Senior home care is a broad term for a range of supportive services provided to older adults in their own homes to help them maintain their independence, safety, and quality of life. Home care allows seniors to remain in familiar surroundings rather than moving to a nursing home, assisted living facility, or other residential care setting. It is one of the most common and most preferred long term care options among older adults and their families.
Types of senior home care
Senior home care encompasses several distinct types of services each serving different needs:
Personal care or custodial care Personal care — sometimes called custodial care or non-medical home care — provides assistance with activities of daily living including bathing, dressing, grooming, toileting, mobility assistance, and meal preparation. Personal care workers are sometimes called home health aides, personal care aides, or certified nursing assistants depending on their training and the state where they work.
Homemaker services Homemaker services provide assistance with instrumental activities of daily living — tasks that support independent living but are not personal care. These include light housekeeping, laundry, grocery shopping, errand running, and meal preparation. Homemaker services are often provided by the same worker who provides personal care.
Companionship services Companionship services provide social interaction, conversation, and supervision for seniors who are isolated or who need someone present for safety reasons. Companionship workers may also assist with transportation, accompanying seniors to appointments, and engaging in recreational activities.
Home health care Home health care involves skilled medical services provided in the home by licensed healthcare professionals including registered nurses, licensed practical nurses, physical therapists, occupational therapists, and speech therapists. Home health care is ordered by a physician and treats specific medical conditions or injuries. It is distinct from personal care and homemaker services which are non-medical.
Specialized home care Some agencies specialize in home care for people with specific conditions such as Alzheimer’s disease, dementia, Parkinson’s disease, or post-surgical recovery. Specialized home care workers receive additional training in the unique needs of these populations.
Benefits of home care
Home care offers several significant advantages compared to residential care settings:
- Familiar environment — remaining in a familiar home environment can be especially important for people with dementia who may become more confused and distressed in unfamiliar settings
- Independence and autonomy — home care allows seniors to maintain greater control over their daily routines, schedules, and personal choices
- One-on-one attention — unlike nursing homes where staff care for many residents simultaneously home care provides individualized attention
- Family involvement — home care makes it easier for family members to remain actively involved in a loved one’s care
- Cost — for seniors who need only part-time care home care is often significantly less expensive than residential care
- Comfort — most people simply prefer to remain in their own homes and maintaining this preference can contribute to emotional wellbeing
How home care is paid for
Home care is paid for through several sources depending on the type of care and the individual’s eligibility:
- Private pay — personal savings, retirement income, and other personal funds are the most common payment source for non-medical home care
- Medicare — Medicare covers skilled home health care — nursing and therapy services — for eligible homebound patients when ordered by a physician. Medicare does not cover non-medical personal care or homemaker services for extended periods.
- Medicaid — Medicaid covers home care for eligible low income beneficiaries through the home health benefit and through HCBS waiver programs. Coverage varies significantly by state.
- Long term care insurance — policies that cover home care typically pay a daily or monthly benefit that can be used for personal care and homemaker services
- Veterans benefits — eligible veterans may qualify for VA benefits including the Aid and Attendance benefit that can help pay for home care
- Area Agency on Aging programs — many local programs funded through the Older Americans Act provide subsidized home care and homemaker services for eligible older adults
How to find home care
Home care services can be arranged through several channels:
- Home care agencies — licensed agencies that employ and supervise home care workers. Using an agency provides important protections including employee screening, training, backup coverage, and liability insurance.
- Registry services — organizations that maintain lists of independently employed home care workers. The family assumes more responsibility for supervision and management.
- Direct hire — hiring a home care worker directly without going through an agency. Less expensive but requires the family to handle hiring, screening, payroll taxes, and backup coverage.
- Referrals — recommendations from physicians, discharge planners, social workers, and other families
- Eldercare Locator — eldercare.acl.gov or 1-800-677-1116 can connect you with home care agencies and programs in your area
What to look for in a home care agency
When evaluating home care agencies consider:
- Licensing and accreditation — confirm the agency is licensed by your state and consider whether it holds accreditation from a recognized organization such as the Joint Commission or the Accreditation Commission for Health Care
- Screening and training — ask how workers are screened including criminal background checks and reference checks. Ask what training workers receive before and after hire.
- Supervision — ask how the agency supervises its workers and how concerns or problems are addressed
- Backup coverage — ask what happens if your regular worker is sick or unavailable. A good agency has backup workers who can fill in.
- Insurance — confirm the agency carries liability insurance and workers compensation coverage
- References — ask for and check references from current or former clients
Creating a home care plan
Effective home care begins with a clear understanding of the senior’s needs. A home care plan should address:
- Which activities of daily living require assistance and how much
- The schedule and hours of care needed
- Any specific medical needs or conditions the care worker should be aware of
- Emergency procedures and contacts
- The senior’s preferences regarding how care is provided
Many home care agencies conduct an initial assessment to develop a personalized care plan. A geriatric care manager can also help assess needs and develop a comprehensive care plan.
When home care is no longer sufficient
Home care is not appropriate for everyone and there are situations where a higher level of care becomes necessary. Signs that home care may no longer be sufficient include:
- The senior’s safety cannot be maintained at home even with maximum home care support
- The senior requires around the clock supervision that home care cannot consistently provide
- The caregiver burden on family members becomes unsafe or unsustainable
- The senior’s medical needs exceed what can be managed in a home setting
- The senior is experiencing frequent hospitalizations or medical crises
When home care is no longer sufficient a transition to assisted living, memory care, or a skilled nursing facility may be necessary.
Helpful Home Safety Products for Seniors
Families arranging home care for a loved one often find that a few key safety products make a significant difference in maintaining independence and preventing falls and injuries at home. These are among the most commonly recommended home safety products for seniors receiving care at home:
- Grab bars installed in the bathroom near the toilet and shower are one of the most effective fall prevention tools available and can be installed without a contractor
- A shower chair or transfer bench allows seniors with limited mobility to bathe safely without standing for extended periods
- An automatic pill dispenser eliminates the daily burden of medication management by dispensing the correct medications at the correct times automatically
- Non-slip bath mats for the shower and bathroom floor significantly reduce the risk of falls on wet surfaces
- A bed rail provides seniors with a secure handhold when getting in and out of bed independently
These books are also highly recommended for families coordinating home care for an aging loved one:
- How to Care for Aging Parents by Virginia Morris — the most comprehensive guide available for adult children managing a parent’s care at home
- The Caregiver’s Survival Guide — practical advice for managing the day-to-day challenges of home caregiving
Key terms to know
- Home care — supportive services provided in the home to help seniors maintain independence
- Personal care — assistance with activities of daily living such as bathing, dressing, and grooming
- Homemaker services — assistance with household tasks such as cleaning, laundry, and meal preparation
- Home health care — skilled medical services provided in the home by licensed healthcare professionals
- Activities of daily living — ADLs — basic self-care tasks including bathing, dressing, eating, toileting, transferring, and continence
- HCBS waiver — a Medicaid program that funds home and community based services as an alternative to nursing home care
- Geriatric care manager — a specialist who assesses needs and coordinates care for older adults
Sources
- Medicare.gov — Home Health Services
- Administration for Community Living — eldercare.acl.gov
- National Association for Home Care and Hospice — nahc.org
- USA.gov — Home Health Care
This article is for general informational purposes only and does not constitute legal or medical advice. Home care coverage and availability vary by location. Consult a licensed professional or contact your local Area Agency on Aging for guidance specific to your situation.