What is Home Care?

In-home care provides assistance for seniors who prefer to remain in their homes, rather than move into a community setting such as assisted living. In-home care professionals offer services related to activities of daily living (ADLs) and instrumental activities of daily living (IADLs). 

ADLs generally include:

• Bathing
• Dressing
• Hygiene (brushing hair, brushing teeth, denture care, etc.)

Toileting (including hygiene, use of incontinence products)

• Transferring (moving from bed to chair, walker to toilet, etc.)

IADLs generally include:

• Light housekeeping
• Meal preparation
• Medication management
• Transportation
• Shopping for groceries or completing other errands
• Using the telephone to schedule appointments, etc.
• Managing money (balancing a checkbook, paying bills)

Although all home care is provided inside the home, there are notable differences between the types of home care listed below.

Like the name suggests, companion care provides regular companionship and emotional support for seniors seeking a better quality of life while living in their homes. This type of care is especially helpful for older adults who suffer from loneliness or depression. Caregivers focus on engaging in meaningful conversations and activities that match the patient’s interests. In addition, companion caregivers often assist with some IADLs, like meal preparation or housekeeping.

Personal care assistance builds on companion care services by adding more focus on helping seniors with ADLs and IADLs. This type of assistance is often most suitable for older adults who are at a high risk of injury or illness if left alone and rely on a caregiver to help meet their daily needs, such as grooming and transferring. Some personal care assistants go through formal training and receive certifications in order to best support seniors with different levels of care.

Home health care can include companion and personal care services, but its primary purpose is to deliver medical services. It is the only form of home care that offers skilled nursing from a registered nurse (RN) or another medical professional who is qualified to work in a hospital setting. This type of care is especially beneficial for seniors who are recovering from a medical condition or surgery. Some of the services offered by home health care professionals include administering medications via an IV or through an injection, ordering laboratory tests and physical therapies, and obtaining blood samples via venipuncture.

Home care costs vary depending on many factors such as location, home care agency requirements, the level of care, and more. Caregivers typically charge an hourly rate, and home health care tends to be the most expensive option due to the services of a skilled medical professional. According to Genworth Financial’s 2021 Cost of Care Survey, the average cost of home care in the United States is $4,957 per month, and the average cost of home health care is $5,148 per month (based on 44 hours per week).

For 24/7 services, Genworth estimates in-home care costs at $18,927 per month or $227,136 per year. Around-the-clock home health care costs are typically more expensive, at $19,656 per month. In-home care costs are significantly higher than 24/7 care at an assisted living facility or nursing home, which runs $4,500 and $7,908 per month on average, respectively. 

Generally, private health insurance plans will not pay for nonmedical in-home care. However, some plans will partially cover home health care, so it’s important to research policies and understand your options. Long-term care insurance and life insurance are two alternative solutions for home care costs, but keep in mind that services and benefits vary depending on the plan.

In certain situations, Medicare and Medicaid cover the cost of home care – with some important requirements and stipulations explained below.

Medicare covers home health care for homebound seniors who have received a doctor’s prescription to prove the medical necessity of home health care services. However, Medicare does not cover non-medical home care like housekeeping and assistance with ADLs when it is the only type of care needed. Typically, a Medicare-certified home health care agency will coordinate all doctor-ordered home care services. In order to qualify for coverage, home care services must be provided on a part-time basis only, which is less than 7 days a week or less than 8 hours each day over a period of 21 days or less.

Medicaid covers both home care and home health care services through original Medicaid and Home and Community Based Services (HCBS) Medicaid waivers. Although specific coverage and eligibility details differ by state, Medicaid typically pays an agency to administer home care services for the recipient, including assistance with activities of daily living and home health care. Several Medicaid programs also cover self-directed care, which allows recipients to hire individuals of their choosing to provide home care, including relatives and friends. Research your state’s Medicaid program to discover your options.

As an alternative to moving into a nursing home or similar facility, the Program of All-Inclusive Care for the Elderly (PACE) provides seniors with healthcare options at home or within their community. Individuals with Medicare and/or Medicaid work with PACE-preferred healthcare professionals, and the program pays for all Medicare and Medicaid-covered services, in addition to any other care deemed necessary for the recipient’s health. This can include services such as:

• Home care
• Hospital care
• Occupational and physical therapy
• Prescription drugs
• Social services and counseling
• Transportation to medical appointments
• And more

Visit Medicaid’s PACE web page for more details on coverage, eligibility, and how to apply.

Veterans currently enrolled in VA health care have the option of receiving home-based health care as part of their benefits. While services for homebound seniors vary depending on local availability and the veteran’s needs, common care options covered by veterans' benefits include:

• Nursing and medical care
• Physical therapy
• Assistance with activities of daily living (like bathing, cooking, and taking medicine)
• Comfort care and help with managing pain
• Support for caregivers
• Home telehealth managed by a VA care coordinator

Visit the VA website For more information on VA healthcare and how to access long-term care services.

Since all seniors experience aging differently, there is no one-size-fits-all when it comes to deciding if and when it’s time for in-home care. However, we’ve identified four indicators that are helpful to consider when making this important decision.

• You’re recovering from a recent illness or injury: As seniors re-enter the home after a hospitalization, they may need assistance during recovery. An in-home caregiver can help with cooking, administering medication, transferring from one position to another, and more.
• You’re have difficulty completing some daily tasks: In-home care is very valuable for seniors who struggle to complete basic activities of daily living, such as bathing, dressing, or using the bathroom. Difficulty with cooking, cleaning, driving, paying bills and other routine tasks are also a good reason to seek in-home care.
• You had a recent fall or another accidents: The presence of an in-home caregiver is very helpful in reducing the chances of falls and accidents and providing quick medical assistance if necessary.
• You notice declining personal upkeep and/or mental health: If you notice a decline in the senior’s physical appearance, such as a lack of grooming or concerning weight changes, it could be time for in-home care. Additionally, signs of anxiety, depression, forgetfulness, or loneliness can also be good indicators.

In your search for an in-home caregiver, we recommend finding a reputable home care agency that is licensed, bonded and insured. These agencies employ caregivers that have successfully completed a background check and formal training requirements. SeniorHomes.com offers a nationwide directory of senior care services and free, professional guidance to help you find the right in-home caregiver. Call 1-800-748-4024 to speak with one of our senior living consultants today.