Seniors and Pain
In-Home Assistance and Care
Oftentimes, people who need help with their daily activities can benefit from the aid of an in-home care worker. There are two key types of care workers: Home Health Aides, who help clients with their medical needs and are often licensed professionals employed by home health agencies, hospitals or state-licensed public health departments, and Personal/Home Care Aides, who help with routine chores and personal care.
There are many different agencies and companies that can provide you with in-home caregivers.
Home health agencies provide many types of skilled health care services through nurses, therapists, social workers, aides and volunteers. Most home health agencies are in charge of hiring and supervising their workers, so they are liable for the care and service their workers provide. These agencies can provide help 24 hours a day, 7 days a week, and are often Medicare certified. A Medicare-certified agency has met the federal minimum requirements for patient care and management and therefore can provide Medicare and Medicaid home health services. For more information, read our article on Medicare and Home Health Care.
Hospice is care for patients who are expected to live six months or less, and have stopped all curative treatment. Hospice teams ensure the patient and his or her family have the medical, psychological and spiritual support needed to help them through this difficult transition. For more information, please read our primer on Palliative Care and Hospice.
Home care aide agencies serve clients in need of meal preparation, housekeeping and personal care (including bathing and dressing). Home care aides also provide companionship for those clients who cannot be left alone. Though not as heavily regulated as home health agencies, home care aide agencies are required by some states to maintain licenses and to adhere to certain standards of care.
Pharmaceutical/infusion therapy companies serve people in need of intravenous fluids, nutrition or treatments, or tube feedings. In addition to delivering the necessary medicines, equipment and care services, nurses teach patients and caregivers to administer these treatments themselves. Some pharmaceutical and infusion therapy companies are certified by Medicare.
Durable medical equipment and supply dealers deliver and install products including respirators, wheelchairs and catheters. Company representatives or nurses will teach patients and caregivers how to use them. Although most of these dealers do not provide medical care, they sometimes will refer a patient to a pharmaceutical or infusion therapy company to ensure he or she is well looked after. Some states require licensing of these companies, and those that bill Medicare are required to meet federal minimum standards.
Registries/private-duty agencies match clients with nurses, homemakers, aides and companions, as needed. These agencies essentially serve as an employment service for home care workers, and are not licensed or regulated by state or federal government.
Additionally, many families choose to hire independent providers to give care as needed. The patient or family takes over all responsibility to find, train, supervise and pay independent nurses, therapists, aides, homemakers and companions. There is no agency involved to oversee care or offer support, and aides are not required to be licensed or meet government regulations. Also remember that when you hire an independent caregiver, you are his or her employer. That means you are liable for injuries, for withholding Social Security taxes, and for filing the proper tax documents. More information about the tax responsibilities of employers of household help can be found here or by calling the IRS at 800-829-3676 and requesting Publication 907.
After you decide what kind of in-home care you need, you must figure out a plan to pay for it. Medicare generally does not cover long-term care or help with personal or household services, but will cover home care services related to acute, short-term health problems under certain circumstances. For more information about Medicare coverage requirements, call 1-800-MEDICARE (TTY/TDD: 1-877-486-2048 for the speech and hearing impaired) or look at its web site. You should also read our article on Medicare and Home Health Care. Private insurance generally does not pay the costs of home care, but long-term care insurance typically does. If you cannot afford care, ask your local department of Area on Aging for advice or help with the situation. Also consider looking into government programs sponsored by the Older Americans Act and the Veterans’ Administration.
Home Health Aide Resources
You can also order "Home Care for Older People," which offers information on various home care options and how to find them. For a copy, send $12 to United Senior Health Cooperative, 1331 H. Street, N.W., Suite 500, Washington, D.C. 20005.
Providers
There are many different agencies and companies that can provide you with in-home caregivers.
Home health agencies provide many types of skilled health care services through nurses, therapists, social workers, aides and volunteers. Most home health agencies are in charge of hiring and supervising their workers, so they are liable for the care and service their workers provide. These agencies can provide help 24 hours a day, 7 days a week, and are often Medicare certified. A Medicare-certified agency has met the federal minimum requirements for patient care and management and therefore can provide Medicare and Medicaid home health services. For more information, read our article on Medicare and Home Health Care.
Hospice is care for patients who are expected to live six months or less, and have stopped all curative treatment. Hospice teams ensure the patient and his or her family have the medical, psychological and spiritual support needed to help them through this difficult transition. For more information, please read our primer on Palliative Care and Hospice.
Home care aide agencies serve clients in need of meal preparation, housekeeping and personal care (including bathing and dressing). Home care aides also provide companionship for those clients who cannot be left alone. Though not as heavily regulated as home health agencies, home care aide agencies are required by some states to maintain licenses and to adhere to certain standards of care.
Pharmaceutical/infusion therapy companies serve people in need of intravenous fluids, nutrition or treatments, or tube feedings. In addition to delivering the necessary medicines, equipment and care services, nurses teach patients and caregivers to administer these treatments themselves. Some pharmaceutical and infusion therapy companies are certified by Medicare.
Durable medical equipment and supply dealers deliver and install products including respirators, wheelchairs and catheters. Company representatives or nurses will teach patients and caregivers how to use them. Although most of these dealers do not provide medical care, they sometimes will refer a patient to a pharmaceutical or infusion therapy company to ensure he or she is well looked after. Some states require licensing of these companies, and those that bill Medicare are required to meet federal minimum standards.
Registries/private-duty agencies match clients with nurses, homemakers, aides and companions, as needed. These agencies essentially serve as an employment service for home care workers, and are not licensed or regulated by state or federal government.
Additionally, many families choose to hire independent providers to give care as needed. The patient or family takes over all responsibility to find, train, supervise and pay independent nurses, therapists, aides, homemakers and companions. There is no agency involved to oversee care or offer support, and aides are not required to be licensed or meet government regulations. Also remember that when you hire an independent caregiver, you are his or her employer. That means you are liable for injuries, for withholding Social Security taxes, and for filing the proper tax documents. More information about the tax responsibilities of employers of household help can be found here or by calling the IRS at 800-829-3676 and requesting Publication 907.
Steps to Get Started
- If you (or a loved one) are elderly, call or e-mail your local Area Agency of Aging and explain the situation. Be specific about your particular needs and wants regarding home care. Representatives will be able to match you with a social worker to help assess your case and recommend care. Local agencies often provide services (including transportation, meals and housekeeping) at a reduced cost or for free, so be sure to ask about its policy for people on a limited income. Call or e-mail Eldercare Locator to help find local resources to provide service for older persons in need.
- Look in the yellow pages or online for service aides advertising under “personal care services” or “home care services.” Expect to pay $10 to $20 an hour for home care aides. Be sure to check whether the service you contact is an agency (which is responsible for screening, training and supervising its employees), or a registry of independent caregivers, which is simply a list of people looking for employment in this field. Be sure to find out if the service is licensed - if required in your state – and/or accredited by a professional association, which may hold it to a higher standard of quality.
- Ask around. Talk to your doctor, nurses, hospital staff and friends and family to find out any recommendations, advice or referrals.
Paying for Care
After you decide what kind of in-home care you need, you must figure out a plan to pay for it. Medicare generally does not cover long-term care or help with personal or household services, but will cover home care services related to acute, short-term health problems under certain circumstances. For more information about Medicare coverage requirements, call 1-800-MEDICARE (TTY/TDD: 1-877-486-2048 for the speech and hearing impaired) or look at its web site. You should also read our article on Medicare and Home Health Care. Private insurance generally does not pay the costs of home care, but long-term care insurance typically does. If you cannot afford care, ask your local department of Area on Aging for advice or help with the situation. Also consider looking into government programs sponsored by the Older Americans Act and the Veterans’ Administration.
Resources
Home Health Aide Resources
- Disability Resources.org
- Eldercare Locator
- Home Health Aide Finders
- Home Health Nurses Association
- National Association for Home Care and Hospice
- Respite Match
- Visiting Nurses Association
You can also order "Home Care for Older People," which offers information on various home care options and how to find them. For a copy, send $12 to United Senior Health Cooperative, 1331 H. Street, N.W., Suite 500, Washington, D.C. 20005.