Remaining in the Home: A Look at Home Health Care Services

The demand for home health care services is rapidly growing in the U.S. This has been driven by an array of factors in recent years.

First, the baby boomers are reaching the age where they are more likely to need assistance. Second, the pandemic has made some people uneasy about the prospect of living in a congregate senior living setting. Some retirement community-dwelling seniors have relocated (or been relocated by their families) back into a single-family residence as a precaution. But one of the biggest factors in this increase in demand for home health care services relates to seniors’ long-standing affinity for “home.”

The desire to remain in the home

According to AARP’s 2018 “Home and Community Preferences Survey” conducted by the National Opinion Research Center at the University of Chicago, more than 3 out of 4 seniors (77 percent) said they wanted to remain in their home and community for as long as possible as they age.

The flip side of this coin, however, is that research also has found that between 50 and 70 percent of people over the age of 65 will require some level of care services at some point. This care could range anywhere from help with a few activities of daily living (ADLs) all the way up to 24-hour skilled nursing care. Of those who do ultimately need care, 20 percent will need long-term care — somewhere between 2 and 5 years — and around 13 percent will need it for more than 5 years.

This is where, for some seniors, home health care can come into play.

Medical and non-medical home health care

The term “home health care services” covers a wide spectrum, but in the simplest terms, it is, as the name suggests, care provided to a person in their own home. That care could be delivered by a caregiver who visits the home for just a handful of hours each week, or it could be provided by a person who moves into the home to offer around-the-clock assistance … or anything in between.

There is, of course, a big difference between needing a little extra help with something like dressing or household chores and needing 24/7 nursing care. That’s why home health care services are typically broken out into two primary categories: medical care and non-medical care.

Medical care

Sometimes referred to as “skilled care” or “skilled nursing care,” this type of home health care is administered by a healthcare provider. This could be a doctor, nurse, or some other type of medical professional such as a physical therapist, occupational therapist, or respiratory therapist.

Medical home health care is needed by people who have more complex needs that extend beyond help with self-care or household chores. They may require services like wound care, medicine injections or IVs, or nutrition via a tube. This type of care would typically be prescribed and managed by a physician.

Depending on the person’s situation, this type of medical care at home could be short-term, such as following an illness or surgery, or it could be long-term, such as after a stroke or during a terminal illness.

Non-medical care

There are also home health care services that are non-medical in nature. Provided by a home health aide (also called a home care aide), non-medical care typically includes assistance with activities of daily living (ADLs). ADLs might include things like help with dressing, bathing, or using the toilet. It also can include help with meal preparation and other housekeeping tasks, transportation, and shopping — what’s sometimes referred to as “homemaker services.”

As with medical care, non-medical care in the home can be long-term or temporary (perhaps a person injured their right foot and cannot drive or had shoulder surgery and needs help bathing and dressing).

Finding the home health care services you need

While there are independent contractors who work as home health aides, it is common for people to work with a home health care agency to coordinate the services they or their loved one requires. Your doctor can likely offer guidance on reputable home health care agencies in your area, though word-of-mouth referrals from friends are also an effective way to locate a nearby agency.

For those who go the agency route, you can expect an initial consultation in which a nurse from the agency comes to your home to assess the situation and determine what services are needed. The nurse will then create a personalized care plan and match your needs with a caregiver who has the appropriate skillset, availability, and personality.

The pros of home health care

If you want to remain in your home, home health care may be a good option to facilitate that senior living choice.

There are additional benefits to using home health care too. Getting regular, predictable visits from a home health caregiver can reduce loneliness and the negative health consequences that isolation can create. Home health care also can reduce hospital admissions since these trained caregivers can sometimes spot health-related issues before they become more serious.

In some cases, home health care can reduce the burden on family caregivers as well — sometimes substantially. This can give families peace of mind, ease anxiety, and reduce the other negative health and financial consequences that family caregiving can spur.

…and the cons

But home health care isn’t for everyone. Some people are uncomfortable with having strangers in their (or their loved one’s) home. It can feel to some like an invasion of privacy to allow someone into their personal space. This obstacle can sometimes be overcome by finding a caregiver who is the right fit personality-wise, although with low pay and high turnover rates in the industry, it can sometimes be challenging to find and keep a good paid caregiver. It’s also important to know that the majority of elder abuse by caregivers occurs in private homes, so it is vital to carefully vet the caregiver and the agency.

Another consideration is the fact that even if a family opts for a paid caregiver, the family’s involvement is not entirely eliminated. While they may not be providing the hands-on care themselves, a family member will still need to coordinate with and oversee the caregiver, ensuring things are not being missed or neglected.

Perhaps the biggest challenge commonly related to home health care is cost. Looking at the average cost in the U.S. (based on Genworth’s Cost of Care Calculator), families can expect to pay close to $54,000 annually for 44 hours of non-medical home health care (homemaker services) per week. Costs for medical care services from a healthcare provider would be even higher.

Prices also vary by state — sometimes dramatically depending on supply and demand for caregivers, as well as cost of living. But no matter where you live, if the average person who requires care services needs them for 2 to 5 years, that expense can really add up for the senior and/or their family.

And bear in mind: Home health care costs are most often not covered by Medicare, so this would be an out-of-pocket expense for a family. (If the senior has long-term care insurance [LTCi], then obviously it would help. The point of LTCi is to cover what Medicare and insurance do not cover.) The only time Medicare pays for in-home care is for a limited time (usually a maximum of 21 days, such as following an illness or surgery) and only if it “prescribed” by a doctor for that specific medical issue. Non-medical care does not qualify for Medicare coverage.

Medicaid, on the other hand, often does cover some home health care costs, but the terms of coverage are determined at the state level and can vary widely from state to state.

The bottom line

For some people who would like to remain in their current home for as long as possible, home health care services can be the ideal solution. The senior can receive the exact level of care they need — from help with household chores and errands all the way to full-time nursing care — right in the comfort of their beloved home. This service can help relieve family caregivers of some responsibilities and can even allay loneliness for the senior.

But for some people, home health care may be cost-prohibitive, or they may not feel entirely comfortable with the idea of a “stranger” coming into their house. For those people, if they want to remain in their existing home, they will likely have to rely on family members or friends to help with their care needs.

If you are considering a home health caregiver, be sure to do your research. Get a referral from a trusted doctor or a friend. Be sure to ask the caregiver or home health care agency all of your questions, and ensure you feel comfortable with their answers. If it doesn’t seem like a good fit, keep looking. You will eventually find a provider who is right for you and your unique situation.

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