In-Home Health Care: What To Look For

  • In-home health care is often cited as one of the fastest growing industries in the economy. Researchers from the Bureau of Labor Statistics have pointed out that the number of home health care workers is expected to grow by 70 percent by 2014.

    For caregivers like us, this means that many of us are having to make some very important decisions about who is caring for our elders — and in what setting. Here is what you need to know to make responsible and informed decisions about in-home health care.

    Joe’s In-Home Health Care Story

    Years ago, my 86-year-old next door neighbor Joe, for whom I’d been caring, took one of his many falls. This time he was injured – he had dislocated his shoulder. We rode the ambulance and got the shoulder fixed up, but he needed some aftercare. The hospital suggested their in-home health care business, which was fairly new, back in 1989. I haven't used this agency for care since, but I did use another one for my uncle. The services were comparable in quality and followed the same procedures for billing. I was wiser, however, the second time with my uncle, and knew what questions to ask.
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    Immediately following the shoulder incident, Joe and I thought the hospitals' in-home health care service sounded good. The hospital-appointed in-home health care workers could fill in for some of the time I couldn’t be there. We were really new at this, how to evaluate and pay for caregiving, and didn’t understand that all of the care wasn’t covered by Medicare. Only the nursing care was covered. The rest was considered custodial. As I recall, Joe had about three weeks of aftercare. It took a couple of months for the bills to arrive. When they did, we were shocked to see he owed over $600 out-of-pocket. Fortunately, Joe could afford to pay the bill.

    Producer's Note: A Florida newspaper recently reported on how common it is for people to be shocked financially when it comes to paying for nursing home and extended care. The St. Petersburg Times wrote: "Americans are woefully unaware of the cost of care at a nursing home or assisted living home. Many people think they have insurance coverage when they do not."

    Read additional reporting in the New York Times: Elder-Care Costs Deplete Savings of a Generation

    Aside from the financial shock, this experience gave me some insight into in-home health care. Joe’s biggest complaint was the people who came to care for him. Some he liked. Some he didn’t. One woman he wouldn’t let in the door. One young man he wanted to stay all day. It was all about the people.

    My Uncle’s Custodial In-Home Care Story

    My uncle had custodial in-home care for eight hours each day for over a year through Oasis Health Care, which was connected with a local nursing facility. He liked the women who came to care for him, and it worked out okay. They didn’t really need to do much – just keep him company. He did have his favorites, and there were a couple of people he didn’t like too well, but my uncle could afford to pay the more than $4000 a month it cost for a full day of care, and he liked most the people, so it was a good solution for him.

  • How to Evaluate In-Home Health Care
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    As with nursing facility care, the most important issue with in-home care, to me, has got to be staff. Who are they? What are their personalities like? Here are some other things to look for:

    - Is this facility new or does it have a history in your community. New doesn’t mean bad, but you will have fewer references, so go carefully.

    - Check with your state to be sure they are licensed and accredited to provide home care.

    - Go to Medicare’s Home Health Web site at:

    - Does the agency work well with the family and/or spouse of your loved one?

    - How much training does the staff have, and how are they trained?

    - How are they supervised?

    - How much does the client pay out-of-pocket?

    - How does the agency interact with their client’s doctor? With another agency that may provide a different kind of care?

    You’ll need answers to these questions and others that you’ll see on the Medicare site. But - remember – it’s the staff that will spend time with your loved one. See if you can talk with some of them. Are the vibes right? No matter who you hire, you’ll need to monitor the care.

    Your loved one is still depending on you to be the main caregiver – the one who is looking out for his or her welfare. Check references and follow through. Drop in and visit. Be an advocate. There are many good in-home health care options around these days. Be sure the one you engage fits that description.

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Published On: December 28, 2006