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What you need to know about in-home care — and why you’ll probably need it

For many individuals, in-home care has become a preferred, and sometimes a necessary alternative to institutional care. But it comes with a cost. 

A home health aide costs an estimated $4,385 per month, while homemaker services average $4,290 a month, according to the 2019 Genworth Cost of Care Survey

Yet in-home care often falls into the category of things many people don’t think about until they actually need it. When an older parent becomes home-bound by a fall or a spouse receives a diagnosis of a serious illness, the situation can create a sudden and urgent need for daily attention from a medical provider or caregiver. 

That’s why professionals recommend it’s a good idea to start researching care options well before a medical emergency or aging becomes an issue. 

The Cost of Care survey predicts that between now and 2030, 7 in 10 people will require long-term care in their lifetime. Most people will require some form in-home care as they age into their retirement years, says Tom Threlkeld, spokesman for the National Association for Home Care & Hospice.

“If they want to age in place in their own homes and communities, as about 90% of Americans want to do, then they need to plan ahead for avoiding institutional care,” Threlkeld says.

Home health care, specifically, can help a patient recover, regain independence, become more self-sufficient, slow down health declines and maintain current levels of function. 

Not only is in-home health care popular, but it’s also vastly more affordable than the institutional alternatives, Threlkeld says. A year in a retirement home with a private room is about twice as expensive as a year of homemaker care.

“Home care allows you to remain in your own home as you age,” he says. “You can be around your friends and family in the place that matters the most to you.”

Types of care

There are some key differences in the types of care an individual can receive at home, and it’s important to understand them when seeking out and planning for in-home care. 

Skilled care 

This refers to in-home medical health care, which Medicare.gov describes as a range of health services that can be administered in the home to treat an illness or injury. This care typically includes services provided by a medical professional such as a registered nurse, physical therapist or occupational therapist. 

Examples of in-home health care include:

  • wound care after surgery
  • patient and caregiver education
  • intravenous or nutrition therapy
  • injections
  • monitoring serious illnesses.

Home health staff can perform tasks such as:

  • monitoring nutritional and prescription intake
  • checking vital signs
  • assessing pain levels
  • evaluating home safety
  • teaching self-care
  • coordinating care

Non-skilled care

This care is care that is not medical in nature. Some types of non-skilled care services include companion care, custodial care, and homemaker services. These caregivers serve primarily as personal care assistants and can provide services such as bathing, mobility and bathroom assistance, dressing, meal preparation, household chores, and social interaction. 

Short term vs. long-term care

Depending on his or her health situation, a person may require care on an interim or longer-term basis. Short-term care would address a temporary need by someone recovering from an injury, illness or surgery. Long-term care is for someone with a chronic or progressive condition such as Alzheimer’s disease, dementia, Parkinson’s disease, or terminal illness. 

Care considerations for all ages

Although it’s more commonly a concern for the aging population, in-home care is something younger people need to think about, too.

“It’s very likely you will need it, and not just for yourself,” Threlkeld says. Younger individuals may want to talk to their aging parents and loved ones about whether they are prepared for the possibility of disability or chronic illness as they age.

“The sooner you begin to think and plan, the better your options will be,” Threlkeld says. Adults may also find themselves in need of care well before retirement age. According to the American Association for Long-Term Care Insurance, 7% or adults ages 18 to 64 required long-term care in 2018.

In the U.S., an estimated 5.6 million adults during a 12-month period provided unpaid care to an adult family member or friend who is 18 to 49 years old, according to a 2015 study by the AARP and the National Alliance for Caregiving.

Most of these caregivers (43%) were looking after an individual with a short-term physical condition. Others were caring for someone with an emotional or mental health problem (36%) or a long-term physical condition (32%). 

Paying for care

Although in-home care is an out-of-pocket expense in many cases, there are some insurance options available. Medicare and Medicaid plans cover in-home health care, but only if a doctor orders these services. A person who is released from the hospital may receive a doctor’s referral for home care such as rehabilitation or therapy to conclude the recovery and transition back to a normal life.

Veterans who are at least 50% disabled due to a service-related condition are eligible for in-home health care coverage by the U.S. Veterans Administration. 

Many insurance providers pay for certain home care and elder-care services, but the specifics of coverage vary greatly from plan to plan. In-home skilled care rarely receives full coverage, and most private policies will not pay for non-medical home care services. 

“Private care exists and would need to be paid for out of pocket, unless you have long-term care insurance,” Threlkeld says. 

Long-term care insurance is an option for individuals who want to make sure they are covered for daily and extended care, which employer-based health coverage generally does not cover. In addition to covering assisted living and nursing home care, long-term care policies cover services for home care, home modification and care coordination.

What to consider

When making plans for in-home and long-term care, Threlkeld suggests asking yourself or your loved ones:

  • Where do you want to live as you recover and return to your normal life?

  • How do you want to manage a disability or a chronic illness?

“If we are lucky, we all grow old, so aging doesn’t sneak up on anyone,” Threlkeld says. “You can prepare for it by thinking ahead, planning and saving.” Individuals can search the NAHC Agency Location Service at agencylocator.nahc.org to find a home care agency in your area. A physician, nurse or other clinician can also offer advice and assistance in finding home care.

“Don’t panic, and don’t assume you cannot recover at home with the best quality care in the world,” Threlkeld says. “You can.”

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