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Home Care Explained

By , 6:38 pm on

If you don’t need home care, you’ve probably never heard of it.  People most often ask about home care once a parent experiences physical or mental declines, such as from a fall or dementia.  This is new territory for everyone whose capable and independent parent suddenly needs help with everyday things, like dressing or getting to a doctor’s appointment. It’s important to know what it is and isn’t, how people use it, how much it costs and how you pay for it.

A Definition

Home care is help with the basic personal tasks of everyday life, known as Activities of Daily Living (ADLs), such as:

    • Bathing
    • Dressing
    • Using the toilet
    • Transferring (to or from bed or chair)
    • Continence (care for incontinence)
    • Eating


When someone needs help with ADLs, they usually also need help with the following sort of everyday activities, sometimes called Instrumental Activities of Daily Living (IADLs)

  • Housework
  • Managing money/paying bills
  • Taking medication
  • Preparing and cleaning up after meals
  • Shopping for groceries or going to the doctor
  • Using the telephone or other communication devices
  • Caring for pets
  • Responding to emergency alerts such as fire alarms


A family may bring in professional caregivers for a variety of reasons:

  • Family caregivers need a complete rest from providing care
  • Family is unable to care for the older adult loved one due to other obligations, work outside the home, or distance
  • An older adult is being released from the hospital and has been told he can no longer stay at home without help
  • Dementia prevents living alone or a caregiver-spouse needs regular breaks from caregiving
  • An older adult prefers one-on-one care vs. facility-based care (often 1 caregiver to 12 residents)


Older adults often choose to stay home with professional caregivers versus move to a facility because home care provides them with the everyday support they need to maximize their independence and maintain a sense of control.

It’s not “Home Health”

Home Health refers to specific services performed in an in-home setting, such as wound care, catheter care, intravenous and injection therapies, and physical, occupational and speech therapies.  Doctors order home health visits, which may be 30-45 minutes, 2-8 times a week for 2-3 weeks, when a patient requires rehabilitation to return to self-care but less than what would be received at a rehabilitation hospital.  Home health can be paid for by Medicare, since it is a medical service.

Home Care Allows “Aging in Place”

AARP surveys say about 90% of people want to continue living in their own homes as they age.  “Aging in Place” is a popular notion with Baby-Boomers and their parents, since it implies the ability to stay in charge and in one’s home of choice during the older adult years, instead of moving from home to an assisted living facility and finally to a skilled nursing facility.  Depending on the type of home care chosen, and the individual’s situation, a person may be able to continue living at home through hospice.

Options, Costs and Paying for Home Care

“Why doesn’t Medicare pay for this?” is usually asked with surprise and overtones of shock.  Medicare is insurance for hospital visits and medical care. It does not cover home care because it is considered “custodial” or non-medical care.  If this weren’t so serious, it would be funny.  The irony is, the best home care services improve a person’s quality of life and reduce the need for hospitalization. Home care comes in two types, generally, both of which are paid for by private funds or long-term care insurance:

Basic Home Care: The care provided focuses on the IADLs and helps with some of the ADLs.  Housekeeping, meal preparation, companionship, medication reminders, bathing and dressing; training and supervision of caregivers varies. Caregivers have many clients and see them for a few hours per day.  Basic home care is typically used for people who need low- to mid-levels of help and varies from $20-25 per hour.

Care Management Focused Long-term Care: Client care begins with a detailed plan of care covering medical conditions, nutrition, physical and mental stimulation and lifestyle concerns.  Caregivers are selected and trained for a specific client’s care team.  The care team is closely supervised. The care provided includes basic home care services, personal hygiene (bathing dressing, and toileting) care, and support for physicians’ and therapists’ orders.  A degreed, professional Care Manager typically oversees all aspects of care, including doctor visits, durable medical equipment coordination, and client lifestyle.  This service is often used for people who need low to high levels of care and varies from $23-$28 per hour.

Healthy Longevity

Aging is inevitable, but where you age is at least in part, a choice.  The human connection side of home care is the most important reason many choose it. The environment of one-on-one care helps client and caregiver create a bond.  Good agencies match caregivers to clients, and train caregivers to engage clients with physical and mental activities.  These connections in turn reinforce or restore purpose for the older adult, enhancing quality of life.  The best home care experience supports a client’s healthy longevity.


Lee Nyberg is a Partner in Home Care Assistance of Nebraska, a long-term care company. She educates caregivers on disease specific care and whole-person wellness, co-leads a Parkinson’s support group, and is part of the Alzheimer’s Association Advocate Team which works with U.S. Congressional Members to secure research funds to end Alzheimer’s Disease.

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