demonstration Waivers: Section 1115 waivers enable states to test new approaches in Medicaid and provide flexibility on how to run their programs. This also allows the waiving of nearly all of the requirements under the state’s Medicaid plan with the goal of testing new approaches.
Who’s Eligible for Medicaid Home Health Care?
Applicants must meet specific requirements to become eligible for Medicaid, hence home care. On top of being a state resident, there are two main eligibility requirements:
- Financial requirements: Although requirements vary by state, the rule of thumb to qualify for Medicaid (and Medicaid waivers) is that the applicant must be a single individual, 65 years of age, and a monthly income of less than $2,523 and $2,000 in countable assets (2022). For regular Medicaid or ABD Medicaid, income limits are even lower at $841/month for single applicants, and $1,261/month for married couples, in approximately half of the states.
- Level of care or functional requirements: For regular Medicaid, the applicant must demonstrate their need for assistance with ADLs such as toiletry, eating, dressing, meal preparation, and laundry. Functional requirements vary by state and program, and applicants must undergo an evaluation to determine the level of care needed.
Requirements are determined by each state separately, so it’s best to contact the Medicare agency in your state for more specific information.
Resource for Medicaid Programs By State
In the table below are direct links to Medicaid programs for each state and their corresponding contact numbers:
Evaluating Home Care Agencies and Providers
Choosing to hire an in-home aide for yourself or a loved one is a good first step, but before accessing care, you’ll need to find the right care provider. You’ll want to be sure that you feel comfortable with the aide, especially if you won’t be present while they’re caring for your loved one.
One of the biggest decisions you’ll have to make is whether to work with a home care agency or an independent provider. Independent providers tend to be less expensive. But after factoring in liability insurance (which agencies should already have and will be built-in to the hourly cost) and taxes, the difference in cost is often negligible. The other advantage of working with an agency is that you’ll likely have more caregivers to choose from. And if one aide doesn’t work out, you can request another. However, if you know that your loved one gets along well with an independent provider and you trust them, going that route may work for you.
Regardless of whether you choose to work with a home care agency or an independent provider, doing some research and taking the time to evaluate different options can save you frustration down the line. Just as you would with a residential care community, do your research and look into several different providers, if possible, before deciding on a caregiver for your loved one.
Some of the top things to consider when choosing a home care provider include:
- Licensure: If you live in a state that requires it, be sure that the provider is licensed to provide the type of care they are offering.
- Dependability: One problem that some clients face with home care providers is that they are unreliable. Read reviews of the provider to see if past clients have had issues with their aide showing up on time. And ask the provider if they have a good back-up plan in place for when an aide cannot make it to their client at the scheduled time.
- Available Services: Make sure you’re clear on what services the provider can and cannot provide. Home health care aides need to have more extensive training and licensure than personal care assistants. So if your loved one needs any health care, be sure you work with a provider with the licensure and experience to do so.
- Cost: Costs can vary between different providers, so check a few in your area if you can and compare. If you’ll be using a form of financial assistance to pay for home care, be sure that the provider accepts the type of assistance you plan to use.
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Frequently Asked Questions
How much does in-home care cost?
According to the Genworth Financial Cost of Care Survey, home care costs an average of $4,290 a month, while home health care costs $4,385 a month. These averages are based on a client receiving care 44 hours a week, which comes out to roughly $24 an hour for personal care assistance and $25 an hour for home health care. Note that this is the national average, and costs can vary widely between different states and even different areas within the same state. Even different providers in the same city may charge different prices. So if keeping costs low is your top priority, be sure to compare the costs of several different providers to find the best value. Is financial assistance available for home care?
Yes, financial assistance is available for home care. Seniors who meet the eligibility criteria may be able to receive assistance from Medicaid or a Medicaid waiver program for home health care. Though the rules surrounding what services are covered and at what amount varies between different states. Medicare does cover home health care for qualifying seniors. But personal care assistance is only covered when services are received in tandem with home health care.
To learn more about the available financial assistance options for in-home care, visit the “How Can I Pay for Home Care?” section.
Is in-home care less expensive than assisted living?
When broken down hour-by-hour, home care is actually more expensive than assisted living. The total monthly cost will depend on the client’s level of need and how often they utilize home care services. According to Genworth Financial, home care costs an average of approximately $24 an hour. So, if the client only needs home care 20 hours a week, they will spend an average of $1,950 a month. This is far less expensive than assisted living, which costs an average of $4,051 a month.
But, residents of assisted living communities have access to 24-hour assistance. If a home care client were to utilize their services 24 hours a day, the cost soars to $16,380 a month. For someone who needs the safety and comfort of having assistance available around-the-clock, assisted living will likely be the more economical choice.
Are home care and home health care the same thing?
No, home care and home health care are not the same thing. Home care refers to personal care assistance, which includes help with the activities of daily living, transportation, and companion care. Home health care involves medical care including first-aid, medication administration, and therapy services.
Home health care providers must undergo specialized training and obtain certification to perform medical services, while home care providers do not. Because of the increased scope of care, home health care is typically more expensive than home care.
Is in-home care covered by insurance?
Yes, in some cases in-home care is covered by insurance. Qualifying individuals may be able to use Medicaid and Medicare to cover some or all of the costs of their in-home care or home health care. Other seniors may have private, long-term care insurance policies that cover in-home care. Though this varies depending on the policy. Long-term care, including home care, is typically not covered by standard health insurance.