The need for in-home care can arise when someone is ill or can't take care of themself and support from friends and family is limited. Before you or a loved one decide on in-home care, some things to think about include:
• Whether the person who needs care is comfortable receiving it from people they don't know.
• Is the need temporary, such as during recovery from surgery, or long-term, for a chronic ailment?
• In-home care includes health-care, personal care, and housekeeping. Do you need some or all of these services?
• Are you looking for a caregiver with certain traits or qualifications, such as an early riser and/or someone skilled at the services you need?
Another consideration is your budget. According to Genworth Financial's Cost of Care 2019 Survey, in-home care in Maine averages $5,117 a month. How will you pay for it? The AARP states that if the patient has long-term care insurance, Medicare or Medicaid, you'll need a doctor's report confirming the need for in-home care. Medicare doesn't cover personal care if it's the only care needed, but some Medicare Advantage plans do -- check with your plan provider. Caring.com details more about the potential costs, and MaineCare and other in-home care programs available. Your local area agency on aging and the National Council on Aging's BenefitsCheckUp may offer more options.
If it's offered where you live, those age 55 and older who meet certain guidelines may qualify for the federal initiative Programs of All-Inclusive Care for the Elderly (PACE). Veterans may get home-care services through the Department of Veterans Affairs (VA). Those who pay for caregiving can qualify for tax breaks. Outside of health insurance, annuities, investments, savings, and life insurance policies that cover home-care expenses are among other choices. Borrowing options may include a home equity loan.
The Types of Caregivers Available
Several kinds of caregivers are available based on your needs.
Personal care aides (PCAs) - PCAs help with daily tasks, including bathing and meal preparation, and provide transportation and companionship. Not licensed, their training requirements vary by state. Health insurance often doesn't cover PCAs, so you may need to pay standard labor rates, whether you hire them yourself or through an agency.
Home health aides (HHAs) - These helpers provide personal care and check the patient's condition regularly. Each state has training and certification requirements and they must meet federal training standards.
Licensed nursing assistants (LNAs) and certified nursing assistants (CNAs) - Besides routine care, they check vital signs and do more medical-related tasks (as directed by a registered nurse or nurse practitioner), such as changing dressings and giving some treatments. Like HHAs, they must meet federal training requirements and may also need to satisfy state standards.
Skilled nursing providers or licensed practical nurses (LPNs) - LPNs offer more medical care, which includes giving shots, advising about treatment, and providing therapy. According to the AARP, Medicare covers part-time or temporary home health skilled nursing care prescribed by a doctor and arranged by a Medicare-certified agency. LPNs are state-licensed and must meet federal health and safety protocols.
Registered nurses (RNs) - They're qualified to provide all types of nursing care, use medical monitoring devices, and help doctors during procedures. They must be certified or have an associate degree in nursing, meet state licensing requirements, and pass a national licensure exam. The most skilled home health aides, their national median hourly wage is $34.54, higher than for other caregivers.
Caregiver Hiring Options
You can hire any type of caregiver yourself or through a company. Whatever you do, the AARP recommends you find someone trustworthy, compassionate, and responsible. Check their credentials, licensing, and references. Maine.gov offers a directory of state-licensed home health-care providers. Your medical provider may be able to give a referral. As part of their duties, the caregiver can follow a care plan, which includes the patient's rights, a list of the aide's responsibilities, and that of any outside firms involved.
Agencies - These companies pre-screen workers and handle the financial aspects of employment, including insurance, payroll, and taxes. However, you might pay more for their services than if you hire someone directly. You also might not be able to choose your caregiver or hire one part-time. Check if the agency is Medicare-certified and meets federal health and safety requirements. Get all information in writing. Agencies may also offer their aides continuing education. Ask for a list of medical providers who have worked with the agency and other references to contact. For more advice, see the AARP's Choosing an Agency for In-Home Care checklist. Caring.com and Medicare's Home Health Compare provide directories of local agencies.
Registries - Registries or staffing services let you choose your caregiver based on your requirements, often with flexible hours, and under your own rules. The registry charges a one-time fee. If you need a substitute caregiver, however, it may take time to find a replacement unless you already have a backup. You'll need to handle the payroll paperwork, insurance, and pre-employment screening yourself.
Direct hire - You can employ someone yourself through job listings, referrals from people you know, your local agency on aging, or sites such as Nextdoor. Define the job requirements, prepare questions, and arrange for interviews. The Mayo Clinic offers a useful list of questions to ask. Reviews and reference checks may help you narrow down the candidates. Like with registries, you'll need to manage the rest of the employment details yourself. We would be happy to assist our client with preparing written contracts for direct hires.
Arranging in-home care takes time, but once it's in place, you can feel better that you or your loved one will get the right support.