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What are In-Home Care Agencies?
In-home care agencies provide non-medical assistance to seniors and people with disabilities so that they can live more comfortably and safely at home. This includes help with activities of daily living (ADLs) like dressing, bathing and eating, as well as household chores, medication reminders, and friendly companionship.
In-home care services are also referred to as “companion care,” “home care,” “attendant care” and “personal care.”
In-Home Care Services vs Home Health Agencies
Whereas home health agencies provide licensed nursing care and specialist therapies, in-home care services do not include any professional medical care.
In-home care services are designed for people who don’t have significant or complex medical needs, but could still benefit from help with daily tasks. Another key goal of in-home care is to provide respite for family members who have assumed the role of primary caregiver for their loved one.
Unlike home health services, non-medical in-home care is not covered by Medicare.
| In-Home Care Agencies | Home Health Agencies | |
|---|---|---|
| ADLs assistance (help with dressing, bathing, eating, etc.) | Yes | Limited / only covered by Medicare when accompanied by a need for skilled nursing care |
| Household chores | Yes | Limited / not covered by Medicare |
| Cooking / meal preparation / meal delivery | Yes | Limited / not covered by Medicare |
| Transportation / accompanying to appointments | Yes | Limited / not covered by Medicare |
| Medical care | No | - Part time skilled nursing care - Physical therapy - Occupational therapy - Speech therapy |
| Cost | $21/hour on average* | Varies based on type of medical care |
| Payment options | Personal funds (if required) - Medicaid (if eligible) - VA benefits (if eligible) - State programs (if eligible) - Long-term care insurance (if you have it) |
- Medicare (if eligible) - Medicaid (if eligible) - Veterans benefits (if eligible) - Personal funds (if required) - Private health insurance (policy dependent) |
What services are included in in-home care services?
In-home care services vary from provider to provider, but often include:
- Assistance with dressing, bathing, eating and other activities of daily living (ADLs)
- Light housekeeping (laundry, dishes, taking out the garbage, etc.)
- Help with ambulation (e.g. sitting, standing, moving from room to room)
- Medication management
- Scheduling / appointment reminders
- Transportation / accompanying to appointments
- Cooking and meal preparation, or meal delivery
- Friendly companionship
- Respite care for family members
What services are not included in in-home care?
In-home care does not include skilled nursing care or specialist care, such as physical therapy. Aides are not licensed to care for injuries, help manage pain, draw blood, or perform any other professional medical procedures.
How much does in-home care cost and who pays for it?
In 2017, the average cost of non-medical home care services in the United States was $21/hour*. However, costs vary greatly depending on where you live, the in-home care provider and the amount of care required.
People use the following methods, or most often a combination of the following methods, to pay for in-home care services:
Since non-medical home care is not covered by Medicare, many people must use their own personal savings and income to cover the cost of in-home care.
For people who meet their state’s eligibility requirements, Medicaid will cover or partially cover non-medical home care. Coverage is typically provided through Home and Community Based Services (HCBS) or Medicaid Waivers to people whose income and assets fall below a certain threshold. Wait lists are common.
Veterans can receive financial support for home care services through the following programs, each with its own eligibility requirements:
- Basic Pension
- Aid & Attendance
- Housebound
- Veteran-Directed Home and Community Based Services (VD-HCBS)
If specified in the policy, home care services may be covered by long-term care insurance or whole life insurance that has a long-term care rider. Another option is to convert a life insurance policy into a plan that covers home care services, or to cancel the policy completely in return for cash.
Many states have programs to help cover the cost of non-medical home care, particularly for people who don’t meet Medicaid’s financial requirements, but who are still considered low income. These programs are designed to keep seniors out of skilled nursing facilities, which are far more expensive for states to fund. Programs vary by state and are typically managed by the state’s Aging Services Division—visit the HHS.gov to view a directory of resources by state
Long-term care insurance and whole life insurance with a long-term care rider are both designed to cover the costs of long-term skilled nursing care. These insurance policies are best purchased when young and healthy, and the amount of coverage varies from plan to plan.
It’s also possible to sell your existing life insurance policy in order to create a long-term benefit plan, or to cancel it entirely for cash value.
Some people pay for long-term home care by getting a reverse mortgage or a home equity line of credit (HELOC), both of which allow you to borrow against the value of your home. For families who need short-term financial help while they wait for Medicaid or veterans benefits, short-term bridge loans are another possible solution.
How to find the best in-home care agencies for your loved ones.
Narrow your search to suit your needs. Look for in-home care providers who specialize in the type of care you require. If your loved one has Alzheimer’s, look for a provider that’s experienced in memory care. If their primary language is Spanish, look for a company with aides who speak Spanish.
Find in-home care providers near you. Look for home care providers with an office close to where you live. This makes it easier for you to request last-minute schedule changes and meet with the company’s management if required.
Avoid large online referral brokers. These companies make thousands of dollars in commission fees for referring you to care agencies, so they might not have your best interest at heart. Instead, research home care providers and submit care requests via Care Listings.
Enquire about staffing policies. Ask if staff are employees or independent contractors. Ask about background checks, turnover rates and training. Ask whether you have the ability to switch aides if you aren’t happy with the person provided.
Request one or two regular aides. In-home care works best when the person receiving the care is able to develop a relationship with the care provider. Make sure the care will be consistently provided by the same one or two individuals.
Review costs and payment options. If you plan to use any form of government assistance (Medicaid or other state programs) to pay for care, make sure the company accepts that type of payment and is familiar with the processes involved.
