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Determining the Type of Care You Need

If you decide to hire a home care worker, you need to determine how much and what type of help your older relative needs. Will several hours a day be enough? Does he or she need help all day until the family returns home? Or does your relative live alone and need 'round the clock care?

The main types of home care personnel available include the following (some aides may take on several of the roles described here):

  • Housekeepers or Chore Workers – these workers perform basic household tasks and light cleaning. Chore workers often do heavier types of cleaning such as washing windows. Both of these workers are supervised by the person hiring them.
  • Homemakers – these workers provide personal care, meal planning, household management, and medication reminders. Homemakers are supervised by an agency or you.
  • Home Health Aides, Certified Nurse Assistants or Nurses Aides – these aides provide personal care; help with transfers, walking, and exercise; household services that are essential to health care; and assistance with medications. These aides are supervised by an agency's registered nurse (RN). The aides complete appropriate records and report changes in the patient's condition to the RN. In most cases, nonprofit and for profit home care agencies recruit, train, and pay the worker. You pay the agency.

Medicare and Medicaid Coverage of Home Care Benefits

Home health care agencies focus on the medical aspects of care and provide trained health care personnel, such as nurses and physical therapists. Home health care workers are a supplement to this care and usually help the older person for three hours a day, several days a week. If these services are ordered by a physician, they may be paid for by Medicare.

If your older family member needs additional hours of care or requires custodial care, he or she may be eligible for services under Medicaid. Medicaid coverage differs by state, and depends on income and assets.

Selecting a Home Health Care Agency

Start by calling a few agencies and asking several questions. Here are some important questions to ask:

  • What type of employee screening is done?
  • Is the employee paid by the agency or the employer (you)?
  • Who supervises the worker?
  • What types of general and specialized training have the workers received?
  • Whom do you call if the worker does not come?
  • What are the fees and what do they cover?
  • Is there a sliding fee scale?
  • What are the minimum and maximum hours of service?
  • Are there service limitations in terms of tasks performed or times of the day when services are provided?

If your older relative needs care for a limited number of hours each day, the rates charged by private home care agencies may be reasonable for your needs. However, if your older relative’s needs are greater than a few hours per day, the expense of such care through a health care agency is often beyond the means of middle-income families. You may want to consider other means of competent help, but at lower rates. It is often possible to hire a health care aide directly, at much lower cost than that charged by home care agencies.

Hiring a Home Health Care Aid Directly

To find possible candidates for home health care, try the following:

  • Ask your physician, friends, family members, your religious leader, and other caregivers for referrals
  • Contact senior employment services
  • Contact agencies that help displaced homemakers and similar people who are trying to enter the workforce
  • Place an ad; ask your physician for an appropriate place to do so

Screen All Favorable Applicants Very Carefully

You may want to meet with the person more than once, and have your older relative meet with them as well, to ensure that they have the necessary qualifications, training, and temperament. Key things to do include the following:

  • Ask for identification and references.
  • Call each of their references and ask many questions.
  • Discuss the aide’s training and skills in detail. Ask to see training certificates.
  • Provide a clear, detailed description of your elderly relative’s needs. Review this and be sure that the aide can do each of the tasks, such as transferring from a wheelchair to a bed and providing insulin injections.
  • Consider transportation needs and how these will be met.
  • Discuss salary, benefits, and work hours.

Live-in Help

If your older relative needs a considerable amount of help or 'round the clock care, consider hiring live-in help. In exchange for room and board, these home care aides will usually work for a salary that is lower than that charged by aides who come in for a few hours, or during the day. Check with your insurance company about coverage for a full-time home care worker, and contact the appropriate agencies concerning social security taxes, unemployment insurance, and workmen's compensation. If you do not want to deal with these withholdings from the employee's salary, accountants and companies that specialize in doing payrolls will issue the employee's check with the necessary withholdings.

Content provided with permission from HealthGate Data Corp. Copyright © 2004 HealthGate Data Corp.


For more information or to discuss elder care concerns please contact Partners Employee Assistance Program at 1-866-724-4EAP.

In case of emergency, please call 911 or your local hospital emergency service.

This content was last modified on: 06/30/2008

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