Ask the Expert: Finding Care in the Home (Amy Natt)

Q: My husband is ten years older than me and is experiencing some cognitive decline. I’m worried about him when I am out of the home for more than an hour. My physician recommended I start to look for care in the home. How would you suggest I go about finding someone?

A: Finding care in the home can feel like an overwhelming task, especially if this is your first experience with in-home care. It’s important that both you and your husband are part of the process and comfortable with the person who will be coming into your home. Here are a few of the frequently asked questions and some tips that might help give you some guidance.

• What might prompt someone to look for care in the home?

There is typically some type of change in a person’s daily care needs. This change may prompt you to find a caregiver who can help provide and supplement care. Other factors might be a change in environment, like a recent move that might be disorienting, a new diagnosis or the death or illness of a spouse or care partner.

• What is meant by level of care?    

The level of care is determined by the scope of care a person needs. The more assistance a person requires, the higher the level of care will be. Level of care can often be a qualifying factor for the type of care and setting care can be provided in.

• How do you determine what type of care is needed?

The level of care is typically determined by assessing how the individual performs certain tasks. A persons Instrumental Activities of Daily Living (managing finances, transportation, shopping and meal preparation, housekeeping, communication and medication management) and the persons Activities of Daily Living (ambulation, eating, dressing, toileting, bathing and transfers).

The level of assistance needed to complete these tasks will help determine if the person is independent, requires assisted care, intermediate care or skilled care.

• Who makes this determination?

This can depend on why level of care is being determined. If it’s for an insurance company, like long-term care insurance, they may send a nurse out to assess for benefit qualifications. A facility or hospital may use a medical professional to determine this for placement or rehabilitation purposes. If care is being brought into the home, a home health provider may assess the need. In some situations, the family may be determining what type of care is needed and seeking a private duty caregiver to come into the home and provide assistance. The pay source for the care typically helps guide who is making the level of care determination.

• What is the continuum of care?

The services offered along a continuum, with independent being at one end and hospice or long-term skilled nursing care being at the other. The continuum is designed to meet changing health care needs throughout the aging process. This is not always linear; a person may experience differing needs at different times. Care should be congruent with current needs. There are a lot of resources along the continuum such as home care, meal assistance, transportation assistance, care management, assisted living, adult day programs, palliative care and many more.

• Once you determine what type of care is needed, how do you find it?

Do your homework. Beyond asking for references, make sure you are using a reputable company, not just the internet. Word of mouth is great, but a background check is even better. Hospital discharge planners, social workers, department of aging, social services and private care management firms can often provide lists of resource or providers in your area.

• Are there different providers for each type of care?

Yes, if you are looking for private duty care, a caregiver registry is a great place to find a large pool or pre-screened and vetted providers. If you are eligible for care under a program like Medicare, you will need to look at licensed home care or home health care providers.

• What safety precautions should I take before I bring care into the home?

Aside from the screening we talked about above, you can ask to interview the caregiver to ensure it is a good fit for you. If you are going through a provider, ask if they are licensed or accredited, how long they have been in business and how many caregivers they have access to. You might also want to talk to your home insurance provider and auto provider (if they will be driving your car or you are riding in their car) to see if any additional coverage is recommended.

• How is care typically paid for and by whom?

This will also be determined by the type of care and often level of care. Programs like Medicare, Medicaid and Long-Term Care Insurance, may provide some home care benefits, but to qualify, you will need to meet certain criteria and there may be limits on the amount of home care you can receive and the period of time you can continue to receive it. Other private duty care is typically an out-of-pocket expense.

• Are there times it is not practical or possible to get care in the home?

Yes, while most people would say they prefer to age in place, or remain in their own home, there can be times this is not practical. If the person has cognitive issues that result in wandering, aggressive behaviors or other safety concerns like leaving the stove on or continued falls, it may not be safe to remain in the home. There can also be environmental concerns. Is the home accessible, or are there lots of stairs to navigate, bath tubes to climb in and out of and other issues that make it difficult to navigate? If equipment is needed, is the home able to accommodate this? Lastly, it’s important to consider cost. If you are paying privately for care, this can be $20 to $30 per hour. Is this feasible, and if so, for how long? These are all important considerations.

• What are the alternatives?

If a change in environment is needed, there are group housing options, like care cottages, independent living communities, assisted living facilities, rehabilitation and skilled nursing facilities. Level of care will help determine what alternatives to your home will be the best fit. Moving in with family may also be an option, and this decision will take into account everything we’ve explored.

You’re taking the first step into finding the care that will be the right fit for you and your husband. It’s okay to start small. Pick one day a week to have a caregiver come into the home and that can be a day you plan to run errands. As you both adapt or care needs increase, you can decide to increase that schedule. Make sure the person you choose for caregiving is the right fit. If for any reason it is not a good match, keep looking for alternatives and find a person you are both comfortable having in your home.