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Clearing Up the Confusion Over In-Home Eldercare


hiring in home caregivers

You realize Mom needs some help at home or you are planning for the recovery period after an upcoming surgery. You know you need help that can come to the home…but beyond that it all seems quite confusing. What qualifications should you be looking for? Where do you find someone? How do you know about the quality of the home caregiver or home health agency? Will your Medicare or health insurance cover the costs (and that are the average costs)? We’ll help clear up the confusion to these and other questions, with this straightforward guide to home health care and in-home eldercare.

First of all…understanding what you need…

The first step in hiring in-home care is understanding the type of assistance you will need. A geriatric care management assessment is a great first step, because a professional can help you identify all the possible needs as well as anticipate things you may not have thought about. The care manager can also build a care plan for you, make recommendations and even carry out the process of getting the in-home caregivers in place and monitoring ongoing care.

In examining home care needs, think about the kind of tasks needed and particularly whether you need all household “hands off” help (in other words, only someone to assist with cooking, light housekeeping, and errands but no physical assistance) or whether you may need help, for example, getting in and out of bed or completing hygiene tasks. As a care manager will often suggest, it is better to err on the side of caution. If you are having surgery, you may think you’ll be able to handle all our own physical needs but you may find yourself in a weakened state or drowsy from medications. In Florida, a companion is only allowed to do household tasks and therefore could not help you if you found yourself needing assistance to get up from a chair or needing help in the bathroom.

There are certain medical tasks which require a nurse (R.N. or LPN) such as giving treatments/injections and changing surgical dressings. Usually these are intermittent tasks which can be handled by a visiting nurse and may be covered by your insurance/Medicare for short-term needs. Medication management also requires a nurse’s oversight and this help is often available through home care agencies on a set basis for long-term needs.

Now…where do I go to get help?

Many elders and families think about hiring someone themselves by putting an ad in the paper or asking friends for references. This is one option, but comes with a lot of extra work and liability for your family. You are solely responsible for the hiring, training and supervising as the employer. You also need to handle any tax and employment responsibilities. Additionally, you should consider the coverage (or lack thereof) should the employee have an accident, get sick or some other liability issue arise. You should also make a backup plan.

If you do not wish to serve as the employer and take on all these responsibilities, you can hire in-home care through an agency. In Florida, home health agencies and other medical/eldercare providers are regulated by the state. There are three basic types of companies providing in-home care to seniors and others: a fully-licensed home health agency (with medical and non-medical agencies in this category), homemaker companion services and nurse registries. You can read more about these categories of Florida Home Care on our EasyLiving home care website.

There are many benefits to hiring a licensed agency, including liability protection and assistance with all aspects of the process. The agency takes on the hiring, screening, training, supervising and can assist you with troubleshooting any concerns. A quality home health agency like our EasyLiving Home Care agency will take extra steps to ensure their caregivers are prepared for their work and continually improving. You can review state inspection reports online for most states, but you should also have a list of questions prepared to understand how the agency operates and handles quality improvement. Getting a referral from a trusted source may be your best bet for beginning this process.

What about costs and insurance coverage?

Medicare (other insurers tend to follow suit with similar rules) covers certain in-home care under limited circumstances. Most likely, the type of in-home care you are primarily seeking is what is sometimes termed “private duty home care”. Long-term care or even day-to-day care that is temporary (i.e. help during the recovery period) is usually not covered under Medicare or other medical insurance. However, long-term care insurance will often cover ongoing in-home care.

We outlined the requirements for Medicare to cover home health care in our blog post, “Paying for Home Care: What Home Health Services Does Medicare Cover?“. In order to receive Medicare home care, your doctor will need to write an order (additional visit requirements were added in recent years). Doctors often prescribe this type of care after surgery, hospitalization or a major change in functioning. Skilled home health care often includes therapy services, to increase strength or resolve specific issues. Many clients also have “private duty” services while receiving skilled care as the skilled care is only intermittent and does not fulfill many of the day-to-day/safety needs clients have in the home.

If you have a long-term care policy, your Aging Wisely care manager or EasyLiving home care representative can work with you to navigate the claims process and help get the insurance company the information needed. Most long-term care policies do cover in-home care if you meet the assessment requirements (demonstrating you need help in certain areas) after any elimination period (kind of like a deductible…you pay for so many days of care before the policy kicks in).

For those who do not have long-term care insurance and need private duty home care services, costs vary by geographic region of the country. In Tampa Bay, Florida home health agency care averages about $17-23/hour. The costs depend on whether the caregiver is a home health aide (i.e. is trained to provide hands-on care) and the amount of care needed (costs may be higher for very short periods of care, such as having a home health aide visit for 1-2 hours to help with bathing versus 6 hours in a day).

When it comes to costs, work closely with your provider or care manager on the most efficient care plan. Again, this circles back to what type of care you need. Your care plan can be built around: what times of day you have difficulties, what duties you need help with, your typical schedule and preferences. Your care plan should then be coordinated with any other care being provided (such as skilled home health care and assistance from family and friends). Because home care is usually a per hour charge, there is a great deal of flexibility to create an individualized care plan and budget.

Have questions about in-home care? Our Senior Care Consultant, Sue Talbott, can offer sage advice and will even come out to your home to complete a needs analysis for you. Call Sue at 727-447-5845 for help with in-home eldercare, Medicare and insurance issues, geriatric assessments and much more!

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