Your Questions About In-Home Care Answered

When the subject of in-home care comes up, there is often a lot of confusion. I first tried in-home care when it was a very new concept, at least in my area. That was in the early 80s when my elderly neighbor, Joe, whom I'd been caring for, fell and dislocated his shoulder. While at the hospital, we were offered help at home for Joe, so we happily accepted, thinking it was part of Medicare. When the eye-popping bill came, I realized that I was lacking some important information. The hospital had its own in-home care service and they were less than forthcoming about other options, as well as costs.

Sure, that was years ago, but some things don't change that much. People still have questions about in-home care. I'll try, here, to answer the most frequently asked questions.

Q. Is in-home care covered by Medicare?

A. In-home nursing care is generally covered when prescribed by a doctor. So, if a nurse comes to your home to check on post-surgery wound healing, that visit is likely covered. However, for many people, their greatest needs are what are known as Activities of Daily Living or ADL help. Showering, dressing, meal preparation, grocery shopping, light cleaning, errands - all those necessary elements of daily life - are ADL and generally not covered by Medicare. The person needing the help must pay the agency out-of-pocket.

Q. Why go through an agency? Couldn't you find your own help cheaper? 

A. You may be able to find a good caregiver on your own. You certainly have that right, and if you find someone you really like, that is great. However, please be aware. I wrote about this subject before in an article titled, "The Accidental Employer," which covers this more thoroughly. The gist of this article is that you, if you hire a person who is not employed by an agency, may find yourself responsible for employment taxes, workers' compensation insurance, Social Security and other employment costs.

Also, you could be liable if the person is hurt. There have been people sued over a back injury, and such a thing is devastating to an elder and his or her family. If you choose to hire someone on your own, please do yourself a favor and check with your state laws so you know what your obligations will be. You may find the best person in the world this way, and that is fine. Just be aware of your responsibility. ALERT: Even if you hire an agency, ask if their workers are covered by worker's compensation insurance. Protect yourself from a lawsuit.

Q. What happens when the person coming doesn't show up? 

A. That's another good reason to hire an agency. If you hire just one person, that is what you get. If you're very lucky, that person may never fall ill or go on vacation, but that's not very realistic, so you'd need to make sure you had family to back you up should the caregiver not be able to make it. With an agency, you would have backup. However, quite frankly, I've known of people stranded, even then. So, ask about backup, too.