A study on “the baby boom cohort” by the U.S. Census Bureau reported that baby boomers began turning 65 in 2011 and by 2030, the entire generation will be 65 or older. This is over 20% of the U.S. population. That will be a total of 74 million Americans!  Senior citizens are the fastest-growing age group in the United States.

According to research from the Senior Health and Housing Task Force, fielded by the Bipartisan Policy Center, about 70% of individuals over 65 will need long term services and support to accomplish daily activities such as bathing, dressing, or feeding themselves. These “long-term services” are not always covered by Medicare, even though these services can become the costliest part of aging life. Since in-home health care options can be extremely expensive when not covered by long-term care insurance, it is very important to weigh your or family member’s options wisely in order to choose the right services.


What Is In-Home Senior Health Care?

In-home care options range from live-in nurses or companions to regularly scheduled visits from medical professionals and caregivers such as visiting nurses.

The convenience of bringing hospital grade care into your or your loved one’s home is arguably the best part of in-home health care. However, this specialized, individual attention can be quite costly. In-home health care staff (nurses or other medical professionals) can provide services from IV/nutrition therapy and injections to wound dressing and round-the-clock care for serious illnesses. In-home medical professionals can also provide education to the family caregiver and patient in order to prevent accidents when the medic is not present.


What Types of In-Home Health Care Are There?

The first type is live-in nurses or companions. The second is scheduled visits from nurses, physical therapists, or care givers. To decide which option is best for you, think about your daily activities, any therapy or medication your illnesses require, and how much help you would truly need to keep an optimal quality of life; this includes nutrition, personal hygiene, mobility, household cleanliness, financial order, and social and spiritual fulfillment.

A geriatric care manager, doctor, hospital discharge planner, or a social worker can provide advice and help you make this life-changing decision. Don’t be afraid to reach out for help.

It is often difficult for an elderly person to see their situation for what it is. An outside perspective from a professional will allow you to take some of the emotion out of the decision and focus on the facts. People hold onto their pride and their independence as they age and don’t want to let either go. In-home care is a great way to retain your independence and self-confidence while receiving the help you need. We all need help as we age. Accepting this fact will help you move on to what you do best, enjoying life!

Home Health Aides (HHAs)

Home health aides are not nurses, but they do receive training and are required to pass a competency exam in order to become certified as an HHA. Home health aides include Certified Nursing Assistants (CNAs) and personal care aides, which may also be referred to as non-certified nurse aides, “personal attendants, caregivers, sitters, companions, or homemakers.”

Home health aides provide less serious medical services, like checking your temperature or heart rate, scheduling and giving you prescribed medications, or changing bandages. Home health aides are usually sent by a Medicare-certified home health or hospice agency and should be supervised by a medical professional. The agency they work for is generally reimbursed by Medicare or Medicaid and, because of that, is regulated by government laws. Make sure to choose a highly competent aide from a reputable agency because not all agencies are up to the same standard. Choosing an HHA from an agency that is Medicare-certified would be a smart option for this reason.

Home Care Aides

Home care aides are a bit different. They are part of a new trend towards non-medical care that not provided by the family and is hired out. This makes sense because more families are now 2-income households where both parents work. Home care aides are not certified to provide medical assistance, but they do assist with personal hygiene, household duties, and other daily activities you cannot perform on your own. These daily necessities include bathing, dressing, using the toilet, eating, and walking. It is common for home care aides to be supervised by a social worker or licensed nurse. It would be wise to choose a home care agency that monitored by these checks and balances so that the highest standard of care is always provided.

Sometimes home care aide agencies are called “personal care, custodial care, homemaker, companion, and private duty agencies.” Other tasks that home care aides offer include buying groceries and essentials, cooking meals, light housework, answering the telephone, and managing money. A home care aide is taking the place of a family member who has other duties to attend to, and this is why you must be able to trust your aide like a family member. It is so important to choose a home care aide that you trust from a reputable agency for you or your loved one.

It is so important to choose a home care aide that you trust from a reputable agency for you or your loved one.

To summarize, home health care services include: doctors, nurses, physical/occupational/speech therapists, medical social workers, home health aides, home care aides (basic assistance), companions, volunteers, dieticians, x-ray imaging or laboratory services (yes, they come to your home!), pharmaceutical and medical supply dealers (referenced below), transportation, and meal delivery or grocery delivery services. As you can see, there are many services to choose from, and that is a good thing! There are now more specialized in-home care services than ever, which makes for a more personalized experience that fits you or your loved one’s lifestyle and medical needs.


What Kinds of In-Home Care Agencies Are There?

Skilled Home Care Health Agencies

Skilled home care health agencies are licensed and typically certified by Medicare or Medicaid. These agencies may also be accredited by a third-party review organization. Some of these home care agencies are starting to offer a private pay, non-medical line of services as the need to outsource care increases.

Hospice Care Agencies

Hospice care agencies offer compassionate, end-of-life care that focuses on the patient’s needs and wants along with the family’s wishes. Hospice care provides pain management, palliative care, mental support, and spiritual support through chaplain services.

Palliative care focuses on the whole person, not simply the physical issues. Palliative care brings together doctors, pharmacists, art therapists, music therapists, mental health counselors, and other care providers to offer continuous and consistent care across the board.

There are strict requirements for enrolling in hospice care, but if you have a terminal illness, hospice agencies will serve you no matter your age. This includes those dealing with cancer and many other serious illnesses. Hospice agencies are licensed and the majority of their services are covered by Medicare in most states.

Pharmaceutical and Infusion Therapy Companies

Pharmaceutical and infusion therapy companies deliver IV (intravenous) therapies for nutrition and fluid repletion at home. They also offer feeding tube therapies. Nurses provide lessons to the patient or family caregiver on how to administer these IV fluids, IV medicines, or feeding tubes. It is also worth checking to see if the company you choose is Medicare certified.

Medical Equipment Suppliers

Home medical equipment (HME) and medical supply dealers provide tools, such as respirators, wheelchairs, and catheters. They are in charge of delivery, set up, and lessons on how to use the equipment. Some companies provide a nurse to assist on-site or administer respiratory therapy. Check to see if your state requires HMEs to be licensed or if they meet federal minimum standards for Medicare.


How To Pay for In-Home Senior Care

The Difference Between Medicare and Medicaid

Both Medicare and Medicaid are government run (created in 1965) and together cover poor and older Americans with health insurance, but there are differences in who can apply to each.

Medicare is available to Americans over 65 no matter their income. It is also available to those with severe disabilities of any age. “Severe disabilities” include those who receive Social Security Disability Insurance (SSDI) and those with End-Stage Renal Disease (ESRD), which means those with kidney failure on dialysis or who have a kidney transplant.

Medicaid is available to pregnant women and children of low income families, as well as the elderly and disabled. Medicaid may cover your nursing home costs. In 2014, 80 million Americans with low incomes received health insurance through Medicaid over the course of the year. Each state has its own Medicaid program and many expanded their coverage under the Affordable Care Act of 2010, so make sure to read about your options below.

Those who are dual eligible may apply for both Medicare and Medicaid.

Which In-Home Health Care Options are Covered by Medicare?

Medicare is a government run social insurance program that covers skilled medical care. Skilled medical care includes (1) certified nurses or doctors, (2) certified therapy services, like physical therapy and speech-language therapy, (3) medical social services, like counseling, (4) medical supplies, like supplies provided by a Medicare certified home health care agency, and (5) long-lasting medical equipment, like a wheelchair or walker. Physical therapy and exercises prescribed by a licensed doctor may be carried out by a non-certified home health aide, and in that case, Medicare would most likely cover the costs.

Learn more about what Medicare will cover.

When Medicare runs out, that is when a long-term care insurance policy steps in for coverage. You can read more about this in our “How to Select a Long-Term Care Insurance Plan” article.

What is Covered by Medicaid?

For the unskilled, non-medical, at-home services provided that are not covered by Medicare, it is worth a look to see if they are covered by Medicaid. Medicaid typically covers counseling therapy or other social services, certain medical supplies, and certain medical equipment. Examples of medical equipment include particular wheelchairs or walkers.

Learn more about Medicaid eligibility and apply.


What Senior Care Option is Best For Me? How Do I Choose?

So, you want to age in place, and you want to have only in-home care. If you aren’t sure that this is the right decision for you or your loved one, take this Senior Living Self Assessment. This assessment will help you understand if your needs and wants are more suited for assisted living, independent living, Alzheimer’s care, continuing care, retirement living, or home care.

Here are 5 great reasons to choose in-home care:
– To be Independent
– To be close to family, or to involve your family
– To keep your same doctors, nurses, or physical therapists
– To avoid the hassle of moving/selling your home and relocating
– To pay less than a nursing home, assisted living facility, or hospital stay would cost in some cases

For family caregivers: You will know that you need an extra, non-family caregiver when household chores like laundry and cleaning are left undone, your loved one isn’t eating correctly when living alone, or if there is just no time left in the day to complete necessary errands and tasks outside of the home (never mind any time for yourself). We love our family members, but we aren’t superhumans. Our parent, grandparent, or other family member often doesn’t want to be a burden, and in this case, he or she would understand the need for extra help. These hired, in-home caregivers can change everything by simply giving family members autonomy, space, and time for self care.


Tips on How to Hire a Caregiver:

You or your family member might want a caregiver who shares the same background and religion as them. Your senior might also have a particular preference on whether they would like a female or male caregiver, especially when that caregiver helps with personal hygiene and dressing. Make sure that all parties are comfortable with each other. The caregiver bond can be very special if paired the right way, and it offers more than just immediate care. Having someone to talk to can provide a significant physical and emotional boost.

AAA is a great resource for hiring a caregiver. AAA can provide a list of home care agencies, senior tax advice, and registries of attendant services for those with disabilities.

In-home care provider recommendations from close family, friends, or your local house of worship are good shortcuts to finding services you can trust.

If you choose to hire a private caregiver yourself and not through an agency, read our “How to Hire a Caregiver” article.

To learn about in-home care options for those dealing with Alzheimer’s disease please reference our “Caring for an Alzheimer’s Family Member” article.


Improvements to In-Home Care

The U.S. Centers for Medicare and Medicaid is running a 5-year project called “Independence at Home” to see if improving home-based primary care options will save money and improve overall care. After two years, the “Independence” demonstration saved over $1,000 per beneficiary and paid out over $5 M in incentives while improving performance in six quality measures. The program is part of the Affordable Care Act.

Million Americans Over Age 65 in 2030

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