Help at home can make it possible to stay in a familiar place safely and comfortably, whether you need a few hours of help a week or daily support. Choosing the right agency takes some research, but asking the right questions upfront can prevent problems later.
Home health care or home care?
These terms sound similar but mean different things:
- Home health care is skilled medical care, such as nursing, physical therapy or wound care, ordered by a doctor. Medicare covers it for people who are homebound and meet certain conditions, through Medicare-certified agencies. See does Medicare cover home health care?
- Non-medical home care helps with personal care and daily life: bathing, dressing, toileting, meals, light housekeeping, errands, transportation and companionship. Medicare does not cover it when it is the only care needed.
Many families use both at different times.
What to ask an agency
Licensing and staff
- Is the agency licensed by the state, if your state requires it? Is it bonded and insured?
- How are caregivers screened? Are there criminal background checks, reference checks and drug tests?
- What training do caregivers receive, including for dementia care?
- Are caregivers employees of the agency? (Employees are usually covered by the agency's insurance and payroll taxes.)
Care and supervision
- Will a nurse or care manager visit to create a written care plan?
- How often is the plan reviewed?
- Who supervises caregivers, and how often do supervisors visit?
- How will caregivers record what they do each visit?
- Can we meet the caregiver before care starts, and request a different person if it is not a good fit?
Reliability
- What happens if the regular caregiver is sick or on vacation?
- Is someone available by phone 24 hours a day?
- What is the minimum number of hours per visit or per week?
Costs and contracts
- What are the hourly rates, and do they differ on nights, weekends and holidays?
- Are there extra charges for mileage, errands or assessments?
- What is the cancellation policy, and how much notice is needed to change or end services?
- Can you provide references from current clients?
Hiring a caregiver directly
Some families hire an independent caregiver instead of using an agency. It can cost less, but you become the employer. You are responsible for background checks, supervision, backup care and possibly payroll taxes and workers' compensation insurance. IRS Publication 926 explains household employer taxes.
Paying for home care
- Private payment from savings or income.
- Long-term care insurance, if your policy covers home care. Check the waiting period and daily benefit.
- Medicaid home and community-based services in many states, for people who qualify financially and medically. See Medicaid for older adults.
- Veterans benefits, including Aid and Attendance and VA home care programs. See benefits for older veterans.
- Area Agencies on Aging, which may offer limited in-home help or connect you to programs. See Area Agencies on Aging.
Keep checking in
After care starts, stay involved. Drop in at different times, ask your loved one how things are going and watch for changes in mood, health or finances. Raise concerns with the agency quickly. If you suspect neglect or abuse, contact Adult Protective Services. See protecting yourself from financial exploitation.
For family caregivers, outside help can also prevent burnout. See caring for a loved one without burning out.
