What is Senior Home Care?

According to the Home Care Association of America and The Washington Post, "nearly 70 percent of Americans who reach age 65 will, at some point, be unable to care for themselves without assistance"^[1]. For some, getting assistance may require moving to a nursing home or an assisted living facility, but it's no secret that the majority still prefer to age in place and remain close to their families, with the help of senior home care services.

But what exactly is senior home care, and what must be considered to determine the quality of a senior home care provider? How can an elderly person's health and wellness be ensured without taking them away from where they are home and happiest?

Types of Senior Home Care

Keeping the senior home and healthy is the whole idea behind senior home care services, which usually come in two key types:

• Personal Senior Home Care
  This type of senior home care provides assistance with daily activities, where caregivers are usually unlicensed and trained differently from company to company. Care costs are also often paid out-of-pocket by the senior or the family. While some Medicare Advantage plans are starting to venture into this type of senior home care, most arrangements are privately made and paid for instead of being coursed through insurance.
• Professional Senior Home Care
  From the term itself, this type of senior home care is provided by licensed professionals and may be described as "personal" senior care with the security and overall advantage offered by medical experts. What ultimately separates personal from professional senior home care is the participation of a doctor in the care plan, which usually means that Medicare or a private insurer will cover the plan, and the senior or the family may have co-pays obligations.

Full-Service vs. Independent Senior Home Caregivers

While full-service agencies are typically more expensive, these providers are known to be extremely strict when accepting caregivers into their staff. Hiring through an agency may also mean the workers are bonded for theft and other issues. And should the assigned caregiver be unable to report for work on a particular day, the agency can easily find someone else to take their place.

On the other hand, independent caregivers usually charge less for their services, but require more work from the senior or the family in terms of meeting tax requirements, conducting background checks, and verifying identities of candidates. Additionally, if the hired caregiver couldn't come for work for any reason, the senior or the family will be responsible for finding a replacement.

Defining "Home" in Senior Home Care

Whether professional or personal home care is provided, or whether the caregiver is hired directly or through an agency, "home" should be defined as a residential area or community rather than the senior's physical house, although that's usually where most care services are rendered. In other words, the overall goal of senior home care is to allow the elderly client to feel safe in their own home while maintaining as much independence as possible.

What to Expect from Senior Home Care

Senior care services may be hired to provide comprehensive caregiving needs or simply to give respite to the client's main caregivers (usually family members). On the other hand, clients with special medical needs may be cared for by a team composed of both personal and medical caregivers.

In general, senior home care workers can be any of the following:

• Doctors
• Physical therapist
• Registered nurse
• Health care aide
• Social workers
• Companion or homemaker
• Volunteers

• Heart rate and blood pressure monitoring
• Catheter and IV management
• Injury or post-surgery wound care
• Physical therapy or psychotherapy
• Health education for clients and caregivers
• Help with ADL (activities of daily living, like eating, bathing, etc.)
• Meal preparation and housekeeping
• Driving and mobility assistance
• Companionship

Benefits of Senior Home Care

In-home care can be invaluable to seniors, offering a wide range of benefits that improve their overall health and well-being, including:

• Good Mental Health
  Most seniors are sensitive to their surroundings and don't usually appreciate unfamiliarity, whether in terms of physical space or the people they share it with. Through in-home services, they can get all the medical and personal care they need without going through the stress of leaving their precious home behind, moving to unknown territory (retirement or assisted living homes), and living with strangers. This helps them maintain a positive mental disposition, which, in turn, increases their longevity.
• Cost-Effectiveness
  No fancy formula is needed to determine that home care is still the most affordable option for seniors. Room and board account for more than half of the cost of moving a senior to a retirement, nursing, or assisted living home. Even for those who have more extensive medical needs, home care is still generally cheaper with the right provider.
• New Bonds and Friendships
  Because caregivers at retirement facilities usually work in rotations, they rarely have an opportunity to form strong relationships and bonds with the senior residents. This isn't true for a home care scenario, though, where the senior is usually assigned the same caregiver until the contract is terminated. This gives the elderly client a chance to foster new friendships and satisfy their need to connect socially, which is innate to all humans, regardless of age.
• Control Over Caregiver Behavior and Qualifications
  When seniors move to a retirement or assisted living facility, outsiders typically have little control over the professional and personal backgrounds of the staff, or how their elderly loved ones are treated. With in-home care, family members can keep a closer watch of their senior loved ones, being able to drop by and check anytime, and even participating in the hiring process.
• Personalized Service
  One of the best things about senior home care is the option to customize the provided services as needed. For example, a caregiver can do some light housekeeping on certain days and accompany the senior to social events on other days. With such a level of customization, seniors and their families can maximize the benefits they get from the service.
• Working with the Senior Home Care Provider
  After finding the right provider, the senior or the family begins to work with the home care team in creating a suitable care plan based on several factors, usually beginning with outlining the specific type or types of health care workers needed. For example, does the senior have medical needs that require the services of a registered nurse? Other crucial considerations include the specific type or types of care required and how often, and, if applicable, the treatment outcomes expected by the doctor.
  Once the details have been ironed out, the senior home care provider will make all the necessary arrangements, including securing any needed medical supplies. Care plans, in general, should be reviewed at least once every two months, but if there are changes in the senior's situation that prompt immediate adjustments, the head of the care team must be informed first. For example, if the senior is receiving medical services, the registered nurse should inform the attending doctor, who will then decide on the necessary steps to be taken. Of course, the family must be notified as well.

Senior Home Care Client Rights and Protections

If a senior or care agency has Medicare, federal law grants the client a number of protections, namely the rights to:

• pick a senior home care provider (seniors with managed care plans can only choose from within their networks)
• demand respect for their property
• take part in decisions involving their care plan and get a copy of it from the provider
• appoint a family member or guardian to act on their behalf if necessary

Additionally, home care providers should furnish seniors or their families a copy of their rights, such as:

• choosing their caregiver
• receiving necessary professional care based on their doctor's orders
• getting a prompt response to any service request
• being admitted into a service that is capable of providing safe, professional, and necessary care
• receiving decent continuity of care
• being referred to another provider if the sole reason for the termination of services is their failure to pay
• expressing their sentiments and proposing service or caregiver changes without apprehensions
• being given a fair hearing when they feel wronged by their provider (for example, when they are declined a service)
• refusing treatment within legal boundaries and being informed of the impact of such refusal
• creating advance directives and obliging their senior care provider to follow them
• being informed about:
• all necessary details when asked for consent to a new procedure or treatment
• proposed care plan changes or a planned termination of services
• provider policies, charges, and third-party reimbursement eligibility
• options during an emergency
• the process for filing complaints against their state-licensed and Medicare-certified senior home care provider

How to File a Complaint Against a Senior Home Care Provider

Complaints against senior home care providers are usually filed at the public health department of the state where the alleged offense was committed. Seniors or their families can also call the federal government's Home Health Hotline (1-800-628-5972), which is accessible 24/7.

If the complaint is deemed serious enough, the department's investigators will usually conduct interviews, study the complainant's records, and go through other documentation to determine culpability. If a complaint includes more than one allegation, only a single substantiated claim is necessary for the department to continue with the process, which, at this point, will seek to determine whether the agency has indeed incurred federal and/or state violations. If so, the division will issue a citation to the erring provider, which will then submit a corrective action plan that is acceptable to the department.

Choosing a Quality Senior Home Care Provider

Choosing a quality senior home care provider requires a bit of online and in-person research, including approaching the local Area Agency on Aging (AAA) for referrals. Our directory of Home Care agencies near you is a great place to start (scroll to the bottom of the page and select your state). Before deciding on a particular provider, here are the most important things to consider about:

• Longevity
• Services and costs
• Medicare approval and national accreditation (such as by the Joint Commission for the Accreditation of Healthcare Organizations)
• Licensing (if applicable)
• Bill of Rights (a list of the senior's and the provider's rights and responsibilities)
• Care plan individualization and the senior's (or the family's) level of involvement as a client
• Degree of staff supervision
• Nursing supervisor availability (should be 24/7)
• Ease of replacement when the assigned caregiver doesn't show up
• Client privacy guaranteed
• caregiver training and background screening
• References
• Conflict resolution/complaint-filing processes
• Sliding-scale fees and financial assistance schemes

When contracting senior home care services from an individual instead of an agency, a more thorough screening process is needed and should include a personal interview and a request for references. Before meeting the potential caregiver for the interview, it's good to make a list of the senior's special needs, such as the client needing help when walking.

The caregiver should be able to provide the required assistance. Also, whether the caregiver is hired directly or through an agency, it pays to orient them about the senior's daily routine by having them spend at least a day together before the job officially starts. This will be a perfect opportunity for the caregiver to understand the client's:

• current health conditions, including injuries;
• attitude issues, if any, and how to manage them;
• medications and medicating schedule;
• need for personal devices like canes, hearing aids, dentures, etc.;
• nutritional requirements and limitations (for example, food allergies); and
• prescribed therapeutic exercises and mobility issues, if any.

Senior Home Care Security

Senior home care agencies are usually required to conduct criminal background checks on their employees, but actual regulations can vary from state to state. This is another reason to get in touch with the local AAA or the state public health department to know what relevant laws apply.

Cost of Senior Home Care

Just as the laws that govern senior home care vary across the states, so does its cost, the biggest factor being the type or types of care needed by the client. For example, if the senior's care plan calls for the expertise of a medical doctor, overall care costs would naturally be higher than if the client only needed basic age-related caregiver services.

Generally speaking, senior home caregivers are paid around $18 to $30 per hour, and payments may be made by clients or their families either directly or through Medicare, Medicaid, the Veterans Administration, or other public and private sources.

Further Reading

The quote used at the beginning of this article, "Nearly 70 percent of Americans who reach age 65 will, at some point, be unable to care for themselves without assistance." is from The Washington Post's "Who will care for America’s aging population?" and also referenced in the HCAOA's "The Value of Home Care."