In-Home Care as Support for Aging
by Felicia Juntunen, CMC, ECM Director of Care Management
One of the services Elder Care Management regularly interacts with is in-home care, services that provide non-medical caregiving and assistance for a client at home. Hiring in-home assistance can help extend an older adult’s ability to remain in place, often supplementing family support, and combined with home modifications and the use of technology to enhance safety at home. In-home care support can provide family caregivers with respite so they can care for their own needs. It’s also possible to enlist an in-home care provider for extra help with an assisted living resident who may be teetering on the brink of needing to move. The additional assistance might help delay a move while options are explored or while waiting for an opening in a chosen setting. Regardless of the scenario, there are some essential facts to understand about in-home care.
Foremost, is knowing that this level of care includes assistance with what are referred to as Activities of Daily Living (ADLs), for example, bathing, toileting, dressing, and meal preparation. In-home caregivers, sometimes referred to as ‘care partners,’ can also help with light housework, transportation, errands, and companionship. The emphasis is on non-medical needs because regulation restricts in-home care providers from helping with activities like injections, wound care, or medication management.
Understanding who pays for in-home care is also imperative. One of the myths we often address is that insurance or Medicare will pay for in-home care, which it does not. In-home care is sometimes confused with the Home Health benefit that is covered by Medicare. Home Health features nursing or physical therapy visits in the home that are temporary and geared toward helping patients regain lost function – such as after surgery and hospitalization. Home health does not include support with activities of daily living – that is the role of in-home care and is not covered by Medicare. Therefore, in-home care is generally a “private pay” service. An exception is for those who have Long-Term Care Insurance, an optional type of coverage purchased to cover needs like in-home care and assisted living. These policies have a benefit that is initiated when the conditions for the coverage are triggered, usually when the insured needs assistance with two or more activities of daily living.
Knowing the difference between agency and private care is also essential in making an informed decision about in-home care. A 2016 consumer protection law stipulates that all Home Care Organizations be licensed by the Department of Social Services. This same law requires that all caregivers undergo a criminal background check. Privately hired caregivers don’t have to adhere to this regulation. In our work as care managers, we have sadly seen older adults who were financially exploited by private caregivers who were never properly screened. An agency assumes the responsibility of hiring and managing the caregiver, including the handling of payroll taxes and liability insurance. If a caregiver can’t fulfill a shift for any reason, the burden is on the agency to find a suitable substitute. For those hiring a private caregiver, these responsibilities land on the care recipient (and often, their family), who becomes an employer to the private caregiver.
An Elder Care Management care manager can assess whether it’s time to pursue in-home care and help an older adult or their family determine just what level of care is needed. We factor in health, environment, and other potentially available resources in guiding these decisions. We refer clients to agencies who have demonstrated good service to other clients during our working partnership. A care manager can provide helpful insight to the agency about a client’s needs as they search for suitable staffing and can help introduce a caregiver to a client who may need some extra reassurance about accepting assistance at home. Finally, a care manager can monitor the care provided, help ensure that the client’s needs are met by the extra support, and communicate with the client’s family about their overall status. ECM values the relationship with our trusted in-home caregiving agency partners and the imperative support it can afford.