A placard on my desk reminds me daily: “Be good to your kids. They pick the nursing home you go to.”
I’ve found that a little humor goes a long way when discussing the subject of aging with families who face the realities of a loved one’s long-term care needs. It’s a stressful subject and often challenging for the older adult and his or her children to discuss.
But, with more than 77 million U.S. baby boomers between the ages of 46 and 65, the struggle to figure out the right care option for an older loved one is a growing concern.
“Aging in place” is the new term for allowing elder adults to remain in their homes as they age. In-home care is one of the primary services that provide an alternative to a nursing home or assisted-living facility.
To help families make educated decisions on obtaining care, I suggest answering the following seven key questions before hiring in-home care services.
1. What exactly is home care? Home care is an alternative for seniors who prefer to receive assistance with tasks of everyday living at home rather than move into an assisted-living facility. The care is nonmedical and usually provided by experienced caregivers or certified nurse assistants who help with activities ranging from companionship to transportation, meal preparation, housekeeping and medication reminders.
2. What are the benefits of home care? Generally speaking, aging in place with the right amount of in-home care can prolong independence and quality of life for seniors. Most older adults are willing to accept care at home when the need arises rather than moving into an assisted-living facility. As care needs increase over time, most elders benefit from the one-on-one attention that home care offers as well as a lowered exposure to contagious illnesses such as influenza, pneumonia and staph infections. Perhaps most importantly, the flexibility and customization of care to your specific needs and lifestyle is often more cost effective than services provided in an institutional setting.
3. What are the options for securing home care? There are three primary options for obtaining in-home care, each with their own pros and cons. With a full-service agency, the agency acts as the caregiver’s employer and handles all screening, fingerprinting, background checks, insurance coverage, payroll responsibilities and management oversight. When hiring directly, the family assumes these responsibilities, including the need to properly account for caregivers as employees. A domestic-referral agency is a bit of a hybrid between the other two options and primarily plays the limited role of matchmaker between a family and a caregiver.
4. What are the legal and tax implications? Whichever hiring option you choose, there are legal and financial compliance issues to consider. In California, neither private caregivers nor home-care agencies require state licensure, which means they have no obligation to seek training, undergo testing, provide background checks, pursue licenses or be fingerprinted. In addition, California employment law mandates that employers assume responsibility for properly accounting for wages, federal and state unemployment insurance, Social Security taxes, disability insurance, garnishments and income-tax withholdings. Strict rules and penalties are in place for improper reporting and payment of amounts due the state, so it’s crucial to understand who is the employer of record when you hire care.
5. What are the costs associated with home care? Unfortunately, Medicare and private health insurance do not pay for nonmedical home care, and that is unlikely to change any time in the near future. The investment in home care is generally paid out of pocket by the family or through long-term care insurance. But there are other ways to offset the costs of care, including reverse mortgages, Veterans Administration benefits, income-tax deductions, California’s In-Home Supportive Services program and Medi-Cal for qualifying low-income clients. Hourly rates for in-home care range from $16 to $28 per hour and $180 to $300 per day for a live-in caregiver.
6. Which hiring option is right for me? Each family’s unique needs, expectations, financial resources and support systems are different. Your choice of hiring options usually comes down to a balance of available time, energy, knowledge and financial resources. Regardless of which option you choose, if you understand the benefits and trade-offs of each, it’s more likely you will make a better decision.
7. How can I trust a care provider? Trust but verify when hiring any in-home solution provider. Ask for proof of key components of an agency’s or caregiver’s claims such as liability insurance, workers’ compensation and their background-checking processes. Solicit testimonials from existing clients and research third-party endorsements through organizations such as the Better Business Bureau or the California Association of Health Services at Home. Good agencies and caregivers should be willing to provide relevant references.