Many people are very surprised when I tell them that I personally attended to all of the caregiving for my father; medical, emotional, physical and personal. Gotta say that it is not for everyone and there was a LOT of awkward moments, but my dad was a good partner in the efforts. My husband was there to carry him when needed as that was way outside of my ability.
When we provide care for a loved one at home who needs help with nearly everything day to day, the care-taking is both emotional and physical. It is akin to being there for a newborn, but on a larger and relationally upending way. There are many things to consider when and if you need to get help with the more personal and intimate needs.
If or when you, the main caregiver, cannot be the person to help a loved one with their "personal needs" it is time to get some help. This is one of the very complicated and tough decisions for caregivers for a multitude of reasons, but when you find the right person, it can be really fantastic for everyone.
There is much to research, consider and prepare for with your loved ones when you bring a new person into their home and into their life on such a personal level. This can be challenging to everyones dignity, humor and comfort. If you are considering an in-home-paid caregiver, our recommendation is to start your efforts as soon as you are serious about it because it takes time.
Some Definitions To Start With
Home Health Aides
A paid person who helps with basic medical care
Helps with medication management like checking blood pressure, pulse, temperature, and respiration rate
They may also help with simple prescribed exercises and with giving medications
If your loved one has illnesses or disabilities that require medical attention, this is a recommended addition to your circle
Personal Care Aides / Direct Care Workers
A paid person who helps with household chores and personal needs
Helps with bathing, eating, dressing and typically, light household chores
A good choice if your person has a lot of "alone" time
Some may share meals and do activities with your loved one
A benefit of having a trained person on the at-home-caregiving team is that they are sometimes the first to spot mental or physical health changes because they are not as emotionally involved as we are. Also family caregivers know a lot, but we just don't know what we don't know. Having another pair of eyes and hands around helps prevent a physical or mental health change from going unnoticed.
People needing care may resist the idea of home personal care aides due to practical and emotional reasons. Take sometime and consider the person you are caring for. They may not be open to letting anyone to help them in the shower or to take care of some of the more personal needs like toileting. It is scary as well as another sign of a loss of control and independence. How would you feel? Naked and afraid?
Everyone will need some time to establish rapport and trust. It's natural.
Costs and Coverage
Paying for help is a huge consideration. Most people pay for home care out -of-pocket, but there are specific Medicare exceptions.
The cost of in-home care varies based on the care setting (in-home or in office), geographic location of care and level of care required, among other things. According to Genworth’s 2021 Cost of Care Survey tool, in-home care from a Home Health Aide averages about $5,200 per month. That is typically during 'normal' business hours.
Generally speaking there is a higher rate if you need help during evenings, holidays, or weekends. You can research your state on the Genworth site at the link above.
Medicare, the health insurance program for people over 65, does not cover long-term-care needs, whether it’s assisted living, a nursing home, or in-home care. It does cover SOME in-home care for short-term medical needs. Medicare may pay for services after a person has been hospitalized or has an illness or injury that keeps them homebound AND a doctor certifies that he or she needs care for that specific condition at home. Read more at the Medicare Self-Directed services link.
Will Social Security pay for a caregiver? Neither SSI nor SSDI will pay a caregiver directly. A beneficiary can use their Social Security payments to help pay for care from a home health care service or another party. In some cases, they can choose to pay a friend or family member if desired. Benefit payments also pay for daily needs such as food, medicine, transportation and some living expenses.
Where to find help
To locate a caregiver for in-home care you can go through an agency or an individual. There are pros and cons to both.
If you chose an agency, they do background screening, hiring (and firing) plus the tax and legal paperwork. Agencies typically source with a variety of people and skill levels, but you will likely NOT get to chose the one you want; services are based on availability. That can be frustrating or exciting depending on circumstances.
If you decide to work with a home-care agency, ask about their screening process. Do they preform a thorough check on employees for criminal history, driving record, and provide recent references? Confirm the details that are important for you. There are some realistic concerns about bringing in new people to a home with someone who is vulnerable.
Direct hiring the person / people you think can provide the best care is a possibility too. While this can be less expensive than going with an agency, there is more work in it for you.
You will need to research, locate, interview and also agree on schedules, salary, and job responsibilities. If your aide worker is sick, you arrange for a backup. You take care of administrative tasks like legal and tax paperwork. These efforts can feel like your Chief Operating Officer duties and responsibilities added on top of the other jobs in your caregiver role.
Caregiver workers and aides are a paid job; interview like it. When you direct hire a caregiver do a background check. Ask for professional and personal references and call them all. There are affordable services to check criminal histories and driving records, and to verify licensing. C3 Intelligence was recommended to us, but there are others out there too.
None of these are simple decisions or directions to move into. We understand 100%, but we know that for many families a professional aide is a wonderful addition to the team. And always, some empathy and humor can see you through some of the awkward times.