Finding affordable home care for your aging loved one can feel overwhelming. With 90% of seniors preferring to age in place, home care has become the most widely preferred long-term care option. (AARP)
While generally more affordable than nursing homes or assisted living facilities, the cost of home care can still cause significant financial stress for families, especially when full-time care is needed.
According to a recent survey, many Americans are financially unprepared for long-term care costs—with only 35% of adults aged 40 years and older having set aside money specifically for long-term care expenses. (PBS)
However, there are several strategies to make care more affordable while ensuring your loved one receives quality care.
What Are the Benefits of In-Home Care?
While it's clear that many older adults want to stay in their home as long as possible, quality in-home care also provides significant value by:
- Alleviating caregiving tasks for family members.
- Reducing stress for family caregivers.
- Addressing individual needs with customized care.
- Providing social engagement and mental stimulation.
- Keeping loved ones healthy by ensuring medication regimens are followed.
Understanding Home Care Options
As the desire to age in place grows among older adults, many families seek cost-effective in-home care solutions. Understanding the types of care available, associated costs, and strategies for affordability can help families make informed decisions.
Types of In-Home Caregivers
Personal Care Aides (PCAs) provide companionship and help with daily activities like light housekeeping, meal preparation, bathing, dressing, and transportation to appointments. Training requirements for PCAs vary by state, and some states don't have formal standards. Medicare and private health insurance typically don't cover these services.
Home Health Aides (HHAs) monitor the patient's condition, check vital signs, and assist with activities of daily living. They must meet a federal standard of 75 hours of training, though additional requirements vary by state.
Licensed Nursing Assistants (LNAs) and Certified Nursing Assistants (CNAs) can perform more medical-related tasks as directed by a registered nurse. They observe and report changes in the patient, take vital signs, set up medical equipment, change dressings, clean catheters, monitor infections, and conduct range-of-motion exercises.
Licensed Practical Nurses (LPNs) provide essential hands-on care under the supervision of RNs and physicians. They typically complete a 12-18 month training program and must pass the National Council Licensure Exam for Practical Nurses (NCLEX-PN).
LPNs focus on direct patient care, assisting with activities of daily living such as bathing, dressing, toileting, and feeding, while also performing routine nursing procedures like taking vital signs, administering medications, and monitoring residents' health status. They also play a crucial role in educating clients and evaluating care.
Registered Nurses (RNs) have more advanced education and training, allowing them to assess patients, develop care plans, administer medications, and provide complex treatments. They direct the whole care team, providing ongoing training and education for team members.
RNs conduct comprehensive assessments of health status, including physical, mental, and psychosocial needs, and develop individualized care plans in collaboration with clients, families, and the interdisciplinary care team.
Companions provide companionship, meal preparation, light housekeeping, shopping, and transportation to appointments. No certification or license is required for this role.
The Cost of In-Home Care
Home care costs have increased significantly in recent years, outpacing general inflation. As of 2023, the median hourly cost for home care was $30 per hour, which translates to more than $60,000 annually for full-time care. According to AARP's Long-Term Services and Supports State Scorecard, the average annual cost of home care in 2021 was roughly $42,000 (for 30 hours of weekly care at $27 per hour)—more than 20% higher than in 2019.
While home care is more affordable than nursing homes (which average $108,000 annually for a private room), it still exceeds what many older households can afford. Nationally, home care costs account for 83% of the entire income of the typical, older middle-income family. (AARP)
Medicare Coverage for Home Health Services
Medicare Part A and/or Part B cover eligible home health services as long as you need part-time or intermittent skilled services and you're "homebound," which means you have trouble leaving your home without help or it's not recommended because of your condition. (Medicare.gov)
Covered home health services include:
- Medically necessary part-time or intermittent skilled nursing care (like wound care, patient education, IV therapy)
- Physical therapy, occupational therapy, and speech-language pathology services
- Medical social services
- Part-time or intermittent home health aide care (only when receiving skilled care simultaneously)
- Injectable osteoporosis drugs for women
- Durable medical equipment and medical supplies
It's important to note that Medicare doesn't pay for 24-hour care, home meal delivery, homemaker services unrelated to your care plan, or custodial care when that's the only care needed.
Veterans Benefits
Veterans and their spouses might qualify for Aid and Attendance or Housebound benefits, which provides financial support for in-home care services.​
Long-Term Care Insurance
Long-Term Care Insurance policies can offset costs, but premiums and coverage vary. It's advisable to review policy details carefully to understand benefits and limitations.
Should You Become a Family Caregiver?
Family caregivers are the backbone of long-term care for many aging seniors in the United States. While it can save you money compared to other forms of long-term care, the job of caregiver comes a lot of responsibility.
Before you decide to take on this role, read our 4 Things You Should Consider Before Becoming a Family Caregiver article.
How to Choose the Right In-Home Care Provider
Hiring a professional caregiver to support and care for your loved can be an emotional process. Safety, skill-set, and compatibility are undoubtedly at the forefront of your mind, but what else should you consider?
Assess Your Loved One's Needs
The first step in finding the right caregiver is to assess your loved one's specific needs across four categories:
- Personal Care: Level of help needed with activities of daily living like bathing, eating, dressing, toileting, grooming, and mobility.
- Medical Care: Complex health needs requiring specialized medical training.
- Emotional Care: Need for companionship and social engagement.
- Household Care: Assistance with meal preparation, grocery shopping, cleaning, laundry, and pet care.
Create a detailed list of caregiving tasks and requirements to help you find candidates with the right skills and experience.
Consider Home Care Agencies
When searching for a caregiver, many families use home care agencies, which handle payroll taxes, insurance, screening, interviewing, and training. While convenient, agencies add costs for their overhead.
The average hourly rate for hiring a caregiver through an agency is around $20-$24, depending on your location. Rural areas may have higher costs due to lower demand and longer travel distances. Heavily populated areas like the Northeast are also costly.
If you decide to use a home care agency, follow these important steps:
- Verify that the agency is licensed in your state.
- Choose an agency that has been in business in your community for at least ten years.
- Ensure the agency requires extensive background checks and drug screenings for all caregivers.
- Ask if their caregivers are bonded and insured.
- Confirm that the agency directly employs its caregivers.
- Review internet testimonials and recent reviews from both clients and caregivers.
- Visit the agency's office in person if possible.
- Ask about their hiring procedures and supervision protocols.
- Consider how professionally the agency dealt with you during initial consultations.
- When looking for skilled nursing providers like LPNs and RNs, verify that they have the appropriate licenses and certifications.
- Look for agencies that employ nurses with at least two years of experience.
- Ask about the specific roles their LPNs and RNs play in providing care and how they coordinate with other members of the healthcare team.
Hiring Private Caregivers Directly
While hiring a private caregiver directly can be more affordable, with rates typically starting at $10-$14 per hour, it requires more involvement from you to vet and manage suitable candidates.
When interviewing potential caregivers, ask targeted questions about their experience, availability, transportation, certifications, and approaches to caregiving. Request multiple references and conduct background checks if you're hiring independently.
Consider arranging a trial period to observe how the caregiver interacts with your loved one and handles daily tasks.
Be sure to ask for your care recipient's honest feedback as well!
Consider Online Caregiver Matching Platforms
Online caregiver matching platforms allow you to search for caregivers based on qualifications, availability, and location. Most platforms ensure that caregivers have passed criminal background checks, giving you peace of mind.
Caring Village has partnered with Care.com to connect you with pre-screened caregivers who live and work in your neighborhood. Search online profiles of caregivers, view their experience, qualifications, and schedule availability. Care.com makes it easier to find someone who meets your needs quickly.
Explore Community and Local Resources
Local senior centers, Area Agencies on Aging (AAA), and Centers for Independent Living (CIL) can help connect you with resources.
Word-of-mouth recommendations are also valuable. Ask friends, family members, and healthcare professionals for referrals to trusted caregivers or agencies.
Conclusion
With proper planning and research, you can navigate the challenges of finding affordable home care and provide your loved one with the support they need.
Remember that home care needs may evolve over time, so it's important to reassess regularly and adjust the care plan as necessary.
