I have relatives who can afford in-home caregivers as they “age in place.” I’ve also helped place other close relatives in both assisted living and nursing homes. And I’ve assisted thousands of seniors (along with hundreds of caregivers) make a move into independent living, assisted living, memory care and skilled nursing facilities. In short, I’ve seen every option up close and personal.
Of those, you may well think that the best option for your parent or other loved one is to remain at home. And it may well be that they prefer to live at home and “age in place,” as well. They wouldn’t be alone in that desire. AARP has found that some 87% of seniors plan to remain in their own homes indefinitely.
However, as your parent’s needs increase (and they will), you just may find that the idea of them remaining at home with “a little assistance” from you becomes less and less viable. The truth is, you can’t work your job, raise your family and be on-call to provide care 7 days a week to an aging loved one. That’s why it’s important for you to know the different “in-home” options available to you. Here’s an overview.
The “foundation of long term care” in the United States is the care provided in one’s own home by family or friends. The preferred choice of most Americans, it is estimated that more than 65 million people, some 29% of the population, provide an average of 20 hours per week of care for a chronically ill, disabled or aged family member in any given year.
While long–term care insurance may pay for some of this care, 78% of adults in need of caregiving rely on the generosity of family and friends as their only means of assistance. This assistance accounts for an estimated $375 billion a year in “free” care—twice the amount actually spent on paid professional home care and nursing home services combined!
If you’ve become a caregiver for your parent or are considering it, the task is certainly not without its challenges. Please be aware that the economic, social, physical and psychological burdens can be substantial and long-lasting. In fact, the resulting “caregiver burnout” may require that you consider hiring professional help on either a part- or full-time basis. That’s when Non-Medical Home Care or Home Health Care come into play.
2. Non-medical home care
Non-Medical Home Care (also referred to as personal care, companion care or homemaker services, among other names) is much the same as a family member such as yourself or other loved one coming into the home. A home care aide can assist with basic companionship or with the Activities of Daily Living (ADLs). These may include:
- Meal preparation
- House cleaning
- Help dressing, bathing or grooming
- Medication reminders
Non-Medical Home Care would generally be paid for out-of-pocket (although long-term care insurance, the VA or Medicaid may help pay for it) at an average cost of $131 a day—though a caregiver may also be arranged on an hourly basis with certain daily minimums, as well.
If you and/or your parent can afford it, Non-Medical Home Care is a great option as it allows the person receiving care to remain in their own home amid familiar surroundings. Depending upon the rates and the number of hours you’re looking at, however, you may find it’s actually less expensive to take a look at adult day care (see below) or even consider a move to an assisted living community.
3. Home health care
Home Health Care sounds similar to Non-Medical Home Care. However, it is actually quite different. Home Health Care means that a registered nurse, physical therapist, occupational therapist or other skilled medical professional is providing clinical medical care in the home. Often prescribed as part of a care plan following hospitalization, Home Health may be paid for by Medicare, Medicaid or other private insurance.
While a home health care aide may assist with any or all of the ADLs that a home care aide can provide, they may also:
- Administer medication (including IVs and injections)
- Assist patients with Alzheimer’s or other forms of dementia
- Assist with recovery from illness or injury
- Care for wounds such as pressure sores or surgical incisions
- Offer expertise in specific medical conditions (like Alzheimer’s disease or dementia)
- Manage diabetes through glucose monitoring and insulin injections
- Manage pain medications
- Monitor medical equipment
- Monitor vital signs
As home health care is obtained through a prescription, home health is generally covered by medical insurance, including Medicare and Medicaid, although the individual being cared for must be homebound and the home healthcare agency must be Medicare-certified.
4. Adult day care or respite care
Looking for something to split the difference between your day-to-day assistance and hiring in-home care? Adult Day Care Centers are designed to provide care and companionship for older adults who need assistance or supervision during the day. These programs can allow you to go to work, handle personal business, or just relax while knowing that your loved one is well cared for and safe.
The goals of an adult day care or respite care center are to delay or even prevent placement in a care facility by providing alternative care, help enhance self-esteem, and encourage socialization. Depending upon the need, there are three basic models you may want to look into:
- Adult social daycare with social services, activities, crafts and some individual attention from workers
- A medical model with the same services as above but also skilled services from nurses, therapists, social workers, psychiatrists, geriatric physicians, and others
- An Alzheimer’s model with services specifically designed to support and care for Alzheimer’s patients
Here’s an overview of each of these models:
Adult social day care
Adult social day care provides social activities, meals, recreation, and some health-related services. A senior benefit from an adult day care because it:
- Allows them to stay in his or her community while the caregiver goes to work
- Gives them a break from the caregiver
- Provides needed social interaction
- Provides greater structure to their daily activities
Services may include:
- Evening care
- Health screening
- Medical care
- Medication management
- Physical therapy
- Respite care
Social activities can include:
- Field trips
- Music therapy
- Pet therapy
Medical or Alzheimer’s daycare
Medical or Alzheimer’s Day Care differs from adult social daycare in that it offers health services (kind of like the difference between Non-Medical Home Care and Home Health Care). In doing so, adult day care providers can be paid for their services under special Medicaid programs or under Medicaid waiver programs for home care.
As the objective is to keep seniors active and keep them out of an institution, Medicaid sees these services as a viable alternative to placing people in a more expensive nursing home. At the same time, Medicaid is offering you a respite break by providing these services outside of your loved one’s home.
The cost of daycare or respite varies with the type of agency and the services needed but averages about $70 a day. Federal and/or state programs through the Area Agencies on Aging (AAA) may help you to pay for it.
While transportation to and from an adult day care or respite care center may be a challenge, many centers provide shuttle services and most urban areas also have free or very affordable paratransit services for the elderly or disabled.
To find out more about centers where you live, contact your local aging information and assistance provider or Area Agency on Aging (AAA). For help connecting to these agencies, contact the Eldercare Locator at 1-800-677-1116 or https://eldercare.acl.gov. The National Adult Day Services Association is also a good source for general information about adult day care centers, programs, and associations. Call 1-877-745-1440 or visit http://www.nadsa.org.
5. Veteran’s adult day care or respite care
Is mom or dad a veteran? Then, you may have other options, as well, depending upon where you live. Through your local VA facilities, your parent may enjoy social activities, support, companionship, and recreation in the company of their peers.
Veteran’s adult day health care
This program is for Veterans who need skilled services, case management and help with their ADLs. Designed for Veterans who are isolated or their caregiver needs respite, it can be used in combination with other Home and Community Based Services, as well.
Adult Day Health Care can be a half-day or full-day program. Usually, the veteran goes to an Adult Day Health Care center 2 to 3 times per week, but they may be able to go up to 5 times a week. Health services such as care from nurses, therapists, social workers, and others may also be available.
Veteran’s respite care
If you are providing caregiving to a veteran and you need assistance, Respite Care through the VA is also available. This program pays for a caregiver to come to a Veteran’s home or for a Veteran to go to a program while you take a break.
Through Respite Care, you can take a break while the veteran receives care through either of three different means:
- A paid Home Health Aide could come to their home
- They could attend an Adult Day Health Care Center
- They could go to a Community Living Center (VA Nursing Home) or a VA medical center for a short inpatient stay
These programs may be provided at VA medical centers, State Veterans Homes, or community organizations. For a list of State Veterans Homes locations, visit the National Association of State Veterans Homes. You can also use the Locate Services page, found on the left navigation menu, to help you find Adult Day Health Care programs.
As benefits for all these programs vary depending on the individual circumstances, you can learn more by contacting contact your VA social worker/case manager or by calling 1-877-222-VETS (8387).
6. Emergency medical alert systems
No matter how safe your parent may feel in his or her own home (or how safe you may think they are), there is always the risk of a slip, trip or fall. That’s why a personal emergency medical alert system may be a good idea. They are referred to by many names, including:
- Assistance call systems
- Fall monitoring
- Life alert
- Medical alert
- Medical call
- A medical emergency response system
- Personal emergency response services
- Remote monitoring
- Wander management
- Other product names chosen by the companies that sell them
Unlike older systems, tied to a landline phone, today’s medical alert systems offer options that are cellular, work on mobile devices or even a smartphone app. They’re GPS enabled and can contact you to let you know exactly where your parent is—inside or outside.
Emergency pendants and bracelets are generally available through one of three pricing models:
- One-time equipment purchase
- Monthly service fee
- Initial set up/equipment fee plus monthly service
The most basic system is available from $25 to $50 a month, while higher-end systems including wearable devices, multiple in-home sensors, two-way communication, online reporting, emergency response, multi-party notification, and add-ons can range from $500-$1000 for initial installation with a $50-$100 monthly monitoring fee.
Depending on the state in which your parent lives and their income level, there may be financial assistance available for Personal Emergency Response Services (PERS) of home safety monitoring through Medicaid HCBS Waivers or Managed Care Programs. Additional information and a detailed listing by state can be found here.
7. Remote monitoring
If you’re looking for something a little more comprehensive, than an emergency medical alert system, companies such as GrandCare, TruSense, and Wellness also offer easy-to-use, interactive touchscreens that can provide activity and health monitoring, medication prompts, as well as easy communication to family and physicians.
TruSense is a completely customizable smart home solution that works in homes of all sizes and can be personalized to both your parent’s needs and your concerns. It does not require an emergency pendant or bracelet because the passive monitoring system is instead installed throughout the home and works by analyzing data from a network of connected devices.
You can set up custom alerts to notify you when your parent has been in the bathroom too long, if the temperature has exceeded a given threshold, or any number of other personalized notifications using text messages, e-mail, automated phone calls or even through your Echo Dot. These notifications can include:
- Too long in a room
- Away from home
- Temperature out of range
- Vehicle out of the area
- Water leaks
- Door open too long
- Fall detection
- Assistance requested
A starter kit is available with one hub, four motion sensors, a contact sensor, smart outlet, and Amazon Echo Dot for a one-time fee of $299 and a monthly monitoring fee of $39. A wide range of additional sensors, pendants, and tracking systems are also available to enhance your basic package. More information is available at https://mytrusense.com/
The heart of the GrandCare System is a large, easily customizable touchscreen that would be placed in your parent’s home. There’s no worry if your parent’s computer skills are limited or non-existent for them to fully engage with the intuitive touch interface.
Through this touchscreen, your parent can access social communications, instructions, reminders (along with photos of pills and dosing information), as well as web-based entertainment.
You, in turn, access the system by logging in to the online Care Portal through any internet connection anywhere in the world. From there, you can add Tasks, Calendar Events, Reminders, Medications, Personalized Content, and Communications to the touchscreen. You can also check on sensors, view graphs, set up notifications and utilize care notes.
Optional wireless activity sensors, environmental sensors, and digital health devices can be added to the system as needed. These devices can be used to notify you by phone, email, or text if anything seems amiss or if wellness readings fall out of range.
There is a one-time fee of $999 for the Socialization/Reminder Touchscreen with a monthly fee of $99 afterward. A package of three motion sensors, one contact sensor, and one antenna is available for $599. More information is available at https://www.grandcare.com/
Your parent may well wish to live at home and “age in place.” You may have even promised them that you would never place them “in a home.” Fortunately, there are options you can take advantage of that will allow you to both sleep a little easier—for at least a while. You just have to know where to look, where to knock and who to talk with as you journey along the gray mile.