How to Decide if a Loved One Needs In-Home Care

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Determining whether an aging loved one requires in-home care -- and, if so, what type of care they need -- can be a difficult and tricky process. The cost of such care can also become cumbersome, if the relative or friend does not have long-term care insurance.

About 7.6 million individuals now receive home care, according to the National Association for Home Care & Hospice. While Baby Boomers are still having these conversations with their own parents, millions of them will soon enter retirement and old age as well.

Home care cost about $57.6 billion last year, about 10% of which came out of pocket and 12% from private insurance. The rest was covered by government programs or other sources. That equates to about $758 in out-of-pocket expenses each year for the average patient. Depending on the service, caregivers charge anywhere from $13 to $55 per hour.

With those who had been largely self-sufficient through their younger years, just broaching the topic can be tough enough.

"The vast majority of people who reach out to us are the children and have to work hard to get the parents to buy into the whole idea that they need our assistance," says Hillory Thorpe, a nurse from Partners in Care, who performs in-home evaluations to determine what kinds of services patients will require.

"You want to take their attitude into perspective," she continued. "It's always best to go about it from a safety standpoint -- say, 'This is what you need to do to remain at home safely.'"

Home Instead Senior Care has launched a campaign for the "40-70 Rule," to push adult children and their aging parents to discuss a range of issues, from home care and end-of-life issues to driving and romance.

"Those topics of independence, dating, money and health don't end when children grow up and, in fact, the roles may reverse," says Co-Founder and CEO Paul Hogan. "Now it's Baby Boomer children and their older parents struggling to begin conversations on sensitive issues."

Thorpe says there are three recurring signs that a loved one may require in-home care. First is poor nutrition. If food in the refrigerator remains the same as it was a week before, or it's otherwise clear that the individual is not eating properly or cooking meals, it can be a red flag that they need assistance. The same is true for medication. It's important to check whether they are using up their medicine at the right rate or forgetting to take doses.

The third sign is poor hygiene, which can occur when the individual finds it difficult to bathe himself or otherwise freshen up.

For a fee of $200, Thorpe and her colleagues visit potential clients' homes to evaluate their mental and physical state and suggest the type of services they might require. Some clients just need basic help with shopping, cooking and cleaning and can get by with a couple of visits from an aide each week. Others are less mobile and require someone in the home seven days a week. The most acute care is required by those who are ill and need a nurse with medical training.

During their visits, Partners in Care representatives also walk through the home to target safety issues -- clutter, rugs or floor boards that can cause a fall, showers that are difficult to step into, or steep steps. They sometimes suggest ramps, grip bars, wheelchairs and other devices that can help the client move around safely.

When it comes to paying for such services, those with long-term insurance who are eligible for Medicaid and Medicare assistance will have the lowest out-of-pocket expense -- but the requirements are stringent. AARP notes that Medicaid or Medicare will not cover home care alone, but only if the patient is homebound and under a doctor's care. The agency must also meet federal standards and provide skilled nursing service to qualify.

When choosing an agency, check on whether it is certified by federal programs, whether it offers a sliding-scale fee structure, and how it bills for services.

It is also important to check whether the agency is state-licensed, offers services 24 hours a day, seven days a week, and has certain quality standards in place. For instance, there should be outlined procedures to deal with staffers who are late, absent, rude or inadequately trained. The agency should also be insured against theft and loss in case the staffer steals items or causes damage to the home.

The Department of Health and Human Services offers an eldercare locator, as does Elder Care Home Instead

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