Different Types of Home Care Services

Different Types of Home Care Services

Many seniors have lived alone or with a spouse for years without any outside help, and are surprised when they gradually recognize challenges to their independent living. Daily activities and chores may get more difficult due to chronic illness or an injury, and concerns for your own safety may cross your mind. If you start to notice signs that you, or a loved one, may need assistance in order to remain living at home, consider your options.

A caregiver or home companion can be invaluable, but the idea of needing someone to help you on a daily or weekly basis after living on your own for many years, can be disheartening. If you or a loved one is reaching this point in their lives, patience and empathy can go a long way in addressing the issue at hand. For adult children of aging parents, it can be tempting to swoop in and try to “fix” the situation, but communication and compassion are necessary in navigating these changes in their lives and in your relationship with them.

Meeting Your Needs

The range of assistance available can vary, of course, so give some thought to your specific needs:

  • Do you need help with daily activities of living, like bathing, dressing, and eating?
  • Can you safely manage to get around your house?
  • Do you require occupational or physical therapy or rehabilitative services?
  • Do you feel that you could benefit from companionship?
  • Could you use an escort to appointments and errands?
  • Do you require supervision due to dementia or Alzheimer’s disease?

There are different types of home care to choose from, so try to be honest with yourself and your family. It is difficult to admit weakness, but being upfront about your challenges can help you make a home care plan that will keep you comfortable, safe, and healthy without having to give up your independent living.

Types of Home Care:

  • Home Health Services
  • Custodial Care

Home Health Services

Home health services include intermittent skilled nursing care, physical therapy, speech-language pathology services, and continued occupational services. “Intermittent” is defined by Medicare as skilled nursing services needed fewer than 7 days each week, and daily for less than 8 hours each day, up to 21 days. (The time may be extended by Medicare in exceptional circumstances.)

Home health care is covered by Medicare Part A and/or Part B as long as you are under the care of a physician who certifies your need for specific services for a limited amount of time while you are homebound. If you have Original Medicare, you will pay $0 for home health services, and 20% of the Medicare-approved amount for durable medical equipment, such as a walker or wheelchair, if required. If you are covered by a Medicare Advantage plan, you can contact them directly for details regarding the benefits and costs of home health care.

Custodial Care

Custodial care is non-skilled personal care that assists with activities of daily living. It can include non-medical services, such as bathing, dressing, using the toilet, transfers (bed to wheelchair, wheelchair to toilet, etc.), assistance with meal planning and preparation, medication reminders, escort to appointments, companionship, and/or supervision. Custodial care can also include minor medical care, such as putting in eye drops.

Many seniors prefer to arrange custodial care at home, instead of moving into an assisted living facility or nursing home. Such a huge move into a nursing home can cause a great deal of stress, and may lead to depression and anxiety. If the level of care can be accomplished at home, and you can afford to have a senior home companion, aide, or caregiver come into your home to help you when needed, you can remain where you are most comfortable.

Custodial care is not covered by Medicare, so it’s important to evaluate your options in regards to your long-term budget and needs.

Family Members as Caregivers

Many seniors who require custodial care assistance would prefer not to put the burden of their care on family members, but with limited incomes, many do not have a choice but to ask a loved one for help. There are several things to consider before making a decision about being cared for at home by a family member:

  • Communication is vital. Discuss your concerns with a trusted family member and express your needs. Be thorough in describing the tasks you need assistance with, and talk about members of the family who might be able to help.
  • Don’t make assumptions. Assuming that you are a burden is just as harmful as assuming family members will all jump in and help you immediately. Everyone involved should talk openly and honestly about how they can help, and what parameters they are comfortable with.
  • Make a plan. With hectic schedules and busy family and work lives, your loved ones may be willing to help, but unable to do so at certain times. Dividing up responsibilities amongst loved ones and creating a calendar that will work for everyone alleviates some of the pressure on the caregivers, and will give you a sense of comfort knowing who will be assisting you.
  • Make sure caregivers get a break. You may have an adult son or daughter who offers to provide caregiving services for you several days a week, but a single primary caregiver can get occasionally overwhelmed. Try to be patient with each other as you get used to a new arrangement. Respite care is available to caregivers through local agencies, including the Family Caregiver Support Program.
  • Don’t wait until frustration sets in before discussing a problem. When the dynamics of a relationship changes with someone taking on the role of caregiver to another, there are bound to be moments of unease, sadness, or even anger. Check in with each other often – and openly discuss your feelings.
  • Get legal and financial advice for you and your family. Having a family member provide long term care for you can be a great solution, but there are serious matters to consider. Family members who need to take time off from work may be able to take advantage of the Family and Medical Leave Act (FMLA) under certain circumstances. You may want to have a family meeting with an attorney to discuss other issues, including conservatorship, guardianship, or durable power of attorney.

What if family members are not available or live too far away?

Many people find themselves needing custodial care, but without close family members nearby to help, they have to explore other options. Family members can be helpful from a distance by researching local community services and private for-hire senior home companion agencies and care managers who can help you coordinate care services and respond to situations in your absence.

The Cost of Home Care

Home custodial care can be manageable and successful, but requires research and financial planning. Most custodial care is not covered by insurance. Its important to be realistic about your budget, especially if you are considering long-term assistance at home.

Long term care insurance (LTI) may help cover some of the costs of in-home care services, but premium costs depend on the age and health status of the insured. Medicaid covers some long-term care costs, such as nursing home care and limited in-home care services, but only for a person who meets income and asset limits, as well as medical criteria.

If you are or a loved one are starting to recognize the signs of needing assistance in the home, start your research now. It can take time to find the customized solution to your specific needs, but it will be worth the effort if you can continue to live in the comfort of your own home and get the help you need to continue to live safely.

Related Information:

Caring for the Caregiver
Caregiving Resources
Medicare Basics for Caregivers
A Caregiver's Guide - Money Matters After an Illness