Finding Quality In-Home Care

People require extended care services due to an illness, accident, or the impact of aging. Some care can be provided part-time by family members but usually trained individuals are the best options to offer.

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Finding Quality In-Home Care
12 Min Read
Guide Updated:
October 31st, 2021

You or a loved one needs help at home due to an illness, accident, or the impact of aging. Maybe you see a loved one declining, and you think they are no longer safe at home without help. Now, what happens? 

If you have Long-Term Care Insurance, you should contact the insurance company's claim department without delay. LTC NEWS has arranged for free claims management with Amada Senior Care, one of the nation’s leading home care providers. They will complete an evaluation and process your insurance claim and provide complimentary care coordination at no cost or obligation to you. Click here for more information and the contact information for the claim departments of the major insurance companies. 

If you do not own Long-Term Care Insurance, you will have to determine what type of care is required. What things can caregivers do for you or your loved one?

What Services Can In-Home Caregivers Offer?

Most home caregivers have the training to perform various services to make you feel comfortable and safe in your home. The caregivers are trained to deliver help with your daily living activities, otherwise known as 'ADLs.'

People require extended care services due to an illness, accident, or the impact of aging. Some care can be provided part-time by family members but usually trained individuals are the best options to offer appropriate and safe care – reducing the stress on loved ones.

ADLs are the self-care we take for granted. They include:

  • Bathing - Helping an individual in a tub or shower, including sponge bath and assistance with bathing and showering
  • Continenceand Toileting - Getting help getting to and from the toilet, including getting on and off the toilet. This care also includes the required personal hygiene following a bathroom visit and any bladder or bowel incontinence care, including help with catheters or colostomy bags.
  • Dressing, Grooming, and Hygiene - Helping an individual with putting on and taking off clothing, including any necessary braces or artificial limbs. Combing or brushing your teeth, your hair, shaving, and other grooming needs
  • Eating - In addition to helping a person with the process of eating itself, getting assistance with meal preparation and planning, grocery shopping, meal cleanup  
  • Transferring - Assistance getting in out of a bed, chair, or wheelchair. Care could include ambulation and range of motion exercises. Caregivers may use special equipment for transferring like Hoyer lifts, gait belts, slide boards. 

You, or your loved one, will also need some help with IDALs known formally as your Instrumental Activities of Daily Living. The IDALs are more complex skills that are important to maintaining a normal life. IDALs include:

  • Homemaker activities  
  • Laundry and dressing   
  • Managing finances             
  • Meal preparation               
  • Medication management       
  • Shopping and running errands
  • Telephone and communication
  • Transportation         

A person may need 'hands-on assistance' or 'stand-by assistance.' With hands-on assistance, you physically need a person to help you with the activity, but with stand-by assistance, you can still perform the activity, but for your own safety and well-being, you need someone there to 'stand by' just in case.

Companionship Services

Often a person will need help with many non-medical and personal needs. Companionship services can include things like:

  • Answering the door and phone
  • Assisting with clothing selections
  • Care for houseplants and pets
  • Conversation and companionship
  • Mail bills and letters
  • Maintaining the calendar
  • Monitoring diet and eating
  • Plan visits, outings, and trips
  • Preparing grocery lists
  • Providing reminders for appointments
  • Stimulating mental awareness

In some cases, spouses, friends, and family can offer some of these services. It is not recommended that a spouse or family member provide ADL assistance and other more skilled services. Family members who even help with a limited amount of these items will need a break. 

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Many home health agencies and providers provide respite care to give relief to a loved one who is providing some informal care. Most Long-Term Care Insurance policies will also pay for respite care.

Memory Issues and Supervision

Often with cognitive decline, a person needs supervision. The individual may be able to person their everyday activities, but they can't be left alone. 

There are care providers that will provide close supervision of the individual as they perform their daily activities to keep them safe. As a person's Alzheimer's or dementia becomes more progressive, the individual may no longer safely stay in their home – they may require some type of memory care in a facility.

If you wonder if your loved one has a memory issue, you can conduct this test before seeking medical advice.

SAGE Test (Cognitive Testing)

Ohio State University has designed the Self-Administered Gerocognitive Exam (SAGE). The test intends to help the family detect early signs of a person's cognitive, memory, or thinking impairments. It assesses thinking abilities and helps physicians to know how well your brain is operating.

Remember, it is normal to experience some memory loss as you get older. It may take longer to recall events. However, it is not normal when you can no longer recall important information like where you live, family member's names, and the day of the week and year.

The SAGE test can be a helpful tool to assess if further evaluation is necessary. Be sure to set an appointment with the individual's primary care physician after completing the test. 

The doctor can review and interpret the results, order additional testing, and score the Sage test.

Access the test by clicking here.

Assessing Your Home for Safety

Falling is a significant concern for those who are older or are suffering from health issues. According to the Centers for Disease Control and Prevention (CDC), falls threaten a person's health and ability to remain independent. Falls can even cause death.

Removing Home Hazards

A person's home is full of obstacles; many of them we create ourselves. However, for an older person or someone with limited mobility, these obstacles are dangerous and increase the risk for a fall.

Start by looking at the care recipients' home. If you are older and have no major health issues, you should look at your own home even if your family has not mentioned anything about the problem.

Look at the major areas of the house. These areas include the living room, kitchen, bedrooms, garage, laundry area, and bathrooms. Don't forget the hallways and stairways are often full of potential hazards. The idea is to make the house safer from falls.

Many people love throw rugs. Often people place throw rugs on carpet, not just kitchen and bathroom areas. These high-traffic areas present a trip danger. Do you need throw rugs? If not, remove them. It is very easy for a person's foot to get caught on these rugs, causing a fall.

In-home care providers will usually review the living environment and recommend changes to keep the person safe. 

You do not want anyone to fall, especially someone who is older and may have mobility problems.

Look for other clutter items and either remove them or place them in a way reducing the risk. These include:

  •  Coffee tables, magazine racks, and plant stands should be removed from high-traffic areas.
  • Carpeting should be secured. Repair loose wooden floorboards.
  • Check hallways and keep them clear. 
  • Make sure any phone cords or electric cords are out of the way from a traffic area.
  • Be sure lamps and telephones have easy access. Keep clutter to a minimum. Don't leave newspapers, magazines, or boxes on the floor.
  • Store often-used items for easy access. Cubs, dishes, food, and other often-used items should be within easy reach.
  • Bathroom showers and tubs should have nonslip floor mats. If necessary, a shower seat can be used to allow sitting during a shower.

Let There Be Light

You want to have plenty of light throughout the house so the person can be safe in their home. There should be easy access to light switches and lamps. There should be night lights throughout the home, including bathrooms, hallways, bedrooms, kitchens, and other living areas. 

Be sure there are flashlights easily available in the event the power goes out.

Assistive Devices 

Place grab bars in the shower or bathtub. A raised toilet seat or one with armrests can be beneficial in helping to avoid a fall. Placing a sturdy shower seat with a hand-held shower nozzle for bathing will limit the risk of falls in the shower.

Medical Alert Device 

A medical alert device is a lifeline for a person to help an individual maintain their independence when they are home alone.

  • It is essential, however, to make sure it is worn at all times. Be sure someone tests the device regularly. 

How to Find Caregivers

There are many home health agencies and individual home health providers available in population areas. Rural areas may have more limited availability of caregivers. 

If the person has a Long-Term Care Insurance policy, the policy case manager may be available to help. Otherwise, the family will help find available quality care.

Remember, LTC NEWS has arranged for free claims management with Amada Senior Care, the nation's leading home care providers. They will complete an evaluation and process your insurance claim at no cost or obligation to you. Click here for more information.

You can ask friends and family who have used home health agencies or providers for recommendations. Searching the internet will bring up many providers to interview.

Most states require a home health care agency to have a license. These are the only states that currently do not require a license: 

  • Alabama
  • Iowa
  • Massachusetts
  • Michigan
  • Ohio
  • South Dakota
  • Vermont
  • West Virginia

Professional staff like registered nurses and licensed practical nurses must be registered and licensed by the state. However, most long-term care services are custodial and use non-skilled or limited skilled staff to help with ADLs or basic supervision that is required for a person with cognitive decline.

Here are the state requirements:

State Training Hours

Alabama 8
Alaska 8
Arizona 8
Arkansas 8
California 10
Colorado 8
Connecticut 8
Delaware 8
DC 8
Florida 8
Georgia 8
Hawaii 8
Idaho 8
Illinois 8
Indiana 8
Iowa 8
Kansas 8
Kentucky 8
Louisiana 8
Maine 8
Maryland 8
Massachusetts  8
Michigan 8
Minnesota 8
Mississippi 8
Missouri 8
Montana 8
Nebraska 8
Nevada 8
New Hampshire  8
New Jersey 76
New Mexico 8
New York 8
North Carolina 8
North Dakota 8
Ohio 8
Oklahoma 8
Oregon 8
Pennsylvania 8
Rhode Island 8
South Carolina 8
South Dakota 8
Tennessee 8
Texas 8
Utah 8
Vermont 8
Virginia 8
Washington 75
West Virginia 8
Wisconsin 8
Wyoming 8

States are reviewing their requirements as more people require long-term care services. 

Key questions to ask:

  • Does the agency and its staff trained and have their proper licenses?
  • Are the workers insured? How does the provider supervise and monitor their staff?
  • Sometimes happy customers will allow them to be used as a reference, ask for names. 

Advantages of Using Home Health Agencies

  • You have peace of mind knowing that providers are appropriately licensed and trained.
  • The cost of the care can be paid through Long-Term Care Insurance.
  • An agency handles the pre-screening, compensation, hiring/firing of the staff, and payment of taxes. NOTE: Some agencies are just glorified employment agencies, and the workers are independent contractors. Ensure it is clear who covers things like payroll taxes - including liability insurance, worker's compensation insurance, unemployment insurance, etc. 
  • Agencies can usually offer many levels of care.
  • Most agencies will be able to handle flexible scheduling.
  • When caregivers need time off - or are sick - agencies can find substitute care providers.

Advantages of Hiring Private Caregivers

  • You find precisely the caregiver you want, and they are accountable directly to you or another family member.
  • Typically, private caregivers are more flexible with their duties.
  • Private caregivers can be less expensive than those from an agency.
  • The caregiver can better build a strong relationship with the care recipient and the family. 

Consider the Cons of Private Caregivers

  • You are responsible for finding another caregiver if your caregiver gets sick or needs time off ... or quits with little or no notice.
  • You are the employer and become responsible for the hiring/firing, payroll, taxes, insurance, and employee disputes.
  • If the caregiver does not have the proper licensing or record-keeping Long-Term Care Insurance may not pay for the care cost.

Checklist When Interviewing In-Home Care Providers

Here is an easy checklist you can use when interviewing prospective home health care companies:

  • Do you do background checks? 
  • What kind? 
  • Where is your office located? 
  • Are your provers local? 
  • Are you available 24/7 to handle emergencies? 
  • Do you cover workers’ compensation for all caregivers? 
  • How do you ensure patient confidentiality? 
  • How long have you been in business? 
  • Do you offer a detailed agreement/contract with all associated fees before the start of services? 
  • Are you bonded and insured? 
  • Do you withhold federal and state payroll taxes for your caregivers? Do you pay unemployment insurance for your caregivers? 
  • Do you conduct supervisory home visits? 
  • Are your caregivers trained? 
  • Do you keep track of what caregivers are doing? 
  • Do you have skilled staff available (RN, LVN, LCSW, CCM)? 
  • Who do I contact if I have a problem?

Who Pays for Caregiving Services?

Medicareand health insurance do not pay for most caregiving services. Caregiving services are usually paid for in three ways:

1. Your responsibility (out of pocket) - Check with your financial advisor if you need help in liquidating assets to pay for long-term health care services.

2. Long-Term Care Insurance - Most Long-Term Care Insurance policies cover all levels and types of care, including in-home caregiving services, adult day care centers, assisted living, memory care, and skilled nursing facilities.

However, remember LTC Insurance is medically underwritten, so you cannot purchase a policy when you need care. The best time to purchase coverage is when you are in your 40s or 50s, when you still enjoy fairly good health.

3. Veterans Aid and Attendance Benefit - Some veterans who served during a time of war qualify for benefits that pay for caregiving services if the care is required from a service-related problem or you have little or no income and assets.

Medicaid

In some states, Medicaid, the medical welfare program, has been expanded to cover some in-home services, although most Medicaid long-term care services are delivered in nursing homes.

You must have little or no income and assets to qualify for Medicaid.

How Much is In-Home Care?

The cost of in-home care can vary depending on where you live. The LTC NEWS Cost of Care Calculator can show you the average cost of long-term health care in all types of settings based on your location. 

Use the calculator by clicking here.

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