The demand for home-care aides — also known as personal-care aides and home health aides — is skyrocketing as the number of seniors continues to grow. The Department of Labor projects that in-home assistance will be the nation’s fastest-growing occupation by 2020. Those workers help seniors, the infirm and people with intellectual or developmental disabilities with personal hygiene, taking medication, preparing meals, doing household chores and other tasks.
To find the right help for a family member, ask his or her doctor for a referral to a social service worker. The doctor also may be able to provide a list of home-care agencies that serve your area (and should disclose any financial interests he might have).
If the services required are primarily medical, such as wound care or home chemotherapy, the best choice might be a visiting nurse; to learn more, contact one of the organizations affiliated with the Visiting Nurse Associations of America.
If the necessary services are more personal than medical, a home-care aide might be best. He or she can help with shopping, cooking, cleaning and laundry as well as personal activities such as dressing, eating, bathing and using the toilet. A homemaker aide might be the right choice if your relative needs help with housekeeping, laundry, shopping and meals, but not personal hygiene.
Next, make sure your relative will accept home care. Many older or ill people resist because they don’t want strangers coming into their home or because they view home care as a sign that their independence is slipping away. Consider asking your relative to try a two-week trial to see if they like home care. People do, in most cases, says John I. Buck, chairman of the accreditation commission of the National Association for Home Care & Hospice, a trade group.
As a last resort, it sometimes helps to tell a “therapeutic fib” that a doctor or nurse has made home care a requirement, says Lois Escobar, a licensed clinical social worker in San Francisco.
Once you’ve determined what type of aide is best and you’ve established that your relative is on board, check to see whether he or she is covered for home care through a private health or long-term insurance policy, the Veterans Administration, Medicare or Medicaid.
Medicare beneficiaries have access to the Home Health Compare Web tool (www.medicare.
gov/hhcompare), which allows you to compare the services of agencies in your area and assess their quality against state and national averages.
Note that Medicare typically covers home health aides for just 60 days at a time, and only if patients are housebound and require a certain level of care (for instance, intermittent, skilled nursing care). It won’t pay for personal or homemaker services if that’s the only care needed.
In contrast, some states allow Medicaid recipients to hire almost anyone for home care, including relatives. Eligibility and benefits vary by state, so check with your state Medicaid office.
If you’re paying out of pocket, contact your relative’s local Area Agency on Aging (800-677-1116, or www.eldercare.gov) for information about home-care agencies and sources of funding that your relative may be eligible for, such as social service programs or grants.
Some people prefer to ask friends or family members to be caregivers through formal agreements and private financial arrangements. Or they find independent workers through word of mouth, classified ads or online registries, sometimes hiring them at below-agency rates.
As many as 800,000 workers offer in-home services under such private arrangements, according to the Paraprofessional Healthcare Institute, a nonprofit home-care advocacy group. But this market is unreported and unregulated, and the terms may skirt basic employment standards. Relying on someone who might be untrained, unscreened and unsupervised could be perilous for your family member.
Home-care aides can improve the quality of life of the people they help. Stay involved and make adjustments when necessary so you can keep your family member living independently for as long as possible.