Understanding What is Senior Home Care

SeaBreeze

SeaBreeze

Endlessly Groovin'
Location
USA
An idea of what senior home care or 'living in place' may entail, cost, etc. Full story here.

Aging is a fact of life – we simply can’t stop the clock, and for most adults, there will come a time when a little extra assistance performing the tasks of daily living would be helpful. The Home Care Association of America reports that “nearly 70 percent of Americans who reach 65 will be unable to care for themselves at some point without assistance.” For some people, this assistance means moving into an assisted living facility or a nursing home, but for many more, “aging in place” at home is a much more attractive goal that can be achieved with the help of senior home care.

With staying at home as the primary goal, Pierotti says senior home care can generally be divided into two big categories. “One of them is what we would think about in terms of personal care, and that might be a homemaker, someone who does light housekeeping, does errands or would assist a senior to do errands. Maybe they help someone get dressed or take a shower – they’re personal care support.” These personnel are not usually licensed, and how these caregivers are trained varies from company to company. The form of care is also typically paid for out-of-pocket by the senior or the family.

“Although some Medicare Advantage plans are beginning to explore these options, mostly right now that’s a service that people contract for privately and pay for directly and not through an insurance company,” Pierotti says.

The second big category of care is what Pierotti calls “professionally-driven care – that’s care that’s going to involve a licensed professional and a physician’s order,” and may be thought of as “more traditional home health care that will involve a registered nurse or a physical therapist. There may also be personal care support that is being done in coordination and under the oversight of a registered nurse as part of a plan that a physician or other licensed provider is making.” The key distinction is whether a physician is involved in this form of care, and health care services delivered this way are usually covered by Medicare or a private insurer. “That is included as part of a physician’s plan,” and the patient may have to pay copays, “but usually those are very low if there are any at all,” she says.

Lakelyn Hogan, gerontologist and caregiver advocate for Home Instead Senior Care, an international in-home care agency with 650 locations in the U.S. and Canada, adds that “when we refer to ‘home,’ it could be a residential or a community setting,” and is not strictly limited to an individual’s private residence, although that’s typically where this type of care takes place. No matter in which version of "home" the care transpires, “the idea of home care is to help older adults remain safe and independent as much as possible by helping with activities of daily living,” such as eating and bathing, “and what we call the instrumental activities of daily living,” such as driving or housework.

The menu of options offered by senior home care organizations is virtually limitless, but is often dictated by the family budget. Services for seniors receiving in-home care may include:


  • In-home nursing care, such as wound dressing, IV therapy, health monitoring, pain control and other nursing duties
  • In-home physical, occupational or speech therapy
  • In-home doctors' visits or telemedicine check-ups via video conferencing or phone
  • Medical social services, such as counseling and identifying community support and other resources
  • Medication management or reminders
  • Light housekeeping – cleaning and laundry services
  • Meal preparation or delivery and diet monitoring
  • Assistance with eating
  • Personal services, such as assistance with bathing, dressing or walking
  • Assistance with shopping and other errands
  • Companionship and social interaction
  • Transportation
  • Volunteer services, which can run the gamut from simple companionship to transportation, personal care, emotional support and more specialized skills such as assisting with paperwork or other needs.
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Thanks!

The cost of care calculator in the article was very interesting.

In my area, we have a program called PACE that is a good option for people on Medicaid. The PACE folks coordinate medical care, routine home care, transportation, etc... that allows a person to age in place.

The self-pay choices are available but very pricey and it is difficult to be sure if you are getting a competent caregiver or just a warm body.

My current plan is to try and piece together readily available resources using technology. Things like shopping, transportation, meals on wheels, cleaning/laundry service, medical alert systems are all within easy reach if I keep up with basic technology and my head continues to cooperate. When I feel that I need someone to keep an eye on me and be available to assist me 24/7 I will head for an assisted living facility. IMO the assisted living facility can be a better/safer overall choice for the frail elderly than continuing to live alone/independently.
 
Aunt Bea said:
Thanks!

The cost of care calculator in the article was very interesting.

In my area, we have a program called PACE that is a good option for people on Medicaid. The PACE folks coordinate medical care, routine home care, transportation, etc... that allows a person to age in place.

The self-pay choices are available but very pricey and it is difficult to be sure if you are getting a competent caregiver or just a warm body.

My current plan is to try and piece together readily available resources using technology. Things like shopping, transportation, meals on wheels, cleaning/laundry service, medical alert systems are all within easy reach if I keep up with basic technology and my head continues to cooperate. When I feel that I need someone to keep an eye on me and be available to assist me 24/7 I will head for an assisted living facility. IMO the assisted living facility can be a better/safer overall choice for the frail elderly than continuing to live alone/independently.
Click to expand...

Thank you for posting the link to this article, SeaBreeze. Lots to think about. On an aside, I usually check US News and World Report's website at least monthly. They have sections specifically for Seniors.
https://health.usnews.com/senior-care
https://money.usnews.com/money/retirement

Aunt Bea, what a wise strategy to use technology to provide help as we age. I'm a fan of a la carte services. If I need a housekeeper I'll hire someone that a friend recommends to get my place spiffed up and have the laundry done. For transportation, yes our city offers free or reduced rate senior shuttles, but what a P in A to arrange them. Meantime, Ubers are a mere five minutes away. Like Bea, I'm not afraid of assisted living. Not eagerly looking forward to it, but not fearful of it either.

My observations of full-time in-home caregivers is that they're mediocre baby sitters who play on their phones most of the time while planting their charges in front of a TV. Ditto for residential board and care homes. A short stint with an in-home caregiver while recovering from surgery would be ok, but for the long term? No thanks. Moving to an AL would be my strong preference.

Minimum wage help who are supposed to be wearing many hats (care-giver, housekeeper, shopper, companion, cook, etc.) generally perform poorly at most of these tasks and burn out in a hurry. I'm not criticizing them exactly - I would do a lousy job myself.
 

This is an excellent topic and one that I think about often. I'm 62, single (although I have a wonderful man in my life but he lives 1200 miles away and we only see one another 4-6 times a year), I live alone in a wonderful small community and I have a keen sense of the passing of time. Aunt Bea, I love your plan to integrate technology into your life to enable you to stay in your home. It has inspired me to look into similar options in my little town. My family wants me to move closer to them (I'm currently about 175 miles away from my nearest relative) and I told them I would consider it but not for a few more years, hopefully longer.

I did purchase a long-term care policy in the event age and illness prevent me from living on my own.
 
It's always wise to have a Plan B, just in case. We investigated 9 facilities for my MIL in 2014, and plan to start doing so again but this time with ourselves in mind.

One issue all the facilities mentioned - many seniors wait too long to apply for CCRCs and Asst Living facilities. Many will only take people if they are healthy enough to be accepted for Independent Living, or at Asst. levels lower than full-out Skilled Care Nursing. IOW, not all who apply will qualify.

I'm on a couple of mailing lists for facilities. Every once in a while - maybe every two yrs or so - I'll get a notice that a facility has a couple of beds available in Skilled Care Nursing and is willing to accept sicker/disabled residents who qualify financially. But it's rare that happens.

Star Song, thank you for posting those two links. Very interesting info! I'm a member of the FIRE forum (Financial Independence/Retire Early) and altho most are very knowledgeable about budgeting, saving, and investing, I've found that only a couple of them have actual knowledge of dealing with eldercare issues.

Most of the FIRE members had absolutely no idea what the difference was between Medicare and Medicaid (well, I didn't either in my 40's, LOL). I also found it dangerous that they seemed to be assuming they could make it through an "active retirement phase" of some 30+ years and also self-insure themselves for serious elder health problems/disability/nursing care. They haven't really got a clue about what cancer drugs cost, or how difficult rehabilitation and coping alone can be after a stroke.

Some of them boast about being able to live on so little they qualify for ACA subsidies (despite being able to retire at age 40), as if that will continue forever and allow them to avoid more expensive healthcare issues.

It cost my MIL $4300/mo in the final year before she died in 2015, to be in one of the top three seniorcare facilities in our state. I can't help but wonder what some of these FIRE folks will do when life starts throwing them really big curveballs?
 
Lethe200 said:
I can't help but wonder what some of these FIRE folks will do when life starts throwing them really big curveballs?
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They will learn about Medicaid sponsored assisted living subsidies and how difficult it can be living with some degree of dignity on the $50.00/month allowance they will be given from their SS check.

I will do everything I can to avoid and ignore the really big curveballs. IMO spending large sums of money on end of life care is a very bad investment. I would prefer to see my life savings devoted to a better cause than funding my last two or three years on earth. If the going gets tough I will opt for palliative/hospice care and slip away as quickly as possible. The sad fact is that no matter how much money you spend you will not make it out of this world alive.
 
These are good discussions, informative. My mother was a CNA (Certified Nursing Assistant) for 20 years or so and then went into home care. I heard sooooo many stories. When my mom needed help herself she was determined to stay alone. A chore girl would come to her apartment (55+) and make her an early dinner, clean up a bit. I lived 5 hours away and visited her when I could and when that did happen I was doing most of the deep cleaning myself. The best event that happened to my mom was that a social worker became her Ombudsman... she was very good at solving problems. We would have been lost without her. Of course my mom lived in a small town and I'm not so sure my mom would have received that help in a larger city.

Because of my experience with my mom I have decided to to share my home with my daughter and her family. I know it's not for everyone... I'm fully aware that not all families are willing to make those kind of sacrifices for care. It can be a hardship for everyone as "old folks" we have a lot of pride and as young families they have even less time to fuss with the in firmed. But we have agreed that we stay together until "my time"... whatever that means.

I am hoping as more of us age in place that more help becomes available whether is is with family or institution.
 
StarSong said:
Thank you for posting the link to this article, SeaBreeze. Lots to think about. On an aside, I usually check US News and World Report's website at least monthly. They have sections specifically for Seniors.
https://health.usnews.com/senior-care
https://money.usnews.com/money/retirement

Aunt Bea, what a wise strategy to use technology to provide help as we age. I'm a fan of a la carte services. If I need a housekeeper I'll hire someone that a friend recommends to get my place spiffed up and have the laundry done. For transportation, yes our city offers free or reduced rate senior shuttles, but what a P in A to arrange them. Meantime, Ubers are a mere five minutes away. Like Bea, I'm not afraid of assisted living. Not eagerly looking forward to it, but not fearful of it either.

My observations of full-time in-home caregivers is that they're mediocre baby sitters who play on their phones most of the time while planting their charges in front of a TV. Ditto for residential board and care homes. A short stint with an in-home caregiver while recovering from surgery would be ok, but for the long term? No thanks. Moving to an AL would be my strong preference.

Minimum wage help who are supposed to be wearing many hats (care-giver, housekeeper, shopper, companion, cook, etc.) generally perform poorly at most of these tasks and burn out in a hurry. I'm not criticizing them exactly - I would do a lousy job myself.
Click to expand...
Thank you for posting those links Starsong. Very informative indeed. I've heard some stories from my BFF and my sister about in home care givers. The home health aide (HHA) for my BFF's father attempted to cash a check he'd forged. Only thing he didn't know that her father was a well known town official for years and the bankers knew him so knew the check was fraudulent. My sister would pop in and find her aunt hadn't been bathed, dressed and fed at a time of day she should have been...so she fired that HHA. I'd like to be able to choose the least expensive option, especially here in Jersey which has some of the highest rates in the country, but I'm also leery about HHAs.


 
Excellent post Seabreeze and right on time. Thank you. I had checked the costs of the different elder care options about 3 years ago and was thinking of doing it again this year.
 
Taking care of elderly parents, grandparents or any other close family member is not an easy task, Home care allows you to stay in your home as long as possible. It's less expensive than institutional care, such as assisted living and nursing homes. This type of care includes home health care and non-medical care such as assistance with activities of daily living and domestic chores.
 
David Thompson said:
...Home care allows you to stay in your home as long as possible. It's less expensive than institutional care, such as assisted living and nursing homes. This type of care includes home health care and non-medical care such as assistance with activities of daily living and domestic chores.
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Actually, costs are so variable that this is no longer always true. The cost of home healthcare aides has been rising faster than all other healthcare segments for the past three years, due to raises in the minimum wages.

Caregiverlist.com has some excellent info https://www.caregiverlist.com/SeniorCareCosts.aspx:
- Senior Home Care: $15 - $25 per hourfor hourly care and $150 - $350 per day for 24-hour live-in care.


- Nursing Home Facility: $180 - $400 perday with a variety of additional fees for beauty salon services,special meals and activities.


- Assisted Living Community: $4,000 permonth*, with possible additional fees for meals, special services and activities +additional cost for private duty caregiver services (see Senior HomeCare costs above).

* My personal note: this figure is applicable to high cost labor areas, such as where I live in the San Francisco Bay Area, and probably other large metropolitan areas. If you live in a LCOL area, costs can drop below $2K/mo. for AL facilities.

However, even at $4K, that is $133/daily for 24/7 housing - and at all facilities we have investigated, that sum includes meals, laundry, housekeeping, scheduled transportation to appts., and both on-site and off-campus group activities. A $5K/mo. price = $166/daily - still cheaper than home healthcare.

People also need to remember that it's not always a question of being able to afford home healthcare even to the very end. There are some medical conditions where hospitalization is required. Also, home healthcare for serious illnesses can be dependent upon finding accredited R.N.s, who are not always available for hire when you may need them.
 
I love reading how we - myself included - as we are aging - are using technology to help us along in our daily activities. I use amazon and walmart to deliver groceries and home items right to my door. I live out in the country and the nearest big store is a half hour away. Although to some that wouldnt seem far, it is far for me when I spend 10 hours each day (or more) at work. Have a husband home that is disabled and three grandchildren, a daughter and a puppy. LOL. I sure can keep busy and going to the store is not really a "what i want to do today" task. I also would love to "cut the cord" on the tv. My husband on the other hand, being home most of the time, likes the tv for company and the internet is too much for him to deal with most of the time. Too many ads pop up and sometimes he hits the wrong places and ends up not where he intended and then cant get back - because more ads pop up. Never ending cycle.

Im for sure rambling on here. Sorry..... so many thoughts in my head.

I, each day, help the seniors in my facility to do their daily tasks. I love to see it when the computer works the way they want and when they discover something like Skype that can keep them in touch with their families.

What seniors need is good food, good company and people that care about them. Unfortunately, and medicine and medical care. So costly.....

nursing homes - horror stories coming from a lot of those, assisted living - somewhat better than a nursing home. Families need to visit and stay in touch with folks in nursing homes and assisted living. That is the best way to make sure elders are really being cared for. Too many times these elders dont get visitors for days on end. Even in the home I am running - non assisted living - independent care - there are folks here that spend days and days and days without outside visitors. We make sure we sit and talk to them each day. And we always encourage their families and friends to come by. We even offer to serve lunch to visitors at a cost of only $5.00 for a full meal, just so family and friends feel welcome and stop in for lunch with "mom,dad,aunt,uncle" whatever.

Technology is great - an awesome tool, but we also always have and always will need real people in our lives. Even those folks - and I was one of them - that think being alone is "where it's at" - usually is just because the folks they have been around have disappointed them somewhere in their lives. And it is easier to just stay alone than deal with others. I get it. I used to be that person too. Seeing my seniors interact with others opposed to when they are by themselves has changed my thoughts. And being around these people I have met here -has changed my thoughts.

When I feel my home is too much for me to take care of - and while I am still healthy enough to enjoy freedom from home care and maintenance I will for sure sell my place and move into where I work. LOL I love it there and most days I am there late just because I am enjoying my time there. I love being around my seniors in my facility and running the place. I have awesome co-workers and the food is great. I have put on a few pounds though that need to go away fast... LOL....

Take care everyone... and use technology to its fullest..... and be with people even more..... best of both worlds.
 

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