With a growing number of seniors and rising nursing home and assisted living prices, many seniors and their families are now turning to home health care. Broadly speaking, home health care consists of a wide range of healthcare, personal and social services that are generally provided to a senior by a home health agency or their family rather than an institution such as a nursing home.
In most cases, these services are provided in the senior’s home. In some cases, these services may even be provided in a senior living community such as independent living, assisted living or even a nursing home if the community does not provide the required service. Finally, in some cases a senior living at home may go to a facility in the community that provides these services, such as an adult day care or respite care facility. Services provided outside of the senior’s home and services provided in a senior living community by outside service providers are sometimes referred to as “community-based” services. The key take-away here should be that wherever the senior lives, they can supplement their care either by bringing in a home healthcare agency or by going to a non-institutional facility that provides services to seniors such as an adult day care or respite care facility.
In this article, we will discuss home healthcare services provided in the home and community-based services such as adult day care or respite care separately, but it is important that you understand how they complement each other. For seniors receiving care in their home, a few trips per week to an adult day care can provide additional oversight of the senior, as well as an opportunity to interact and socialize with peers.
Home health care and community-based services are often the preferred options for seniors who need assistance on a part-time basis or need temporary assistance in the aftermath of an injury or hospitalization. The dual objectives of both home healthcare and community-based services are generally some combination of reducing costs and keeping the senior out of an assisted living community or nursing home for as long as possible. As the level of services required increases, due to increased costs and safety considerations, home healthcare gradually becomes less practical and assisted living or nursing home care becomes inevitable.
Due to this sliding scale, home healthcare is more of an alternative to assisted living than nursing home care, as by the time a senior requires the level of services provided by a nursing home on a full-time basis, home healthcare will have become impractical or unaffordable for the reasons discussed above. Nevertheless, as you will see below, many seniors are receiving the types of services provided by both assisted living communities and nursing homes on a part-time basis in their homes or at community-based facilities with excellent results.
Home healthcare is provided by both home health agencies and family members. In fact, according to the Family Caregiver Alliance, family members perform 37 billion hours of unpaid home healthcare services for their relatives every year, worth an estimated $477 Billion annually. For many seniors, receiving care from family members is impractical, either because their family does not live locally or because the care required exceeds their family’s capabilities. Others simply choose to hire home health agencies because they believe they can provide better care or because they don’t want to strain relationships with family members by overburdening them as care providers. Regardless of their motives, more and more seniors are turning to home healthcare agencies for their care.
It is important to realize that the phrase “home healthcare services” includes a variety of services, including both healthcare and non-healthcare related services. Sometimes these non-healthcare services are distinguished as home care, but to avoid confusion, we will use the phrase “home healthcare services” to describe all of the services that are often provided by home health agencies, including non-healthcare services such as personal care and homemaking. Home healthcare services that may be provided in a senior’s home include, but are not limited to:
|Healthcare||Personal Care||Homemaking||Social & Safety Needs|
|Nursing Care||Assistance with ADL’s||Cooking||Coordination of Care|
|Physical Therapy||Monitoring Vitals||Cleaning||Transportation|
|Occupational Therapy||Medication Management||Grocery Shopping||Companionship|
|Respiratory Therapy||Medical Equipment Management||Laundry|
|Speech & Language Therapy||Paying Bills|
There primary distinction between full-service home healthcare agencies and other caregivers is that full-service home healthcare agencies provide health care services. As mentioned above, many also provide non-healthcare services in connection with healthcare services. Nevertheless, this distinction is significant for some seniors because full-service home healthcare agencies are generally state-licensed operations, staffed by licensed nurses and other medical professionals. This allows these agencies to provide various medical services, including nursing care and physical therapy. In many cases, these healthcare services are ordered by a physician following a hospitalization or injury and are only necessary on a short-term basis while the senior is rehabilitated. For seniors in need of these services, it is important to confirm that the agency you choose offers these services. For seniors who don’t require healthcare services and only require personal care, it may actually be preferable to use a caregiver that doesn’t offer these services, as they may be less expensive.
The most common healthcare services provided in the home are skilled nursing and physical therapy. According to a MetLife Market Institute survey, 84% of seniors receiving home healthcare receive skilled nursing and 40% receive physical therapy. Healthcare services provided by home healthcare agencies also include many other types of therapy (i.e. occupational and speech), as well as nutritional counseling.
Of the services listed above, the broadest is nursing care, which includes a range of services, including wound-care, drawing blood, administering IV’s, monitoring vital signs, oxygen therapy, medication management and certain types of limited physical therapy. The more sophisticated services, including monitoring, assessment and creating a care plan may require the services of nurse practitioners or registered nurses, while more routine healthcare services may be provided by licensed nurses. The availability of these skilled nurses are really what set apart full-service home healthcare agencies in their ability to deliver quality care.
After nursing and physical therapy, the next most commonly used service in the home is personal care assistance with activities of daily living (“ADL’s”). ADL’s include bathing, dressing, using the bathroom, eating, transferring from a bed to a chair and moving around. Most personal care is performed by home health aides rather than nurses. Home health aides generally have the advantage of being less expensive. In addition to assisting with ADL’s, home health aides also monitor vitals and assist seniors with their medication and medical equipment. For many seniors who do not require advanced medical care, this type of assistance is really all they need. While home healthcare is more frequently used for skilled nursing and physical therapy as a rehabilitation tool, the reality is that home healthcare may be best suited to delivering personal care. In the home, seniors receive one-on-one attention in the home setting rather than sharing these home health aides with ten to twelve other residents in an assisted living community or nursing home.
Homemaking services consist of the wide range of maintenance and tasks required to live at home and maintain a house or apartment. These tasks include cooking, cleaning, grocery shopping, laundry paying bills and countless other household chores. While many home health aided will assist with some of these tasks, these people are not housekeepers. In many cases, health care agencies will have people on staff who will provide these services as necessary. If that is not the case, you can generally find other caregivers who will provide these services to supplement your home healthcare.
In addition to the services performed by nurses, therapists, home health aides and housekeepers, many seniors often require additional services, including an occasional ride to a doctor’s appointment, supervision, coordination of care and companionship. Many home health agencies offer social workers to help plan and coordinate your care plan and transportation services for when you need a lift. With modern technology, home healthcare agencies may also be able to monitor vitals and even check in on seniors remotely.
As you can see, home healthcare covers a wide range of services and we haven’t even covered all of them. It is very unlikely that any home healthcare agency will cover all of these services. As a result, many seniors supplement their home healthcare services with community-based services, including adult day care and respite care. These are non-residential facilities where seniors can go for anywhere from a few hours (in the case of adult day care) to a few weeks (in the case of respite care) to give their caregivers some time off, fill in a gap between home care or simply hang out with their friends. These facilities provide many of the same healthcare and personal care services provided by home healthcare agencies, only without the convenience of coming to your home. Respite care is often provided by assisted living communities or nursing homes that allow seniors who typically live at home to live in their community temporarily while their caregivers are away. You can find a more detailed explanation of adult day care and respite care here.
In addition to home healthcare agencies and community-based options, there are many other organizations that may be able to supplement your care, including, but not limited to your local senior center, Meals On Wheels (which delivers hot meals to seniors), companion services and many others.
In addition to the services provided by human caregivers, staying home can be made much more practical with modern technology. Many medical procedures once performed in hospitals can now be performed in your home. There also an array of durable medical equipment designed to make you or your home safer, including hospital beds, wheelchairs, lifts, traction devices and grabber railings. Finally, you can also buy monitoring equipment for monitoring your vital signs or to allow others to monitor you remotely, as well as medical alert systems and other devices. You should ask your home health agency if they offer any equipment you require before you go out and buy it.
According to the Genworth Cost of Care Survey 2019, the median cost of home health care services is around $4,300 per month. However, it should be noted that these figures are presumably based on seniors receiving a high frequency of care, likely daily. It is difficult to provide averages for home healthcare costs because the price will vary wildly based on the level of services you are buying and the degree of skill of the service providers. For a senior who requires only a few hours of care per week, the monthly costs may be $500 per month or less.
Generally, the costs per hour for various types of service providers will be in the following ranges:
Like other forms of long-term care, insurance coverage is limited, largely due to many home healthcare services being nonmedical. Medicare covers short-term home healthcare ordered by a physician for rehabilitation purposes. This coverage is generally limited to healthcare services listed above, such as skilled nursing and various types of necessary therapy. Medicare does not cover any personal care, homemaking or other nonmedical services. If you have a Medigap supplemental insurance plan, you should check your plan as you may have some additional coverage.
Due to limited coverage under Medicare, most seniors end up privately paying for home healthcare services. If you lack financial resources or exhaust all of your financial resources from paying for your medical care, you may qualify for Medicaid. All states are now required to cover home healthcare services through their Medicaid programs. Unlike Medicare, Medicaid will generally cover all of your home healthcare costs. This page has a more thorough detailed analysis of Medicaid eligibility.
Finally, you may also receive coverage for home healthcare through long-term care insurance, private health insurance or Veterans Administration benefits, but you should check your plan for coverage limitations and restrictions.
There are three major considerations in deciding between home healthcare services and a residential facility, such as assisted living or a nursing home. First, each person places a different value on staying in their home. This is assessment is personal. Second, you need to be realistic about the degree of care you require and whether it is safe for you to remain at home, presumably alone at some points during the day. If you need only a few hours of care per day or week, home healthcare is likely your best option. If you require care around the clock or medical care that would be more appropriately provided in a hospital, you would probably be better off in a nursing home. For this reason, we often find that home healthcare is a better alternative for those looking at assisted living than it is for those who really belong in a nursing home, which is more like a medical facility.
Third, you should do an assessment of the costs. This is the part we feel we can help you with the most. There are two reasons home healthcare will typically be less expensive than residential care provided by an assisted living community or nursing home. First, you are only receiving care intermittently for a few hours per day or week, whereas in a residential setting you are paying to be cared for around the clock. Second, you are only charged fees for services and those fees do not include room and board. In an assisted living community or nursing home, half or more of the fees you pay may be to cover room and board.
According to the Genworth survey, the median hourly cost across the board for all home healthcare services is around $23 per hour. If we compare costs to assisted living which averages around $4,000 per month, we find that a senior could probably pay for 40 hours of home healthcare per week for the same cost as assisted living. However, these figures can be misleading because with home healthcare services, your housing expenses are not included in the fees, but you are still likely paying for them out of pocket. We suggest that you factor in your housing expenses with the home healthcare costs to determine whether home healthcare would actually be more cost-effective than a residential facility, such as an assisted living community or nursing home. On the other hand, if your spouse will be staying in your home even if you moved into a residential facility, it probably makes more sense to treat your housing expenses as a fixed cost and disregard them. For these seniors, the scale may be more likely to tip in favor of home healthcare services.
The key take away here is that for many people, home healthcare services are less expensive and a great way to save money, but it depends on the level of care you require. Secondly, you need to make sure you are factoring in housing expenses properly so you are not comparing apples and oranges when comparing home healthcare to assisted living or a nursing home.