4 Steps to Finding the Best In-Home Care for You

By Kate Rockwood |

Need extra help at home? Start here.

Home nurse checking on an older man at home

The vast majority of older adults — 93.5 percent, in fact — don’t live in nursing homes or assisted living facilities. And, not surprisingly, more than 3 out of 4 people age 50 and older want to stay in their own homes as long as possible. To make that happen, some people need support from a caregiver, who might be a family member or someone they hire. 

The help may be temporary — perhaps you need assistance getting around your house after surgery. Or it may be a permanent arrangement to help an older adult keep living in their home. Whatever the reason, figuring out how to get the help you need can be overwhelming. That’s why we created this guide, outlining the first four steps to making in-home care a reality.  

Step 1: Decide What Kind of Support You Need 

Maybe you’re a caregiver who could use an extra set of hands to look after a loved one. Or you live on your own and can no longer keep up with some of the household chores. Perhaps you’re having a tough time doing things such as managing your medication.  

To identify the tasks you need help with, consider the basic activities of daily living and instrumental activities of daily living. These are the skills people need to take care of themselves at home. Basic activities of living include:  

  • Walking 
  • Eating 
  • Getting dressed 
  • Bathing  
  • Going to the bathroom 

Instrumental activities of daily living require more complicated thought. They include:  

  • Grocery shopping 
  • Housecleaning and home maintenance 
  • Medication management 
  • Financial management 

People often first struggle with the instrumental skills of daily living, says Amy Goyer, author of Juggling Life, Work, and Caregiving and AARP’s family and caregiving expert.  

“Someone might start having trouble because they’re not driving anymore or they don’t have the mobility to keep up with the laundry because it’s in the basement,” she says.  

Later in life, or after an illness or injury, people might struggle with personal care such as bathing or dressing themselves. And some people need help with medical tasks such as wound care or diabetes management. Goyer recommends reaching out to a local Area Agency on Aging, many of which provide free in-home evaluations to help you decide what kind of care is best for you. (Simply enter your ZIP code here to find a location near you.)  

“Ideally, you would find someone who can stick with you for the long term,” Goyer says. “You want to make sure they can do all the things you need them to do, but also that you’re not hiring someone who has more skills and training than you need since that can get very expensive.”   

Your doctor should also be part of any discussions. In most cases, you’ll need your doctor to prescribe in-home care for insurance to pay for it, says Christina Irving, director of client services for the Family Caregiver Alliance in San Francisco.  

Step 2: Learn the Different Types of In-Home Caregivers Available 

There are several kinds of in-home care providers depending on your needs. Some offer more companionship and help around the home, while others have more medical training. Here are four types to consider:  

  1. Personal care aide: These aides typically help with transportation, light cooking and cleaning, shopping, and errands. Some may also help with bathing and dressing, Goyer says.

Some states require personal care aides — in particular those who work for agencies that receive Medicare payments — to have a set number of training hours. But other states don’t require any training.   

Cost: The median hourly pay for a personal care aide was $13.02 in 2020.  

  1. Home health aide: Like personal care aides, home health aides can help with tasks such as light cleaning and cooking, shopping, planning appointments, and providing transportation. They also assist with bathing, feeding, and going to the bathroom. Home health aides have limited medical training, but many can handle basic tasks such as monitoring symptoms, giving medication, and checking pulse and temperature.

Home health aides must have at least 75 hours of training, Goyer says, although some states require more. You can find your state’s requirements here  

Cost: The median hourly pay for a home health aide was $13.02 in 2020.  

  1. Certified nursing assistant (CNA): These professionals perform many of the same duties as home health aides, but they’re required to go through a formal training process and pass a state certification exam. CNAs have more medical experience than home health aides, Goyer says. They can reposition and move patients for comfort as well as take and report health information such as level of alertness, appetite and food intake, and vital signs (temperature, pulse and blood pressure).

One of the biggest differences between home health aides and CNAs is that CNAs don’t work only in people’s homes. They often work in hospitals and long-term care facilities. Another difference is that they can speak with clients about health concerns and consult with their supervising nurse — typically a licensed practical nurse (LPN) or registered nurse (RN).    

Cost: The average median hourly pay for a CNA was $14.82 in 2020.  

  1. Licensed practical nurse: Also known as skilled nursing providers, LPNs are licensed by the state and must complete an approved educational program. They work in hospitals, doctor’s offices, nursing homes, and private homes. LPNs perform similar tasks as home health aides and CNAs, but they have more medical training. That means they can offer more direct medical care such as starting an IV drip, inserting a urinary catheter, or collecting blood or urine samples.

Cost: The median hourly wage for home health skilled nursing was $23.47 in 2020.  

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Step 3: Decide How You Want to Hire In-Home Help 

There are two main ways to hire someone for in-home care: Do it yourself or rely on a home health agency to hire someone for you. Hiring someone on your own is almost always less expensive, Goyer says, but it’s also more work. You can seek referrals from friends or a doctor and/or place an ad on a reputable site such as Care.com  

If you choose the latter, your job description should be very detailed and include the hourly pay range, expected qualifications (CNA vs. LPN, for example), and what the job will require, Goyer says. You’ll also have to interview candidates, check references, and potentially hire someone to do a background check once you’ve narrowed down your options, she adds.  

Using a home health agency is often easier because they’ll screen and hire someone for you — you’ll just pay more for it. You can learn more about your options, find agencies near you, and read user reviews on Medicare.gov.  

Step 4: Know Your Payment Options 

Unfortunately, insurance doesn’t always pay for in-home care, but sometimes your plan will cover part of the cost. The best thing to do is contact your insurance provider before you hire anyone to confirm what types of in-home health care it covers and whether certain home health agencies are included in your plan.  

If you or the person you’re caring for is a veteran, Goyer also recommends reaching out to Veterans Affairs, which may provide coverage for assisted living or home health care services. The VA’s Program of Comprehensive Assistance for Family Caregivers, for example, pays a stipend to some people caring for veterans. You can apply here or call 855-488-8440.  

Otherwise, here’s some background on five types of insurance that might help you prepare for calling your provider.  

  1. Original Medicare: Medicare covers some doctor-prescribed, in-home care such as part-time skilled nursing care, physical therapy, and part-time home health aide services. But it often does not cover long-term home health aide care, Irving says. It also doesn’t pay if you need help only with personal care such as bathing, dressing, or using the bathroom, or if you need only services such shopping, cleaning, and laundry.
  1. Medicare Advantage: These plans must cover at least what Original Medicare provides, but some impose different rules, restrictions, and costs. In those cases, you’ll likely need prior insurance approval and/or a referral from your doctor. You may have to work with a home health agency approved by your insurer, and there may also be a copayment (a flat fee you have to pay) for care.
  1. Medicaid: Depending on your state’s requirements, some Medicaid programs cover home health care and/or allow you to hire family members as caregivers. You can find your state’s Medicaid contact information here.
  1. Private insurance: Some private insurance plans will cover in-home care, but you’ll need to contact your insurance company to find out.
  1. Long-term care insurance: These insurance policies can be used for ongoing care, whether at home or in a skilled nursing facility. Most pay about $160 a day for up to three years of care. However, these plans can be pricey, with the average annual premium for a 65-year-old couple estimated at $3,750.

To learn more, ask your insurance provider about your options. 

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