By Nancy Webre, BS, MS
My parents are resisting in-home care help even though their clothes are regularly soiled and their personal hygiene is increasingly neglected. They have never had help in the home and do not want strangers coming into their home. Their physician has recommended they get in-home care assistance to help with daily tasks. I don’t even know what kind of in-home care services are available in our community.”
Does this scenario sound familiar?
Making the decision to engage in-home care assistance for a loved one is an important and difficult decision. The increased desire to remain living at home has created the emergence of a service industry called in-home care. A range of companionship, supervision, and personal care services are provided by in-home care agencies and private individuals in the comfort and convenience of a person’s home, averting a move to a facility. Increasingly, people are choosing to live independently while receiving in-home care services as their physical and cognitive abilities decline, enabling them to age independently and not burden their family.
Care in the home may include skilled home health care services and in-home care or non-medical services. The difference between home health and in-home care services is important as this helps to determine the level of care provided, which determines the cost and funding sources to pay for care.
Home health care refers to skilled care provided by licensed professionals, such as registered nurses and physical, speech, or occupational therapists. Home health care is typically warranted when a person has had a recent inpatient stay at a hospital, rehabilitation, or skilled nursing facility. Home health care can benefit those who have had recent medication changes or someone who shows a recent decline in physical functioning. Generally, home health professionals are only authorized to perform tasks prescribed by an individual’s physician and for a limited amount of time. Such skilled services might include wound care, pain management, physical therapy, or speech therapy. Home health services are usually covered by Medicare, Medicaid, Veteran’s Administration, and/or private insurance if an individual meets the qualifying criteria. While there are differences between home health care and in-home care, many older adults will eventually need both at some point.
In-home care services refer to non-medical or custodial care. Non-medical services may include personal care, companionship, supervision, and help with tasks of daily living, such as medication reminders, laundry, light housekeeping, meal prep, shopping, transportation, and escort to medical appointments. Unlike home health and hospice services, in-home care does not need to be ordered by a physician. Determining if a loved one needs in-home care assistance is easier if you know what to look for and the questions to ask while observing patterns of behavior and neglect within these areas:
• Activities of daily living
Difficulty eating, cooking, dressing, walking, or managing medications
• Cognitive abilities
Consistent forgetfulness about where things are, getting lost walking or driving, confusion, loss of reasoning skills, inability to find the right word or complete a sentence, wandering, forgetting how to use ordinary things like a pencil, consistently forgetting to close windows or lock doors.
• Isolation
Lack of interest in activities, hobbies, or friendships. No access to transportation.
• Responsibility tasks
Spoiled food in the refrigerator, unopened mail, unpaid bills, unfilled prescriptions, laundry piled up.
• Attitude
Feelings of depression and despair, sadness, abuse of drugs or alcohol, paranoia, unusual argumentativeness or verbal abuse.
• Health condition
Changes in appetite, weight, sleeping too much or too little, dehydration, general
fatigue, hearing loss, incontinence, bruising, spilling or dropping things.
• Personal hygiene
Infrequent bathing, bad body or mouth odor, sloppy appearance.
In-home care services can be paid through several resources, including private pay, long-term care insurance, Veteran’s Administration, and Medicaid. It is not covered by Medicare. The cost of care can vary significantly depending on the type and amount of care required. In-home care may benefit not only seniors but also younger adults who are disabled or recuperating from an acute illness, as well as chronically ill or terminally ill persons receiving medical treatment in the home.
Before searching for services, determine what the care needs are and how much time each week will be required. Most home care agencies will conduct a free assessment to help determine care needs and develop a specific care plan. Once the decision has been made to have in-home care services, the next step is choosing an agency or caregiver. It’s best to conduct research on several local providers to gather information and read customer reviews and ratings. Don’t hesitate to ask for references from people who have utilized their services.
Hiring in-home care can be a process but it is time well spent. After all, there’s no place like home, and receiving safe and quality in-home care can enable a loved one to remain in the comfort of their own home.