|Studies show that older Americans prefer to stay in their own homes if they possibly can. It is no surprise, then, that most care of older persons is provided at home, whether by family or by hired help. While many consider in-home care preferable to institutional care, there are public benefits and legal considerations, some of which may be quite unexpected.
To begin with, family members shoulder most of the burden of caring for the elderly at home. Being the primary caretaker for someone who requires assistance with activities of daily living, such as walking, eating and toileting, can be a consuming and sometimes exhausting task. One important consideration when one family member has the sole responsibility of caring for a parent or other older relative is the question of equity with other family members. For example, is the family member being fairly compensated for her work? If the older person is living with a child, does the elder help pay for the house? If the care is taking place in the elder’s home, does the child have an ownership interest in the house?
For parents with only one child, such arrangements may not be so complicated, but if the parent has more than one child, it can be difficult to know what’s fair. An arrangement that seems equitable today may not seem that way after a child has devoted, say, five years to the care of the parent. And if a plan is set up that is fair for five years of care, what happens if the parent suddenly moves into a nursing home during the first year? With no planning for such eventualities, the care of an older person can foster resentment and guilt among family members. Fortunately, most elder law attorneys are skilled in helping families devise creative solutions to such problems.
At the same time, state and federal government officials are slowly recognizing that home care can be more cost-effective than institutional care. This means that, depending on the state, financial or other assistance may be available for those who choose to remain in their homes despite declining capabilities.
Getting Outside Help
Public and private agencies offer a variety of home care services that may be available to you:
- Home health care, either part-time or 24-hour care
- Personal care and homemaking services, such as shopping, cooking and cleaning
- Services delivered to the home, such as meals programs, transportation and home repair
- Adult day care centers that offer more intensive services than senior centers. There are more than 2,000 such centers around the nation and they are usually affiliated with churches or non-profit community agencies. (See below for more information).
- Respite services. These programs provide caretakers a periodic break. A home care professional or aide substitutes for the caretaker for a specified period of time. (See below for more information).
Medicare and Medicaid provide some coverage of the medical portion of home health care. Although the coverage is often inadequate, when combined with other resources available to the client and his family, it may be enough to keep a fragile older person at home for a longer period of time. For an explanation of the coverage of home health care available under Medicare, click here. Medicaid offers very little in the way of home care except in New York State, which provides home care to all Medicaid recipients who need it. Recognizing that home care can cost far less than nursing home care, a few other states—notably Hawaii, Oregon and Wisconsin–are pioneering efforts to provide services to those who remain in their homes.
There are thousands of private home care agencies around the nation. About half of these are Medicare or Medicaid Certified Home Care Agencies, meaning that these two federal programs will reimburse for services provided by the agency if the services are covered. Such certification also means that the agency has met certain minimum federal standards regarding patient care and finances. Home care agencies can also gain accreditation from private accrediting organizations. The three major accrediting groups for home care agencies are the Community Health Accreditation Program https://www.chapinc.org; the Joint Commission on Accreditation of Healthcare Organizations https://www.jcaho.org; and the National Association for Home Care https://www.nahc.org
Non-medical services are also available to help older persons remain independent. The Older Americans Act funds more than 10,000 senior centers and makes grants to State and Area Agencies on Aging to provide services to seniors that include Meals-on-Wheels, transportation, respite care, housekeeping and personal care, money management, and shopping. Services are usually free but staffing may be limited. To find Area Agencies on Aging programs across the country, visit the Eldercare Locator Web site at https://www.eldercare.gov or call the nationwide, toll-free Eldercare Locator at 1-800-677-1116. In many cases, these agencies may offer case management and coordination services.
The new profession of “private geriatric care manager” has evolved to help coordinate services for seniors. Private geriatric care managers usually have a background in either social work, nursing, or psychology and they are experts in helping older persons and their families make arrangements for various kinds of long-term health care. These care managers evaluate an older person’s needs, review the options available, and monitor care once it is being delivered. To find a geriatric care manager in your area, visit the Web site of the National Association of Professional Geriatric Care Managers at https://www.findacaremanager.org.