Safe & Sound At Home: Part 2- Things You Should Know About In-Home Care

Written by: Craig Falk


While caring for your loved one at home creates a number of challenges, most elderly people prefer being at home. According to AARP surveys, 89 percent of older adults prefer to remain in their homes for as long as possible. Home is a place of comfort, familiarity, and privacy, where help can be introduced incrementally as the need arises, quickly and without a long term commitment. 

Although in-home care is preferred, for most, the biggest concern is cost. If you hire a caregiver, the cost is monetary. Time and energy are also required to maintain an optimal situation. If you or another family member serves as the primary caregiver, the cost is physical, emotional and financial. The average working family member who takes on the responsibility of a caregiver, forfeits $660,000 in wages and social security benefits during their lifetime (per Texas Department of Aging and Disability Services). Regardless of who provides the care, there will be challenges. 

Who Pays

The most common assumption is that private health insurance or government programs such as Medicare cover the cost. They do not. This comes as a shock to most. The fact remains: non-medical needs are not covered, while skilled medical needs are covered but with strict limitations of duration and amount of care. Be sure to call your insurance company to discuss your coverage. 

In Home Supportive Services (IHSS) is a government funded program that pays for non-medical caregivers in the home. It is a means-tested program with basically the same qualifying tests as Medi-Cal. To qualify the recipient can have no more than $13,600 annual income and $2,000 in assets (not including home or car). The program is administered by county agencies. In Sacramento county, the phone number is (916)-847-9471. Veterans (and their spouses) who served during a period of war may qualify for the VA Aide and Attendant benefit. Call your local VA office for information. 

Long Term Care Insurance

Long term care insurance policies are designated to cover the costs of non-medical care. Most policies cover care in the home. You should investigate whether your loved ones have such policies and determine what types of care are covered in their plans. 

Reverse Mortgage

If their home is paid for, your loved ones could use its value to pay for a caregiver. A reverse mortgage could make sense. Based on their ages and the value of the home, it could pay a monthly amount for as long as they continue to live in that home; e.g., if a person is 70 years old with a $300,000 home, he could receive approximately $950 per month. (Get advice before obtaining a reverse mortgage.) 

How much does it cost? 

Elderly care can be expensive, especially if 24-hour care is required. The graph illustrates the costs in 2010 figures for various types of care (Source: Genworth Financial). 

 The monthly average spent on home care (using full-service agencies) is $1,600. Not all persons require 24-hour care in order to maintain a quality life at home. 

The monthly average spent on home care (using full-service agencies) is $1,600. Not all persons require 24-hour care in order to maintain a quality life at home. 

The physical and emotional toll of care giving

If you or another family member will be the primary caregiver, you may find that caregiving is physically and emotionally costly, regardless of the wonderful attributes of your loved one. Elder care is often compared to the first few years of parenthood--newborns, infants and toddlers are delightful additions to families, but their needs are comprehensive and unrelenting. Care giving in some situations is a 24-hour responsibility. If you are a full time caregiver for a spouse or relative, you need to make time for yourself. If you don't, you'll burn out. A well-known study concerning the health risks of caregivers revealed a 63% higher mortality risk than non-caregiver controls. Statistically speaking, a caregiver is likely to die before the care recipient. (Schulz R, Beach SR. CareGiving As A Risk Factor For Mortality: The Caregiver Health Effects Study. JAMA. 1999:282:2215-2219)

Tailored to meet individual needs

One of the primary benefits of in-home care is that it can be tailored to suit individual needs. In contrast, care in a facility is designed to serve the needs of a larger community. The needs of your loved one are unique. A clear advantage of home care, regardless if it is needed full-time or a few hours per week, is the one-to-one ratio. 


Caring for people with memory impairments

Memory-care patients, in advanced stages, add a new level of difficulty in achieving good care. They present many behavior concerns and issues such as disrobing in public, sun-downing, agitation, hallucinations, delusions, and aggression. These behaviors create a very stressful care situation. Home can be the best place for those suffering with memory loss. The layout of the home and routines of daily activities are usually locked in a person's long term memory. This helps as short term memory fails and episodes of confusion cloud a person's judgement and ability to make decisions. However, caregivers need to be educated about memory issues so they understand what behavior changes to expect and how to handle them. 

Prevention and intervention

With careful consideration, the home can be designed to meet the safety needs of most people. Experts advise that you consider worst-case scenarios. here are some suggestions you should consider: 

  • Is your loved one prone to fall? Risk factors like throw rugs or uneven surfaces can be minimized. 
  • Is she or he unable to bear weight on his/her extremities? Lifts and wheelchairs are among the many types of devices that enhance mobility. 
  • If there was a fire, could your loved one get out of the house or apartment in a safe manner? 

Resistance to care

Most seniors don't welcome the idea of having a caregiver in their homes. However, the vast majority ultimately bond with the caregiver and look forward to her visits. Convincing an elderly person to accept the help of a caregiver can be difficult. A good approach can be to tell the person that having help is a next step and that it is not necessarily how he/she is going to spend the rest of his/her life. Another idea is to ask the primary doctor to recommend a caregiver. 

The Pros and Cons of In-home Care

Assessing Care Needs

Before you can even consider options for care, you must assess the needs of your loved one. This can be a difficult and emotional process. need for a caregiver is usually caused by either physical limitations or cognitive issues. Physical limitations are usually mobility based, but poor eyesight and hearing contribute, as well. Cognitive issues are usually related to short-term memory-loss and diminishing reasoning ability. All of these issues can be at play and often magnify each other. 

The following are some questions that can help you assess your loved ones' needs for in-home care. 

  • Is your loved one able to practice good, disease-preventing hygiene (e.g., toileting and bathing)? 
  • What events have happened in the past that indicate he could be a danger to himself or others? (e.g., wandering, leaving the stove on or forgetting to take medications. Is he safe while alone at home?) 
  • What are the three most important tasks that an in-home caregiver could help accomplish successfully (e.g. meal preparation, bathing, laundry)? How much time is needed, per day or per week, to provide this help? 
  • Who are possible candidates (family members, friends, neighbors) who could help provide care? 

Indications of Home Care Needs

Activities of daily living

The caregiver or agency must know, in detail, the kinds of care your loved one needs. The best way to know is for you to take care of your loved one for a few days. First-hand experience will give you the clearest picture of care needs. If this is not feasible, find out from others who know your loved one well. If there was a recent hospitalization, find out what was documented about your loved one's ability to perform activities of daily living (ADLs), including: getting out of bed, getting dressed, eating, going to the restroom, and showering. If rehabilitation was a part of the recovery, information from the therapists can be gathered about capabilities and limitations. If possible, attend a couple of physical therapy sessions. The following observations should be noted: Can she bear weight on her extremities? Can he get out of a chair? Is there difficulty in using eating utensils? 

Some individuals maintain proficiency with ADLs, but still need help with activities like grocery shopping, cooking and cleaning the house. It is important to observe what your loved one can and can't do as well as asking which activities are becoming too burdensome. 

Family evaluations are difficult

Family members often have a difficult time evaluating needs. They would rather believe a problem is temporary than face the reality of the progressive loss of physical or mental abilities. An outside opinion from a health professional or a geriatric care manager is a good idea. They can be found at or, 520-881-8008. If hiring through a full-service agency, the agency should do an assessment. 

When 24-hour care is needed

There are times when the family members hear these words from a doctor or case manager, " This person should never be alone," or, "This person should not be alone during these certain activities." Sometimes, family members assume that if their loved one is sleeping, they can run to the grocery store or stop by the bank. However, if the individual has a history of self-injury, wandering off or falling, then no time unattended is safe. It is important to take the advice of the doctor and case manager seriously when considering the amount and type of care needed. 

"If you are a full-time caregiver for a spouse or relative, you need to make time for yourself. If you don't, you'll burn out." - Peggy Rossi, Director of Case Management, Mercy San Juan Hospital