For many elderly people, the availability of someone to help them a few hours a day with personal care or household chores can mean the difference between continuing to live at home or moving into a nursing home.
Home-based care is a new and growing field and many of the services are unregulated. Here are some tips on finding an appropriate care provider and paying for that care:
Consider community resources first. Contact your local Area Agency on Aging, often listed in the phone directory under "senior services" or "human services." Almost every county has one to help seniors remain independent in their own homes. Explain the need for home care and seek recommendations of service providers. A social worker usually will visit to assess the elderly person's needs.
Some services provided by local aging agencies, such as transportation, home-delivered meals and help with household chores, may be available for free or at modest cost, depending on the person's income.
Long-distance caregivers can call the Eldercare Locator at 800-677-1116 to find the appropriate state or local agency to arrange service for an older person in need of assistance.
Private home-care services. Some people may not qualify for government programs or may require more help than local aging agencies offer. They, or their family members, may have to look for private home care services providers. Check your phone directory under "personal care services" or "home care services."
Home care aides run the gamut from companions and housekeeping aides to those who help with personal care such as bathing, dressing, and grooming. Fees usually run from $10 to $16 an hour. People with specific health problems may require a visiting nurse.
In exploring home-based care, check whether the service you contact is an agency, which screens, trains and supervises its employees, or merely a registry of independent caregivers. Also, ask if the service is licensed - if required in your state - and accredited by a professional association, indicating a higher standard of quality.
"Usually, the people who are referred instead of being employed are cheaper," said Margaret Terry, executive director of Homemaker Health Aide Services of the National Capital Area, a home care agency in Washington, D.C.
"But the less costly person comes with a potentially big price," she said. Terry explained that if one of her employees is unable to visit a client on a particular day, a replacement is found. And if an aide is injured on the job, such as hurting her back when trying to lift an elderly person out of bed, the agency - not the client - is liable.
When you hire an independent caregiver, you become the employer. That means you are liable for injuries, for withholding Social Security taxes, and for filing the proper tax documents. (To learn more about tax responsibilities of employers of household help, call the IRS toll free at 800-829-3676 and request Publication 907.)
Some people find, however, that less expensive independent caregivers are the only way they can afford home-based care. An excellent book on the subject, "Home Care for Older People," discusses the advantages and disadvantages of various home care options and how to find needed help. For a copy, send $12 on United Senior Health Cooperative, 1331 H. Street, N.W., Suite 500, Washington, D.C. 20005.
Paying for care. Once you find the home-based care you need, the next challenge is paying for it. Medicare, the government's health care program for those 65 and over, does not cover long-term care or help with personal or household services. However, Medicare will pay for home care services related to acute, short-term health problems if a person is homebound, under a physician's care, and needs part-time or intermittent skilled nursing services or physical or speech therapy.
Private insurance pays very few home care costs. Some newer supplemental medical insurance policies, known as Medigap, offer limited coverage for home care, but only when a patient is also receiving Medicare.
Private long-term care insurance policies often cover home-based care. But these policies are still so new and relatively expensive that only a small percentage of the elderly have them. The bottom line is that if you need private home care services, you're probably going to have to pay for it yourself. That may mean liquidating assets or engaging in some creative financing, such as applying for a reverse mortgage where the lender pays the homeowner.