These days, even people who are seriously ill or incapacitated can be cared for at home and, indeed, most older people want to stay in their homes as long as possible. Most communities have a spectrum of elder-care services ranging from the basic (available at no cost or a nominal fee), such as transportation and meal delivery, to the formal, including skilled nursing care, physical therapy, or speech therapy. You may also find a range of day-care and recreational programs. Many seniors use a combination of services. The costs vary depending on the type of service and location. On average, seniors spend $24,000 a year on home care— which is about 65 percent less than the $68,700 average annual cost of nursing-home care.
When it comes to hiring in-home care, you can go through a home-health agency or hire independent help. Agencies may charge more than independent caregivers but there are significant advantages. The agency's workers are screened, often with criminal background checks, and bonded— if anything is stolen, the agency's insurance pays. And if you have a complaint, they'll often assign a different caregiver at no extra fee. Agencies are also responsible for paying and insuring their workers. If you hire help on your own, you're the employer, which means dealing with payroll taxes and social security withholding. And your parent may need to bolster her homeowners insurance in case the caregiver is injured on the job. If the worker is a full-time employee, most states require that you carry workers' compensation coverage. Plus, if the caregiver gets sick and can't show up for work, the agency will send a backup. With independent help, it's up to you to make other arrangements.
Choose a home-care agency that's accredited by either the Joint Commission on Accreditation of Healthcare Organizations or the Community Health Accreditation Program. Thirty-nine states require home-health agencies to be licensed. To find out if your relative's home state is one of them and, if so, to verify that the agency you're considering is licensed and in good standing, contact the state's health department. If your parent requires skilled nursing care and you choose an agency that's Medicare-certified, you'll have the added assurance that the agency has met minimum federal standards for patient care. Besides, Medicare and Medicaid will only pay for certain types of home care, provided by agencies they approve.
If you hire an independent home-care worker, get several references and check them carefully.
