Senior Home Care Guide

How Much Does Home Care Cost?

Most home care personnel charge hourly rates. The cost will depend on how much assistance the person needs. According to Genworth, the estimated median national hourly cost for home care is $31.83 for homemaker services and $35.01 for home health aides, but this can vary by the person, location, and services provided.1 Home health aides (who can offer some medical care or supervision) typically charge a few dollars more per hour for their medical experience.

How you hire the care worker also affects the cost. For example, hiring home care personnel through a home care agency may cost 20 to 30 percent more than a private hire. The extra money is worth it to many families, because agencies vet all employees, handle financial payments and taxes, and provide backups.

Other factors that impact the cost include:

• What state you live in
• Which agency you choose
• Needing specialized care like rehabilitation services
• Hiring a live-in caregiver or a private-duty nurse

Learn more about the cost of home care in your state by reading our in-depth coverage of senior in-home care costs.

Is In-Home Care Tax Deductible?

Deducting eligible home care expenses can make the cost somewhat more manageable. What you can deduct (as a caregiver) depends on your loved one’s condition and what in-home care services they receive.

For example, you can deduct medical expenses associated with in-home care, but the services provided must be those generally performed by a nurse.2 Covered services include giving medication, changing dressings, monitoring vital signs, or other responsibilities relating to your senior’s medical condition(s). It also includes services like bathing and grooming.

In-home care expenses you can’t deduct include money spent on household or personal services like cooking, running errands, doing dishes, or folding laundry.

One exception kicks in if your loved one is chronically ill and they’re receiving services that align with a plan of care from their doctor. In that case, personal care services and help with ADLs are deductible medical expenses.

How to Pay for Home Care

Figuring out how to pay for senior care is important, especially if your loved one will need ongoing care. It can also be confusing if this is your first time navigating senior care. Along with paying privately, there are several ways to get coverage for care. The section below explains a little bit about the common ways seniors and families pay for home care.

Original Medicare

Is coverage available?

Yes, but only for seniors with Medicare Part A and B who are:

• Under the care of a doctor,
• In need of a covered service, and
• Homebound

Covered services

• Intermittent skilled nursing care
• Physical therapy
• Occupational therapy
• Speech therapy
• Medical social services
• Intermittent home health aide services
• Osteoporosis drug injections for women

Not covered services

• 24-hour-a-day in-home care
• Meal delivery
• Homemaker services like shopping and cleaning (if this is the only care required)
• Personal care services like bathing or dressing (if this is the only care required)

Medicaid

Is coverage available?

Yes, all states must provide some home health care services, but what’s covered varies by state.

Covered services

• Help with ADLs and IADLs
• Skilled nursing care
• Respite care
• Therapy services
• Meal delivery
• Home health care

Not covered services

What is not covered will vary by state. See your state’s Medicaid website for more details.

Veterans Administration

Is coverage available?

Yes, all enrolled Veterans are eligible if they meet the clinical need for the service and it’s available.

Covered services

• Help with ADLs and IADLS
• At-home primary care visits
• Rehabilitation services
• Psychological care
• Nutrition services

Not covered services

Some services may not be available depending on your location.

State Medical Program

Is coverage available?

It depends on what state you’re in and what programs are available to you, but most programs help cover costs for low-income seniors.

Covered services

• Safety monitoring
• Basic skills lessons
• Making home living spaces conducive to seniors with illnesses (like building ramps throughout the house)
• Additional services and support unique to the program

Not covered services

It depends on the program and state you’re applying for, but most of these programs do not provide rigorous medical supervision, like managing medical machines or distributing medicine.

Types of Home Care Agencies

As mentioned above, home care agencies will be slightly more expensive than private hires. So what exactly are home care agencies, and are they worth the extra cost? Below, we’ll look closer at the different types of agencies and questions to ask when choosing one.

Home care agencies in the US fall into four main categories. Comparing the categories, you'll see they vary in terms of licensing, services, and accepted payments.

Categories:

1. Medicare Certified Home Health Agencies
2. State Licensed Home Health Agencies
3. Non-Medical Care Agencies
4. Home Care Employment Agencies

Medicare Certified Home Health Agencies (CHHAs)

Medicare is the USA's federal health insurance program for adults 65 and older. It also insures younger adults with kidney disease and children with disabilities. When Medicare patients receive home care, Medicare will only pay if a Certified Home Health Agency (CHHA) provides the services. Agencies eligible for certification provide skilled nursing and at least one therapy.

Each Medicare Certified Home Health Agency directly employs skilled nurses. (Direct employment means that the work isn't subcontracted.) Additionally, each CHHA directly offers at least one of the following services and may subcontract others:

• home health aide services
• medical social services
• occupational therapy
• physical therapy
• speech therapy

Some CHHAs offer personal care support that's subsidized by Medicare or Medicaid.

AA complete list of Medicare Certified Home Health Agencies is available at data.medicare.gov.

State Licensed Home Care Agencies

While the federal government certifies home health care agencies for Medicare, many state governments set agency licensing standards to help protect consumers. When states do not issue special licenses, the agencies only need standard business licenses for legal operation.

States that license their home care agencies may have more than one type of license available. The biggest distinction is whether a license approves medical care or non-medical care. Many home care agencies hold multiple licenses to offer a wide range of home care services.

Because each state sets its own standards, the laws governing home care agencies are quite different from place to place. Some states have rigorous licensing standards for home care agencies. Successful applicants provide:

• Business plans and names of investors
• Copies of criminal background checks for all intended workers
• Proof of liability insurance and property damage insurance
• Other evidence of readiness to effectively serve the community

States may also stipulate that licensed home care agencies have two administrators rather than one, and they may require that an RN be available 24/7. States also have the leeway to require that administrators have specific experience in healthcare management.

Some states have easy-to-meet licensing standards. It's important to know that states sometimes grant licenses based solely on paper applications. This lets new agencies run for several months or longer before the facilities are actually inspected by the government.

A minority of states lack industry-specific licenses, including:

• Alabama
• Iowa
• Massachusetts
• Michigan
• South Dakota
• Vermont
• West Virginia

Home health agencies in the above states can legally operate with the same licensing required of any standard business or employment agency.

Whatever your state’s licensing standards might be, knowing the best practices can help you choose wisely. For instance, if you live in a state without licensing for home care agencies, specifically look for a center that conducts full criminal background checks on all its employees. With the following links, you can see laws and license applications to get a sense of what state governments have deemed important.

• Alaska
• Arizona
• Arkansas
• California
• Colorado
• Connecticut
• District of Columbia
• Florida
• Georgia
• Hawaii
• Idaho
• Illinois
• Indiana
• Kansas
• Kentucky
• Louisiana
• Maine
• Maryland
• Minnesota
• Mississippi
• Missouri
• Montana
• Nebraska
• Nevada
• New Hampshire
• New Jersey
• New Mexico
• New York
• North Carolina
• North Dakota
• Oklahoma
• Oregon
• Pennsylvania
• Rhode Island
• South Carolina
• South Dakota
• Tennessee
• Texas
• Utah
• Virginia
• Washington
• Wisconsin
• Wyoming

Non-Medical Home Care Agencies (Companion Agencies)

Non-medical care agencies, or companion agencies for eldercare, are not subject to federal or state licensing. Workers are paid to provide friendly companionship and help their clients accomplish chores and errands. These services are not covered by public or private insurance.

Employees’ qualifications are extremely varied. For safety’s sake, work with agencies that show proof of up-to-date criminal background checks. Also, check an agency’s reputation with the Better Business Bureau.

Home Care Employment Agencies

Home care employment agencies give referrals to people seeking home care nurses and health aides. Clients may contact, hire, and pay caregivers directly.

When you directly hire home care workers, the advantage of working with a reputable home care employment agency is that they've screened each person in their database. Additionally, home care employment agencies may provide worker training and occasional on-the-job supervision.

Questions to Ask Elderly Home Care Agencies

The most appropriate educational background for a home care agency leader is in health care administration or public health. Typically an administrator has a master’s degree, but competence for the role is certainly possible with a bachelor’s degree plus work experience. Longtime health care professionals such as RNs and psychologists also move into administrative positions.

The most appropriate educational background for a home care agency leader is in health care administration or public health. Longtime health care professionals such as RNs and psychologists also move into administrative positions.

The best home care agencies are led by people with relevant training and a genuine commitment to human well-being. If you get the sense that money is the manager’s main motivator, then it’s time to wiggle out of the interview.

1. What is the administrator’s background? Ask the question in a friendly getting-to-know-you manner. All sorts of people direct home care agencies, and some are more qualified than others! A director’s duties are important and diverse: setting the agency’s policies, managing the employees, negotiating with insurance companies, ensuring compliance with healthcare laws, and more. Many states require that two people serve as an agency’s administrators.
2. Is the agency Medicare certified? To receive Medicare coverage for home care, a patient needs to work with a Medicare Certified Home Health Agency (CHHA).
3. Is the agency licensed by the state? Not all states have industry-specific licenses for home care agencies. If your state has the option, choose a state-licensed home care agency for assurance that state standards are met.
4. Does the agency carry insurance? Choose an agency that has its caregivers bonded and insured. A well-run agency also has professional liability insurance and general liability insurance.
5. What services are available? Home care agencies may provide medical services, non-medical services, or both. Confirm that the desired services are available. For example, not every state-licensed center has an RN on call 24/7. Some, but not all, have caregivers trained in speech therapy, physical therapy, Alzheimer’s therapy or memory care, and other healthcare specialties.
6. How are the caregivers trained? The best home care agencies have extensive orientations for caregivers and provide continuing education. One essential part of caregiving is effectively handling emergencies, so ask if emergency training is included in employee orientation. (Are employees trained in fire safety? Do they know the Heimlich maneuver and CPR?) Continuing education lets caregivers build their healthcare skill sets and stay up-to-date with best practices in home care.
7. How thorough are the agency’s background checks? Effectively vetting a potential employee involves talking with their previous employer and other references. It also involves getting a full criminal background check to be aware of any felonies, misdemeanors, and driving violations.
8. How many caregivers are assigned to each client? The best home care agencies assign more than one caregiver to each client. Because two or three people become regular visitors, a worker familiar to the senior is available even if one person takes time off or leaves the agency.
9. If the senior is unhappy with a caregiver, can another worker take the shift? You might also ask the director to explain their procedure for matching clients with caregivers.
10. How are caregivers managed? When caregivers are treated well, their patients can benefit. Before hiring a home care agency, observe how the management interacts with staff. Ask the director how the agency motivates its workers and recognizes great work.

Also, ask about employee supervision and evaluation. Directors should occasionally observe their employees in the field — preferably unannounced to help ensure quality control.

Questions to Ask Elderly Home Care Workers

The following tips and interview questions may be helpful as you hire home care workers.

Before You Interview…

First things first! Protect your family’s assets. Before letting people into the senior’s home, verify that the space is insured against accidents. Renter’s insurance and homeowners insurance can cover expenses in case of accidents injuring household employees.

Next, clarify your needs before interviewing caregivers. Here are three steps.

1. List the specific areas in which help is needed. Some possibilities:
   • Personal Care: bathing, dressing, eating, dressing, using the toilet, lifting out of bed
   • Homemaking: preparing meals, cleaning, washing laundry, buying groceries
   • Medical Care: managing medication, intravenous treatments, dialysis, physician's appointments, physical therapy
   • Emotional Care: companionship, conversation, enriching activities
2. Calculate how many hours of care are needed daily or weekly. How long is each visit? What are the best time windows?
3. Decide how much you will pay per hour. Also, list any special benefits of the job.
   • For help determining your pay rate, research the wages offered by local home care agencies.
   • Also put yourself in a worker's shoes… because paying the local norm isn't necessarily fair to the employee, which doesn't serve your loved one's best interest.

Living on market rates can be especially stressful for entry-level home care workers. If the market rate is just $10 in your town, then a full-time worker would take home just $1600/month before taxes. Their annual income would be so low, they'd qualify for federal assistance.

If home care workers sense that they’re “living on the edge,” they can’t maintain a high level of care for long! When setting a rate, put yourself in the worker’s shoes.

Employment benefits can make your job offer more attractive. Home health care agencies typically offer health care and other benefits to their employees. A few examples of benefits you might offer:

• Meals
• Paid vacation days
• Paid sick days
• Dental insurance
• Health insurance
• Travel opportunities
• Tuition for healthcare education

Figure out how you’ll make payments and comply with the law. When hiring home health workers directly, you must report the expense to the Internal Revenue Service. Reporting the work may bring tax deductions, plus it gives social security benefits to the employee. For more details, you can see the IRS publications “Hiring Household Employees” and “Independent Contractor (Self-Employed) or Employee?”

Finally, start writing a job contract to protect yourself and your employees. A sample home health care contract is posted at RocketLawyer.com. It's wise to first have a trial agreement, e.g., for 30 days.

Preliminary Interview by Phone

Before meeting a job applicant in person, interview them by phone. This can be a great timesaver. Covering the following topics might rule out an applicant.

• Work hours
• Relevant training and work experience
• Access to transportation
• Why the person is interested in the job

If the phone interview is to your liking, then arrange to meet in person.

• Agree to meet in a public place unless you already trust the individual based on a friend's recommendation.
• Ask the applicant to bring a photo ID, their job history or resume, and contacts for references.

Full Interview in Person

Below are ten interview questions for home health care workers. Remember that the main tasks of your interview are:

• Presenting your needs
• Explaining the compensation
• Deciding whether the applicant is a good match for your family

If possible, have the senior participate in the interview.

1. Why are you working in home eldercare?
2. What is your work experience as an in-home caregiver?
3. What do you like about home care?
4. What are the greatest challenges of home care work?
5. Why did you leave your previous job?
6. Are you insured to provide in-home care?
7. Can you provide documentation of your health status including immunizations?
8. Can you provide documentation of your relevant training?
9. Are you certified in CPR or willing to become certified?
10. How do you prefer to receive feedback? Would you be comfortable with a weekly or monthly check-in about progress and any problems?

After the Home Care Interview…

Following a positive interview, here are steps you can take to help ensure an effective home care agreement.

1. Call the job applicant's references. Previous employers and other references might confirm your impressions of the individual, or they might share “red flags” that you missed. When you speak with other employers, ask about the worker's punctuality and work quality. Ask why the person no longer holds that job position.
2. Pay for a criminal background check. Ask your local police station for guidance to get an accurate report. Many companies offer background checks via smartphone apps or the web, but their reports can be misleading.
3. Make the job offer. If the candidate accepts, then put your agreement in writing. Include mention of a trial period before the job position is considered permanent. A contract for home care should also include:
   • Job duties
   • Wages
   • Payment schedule and method
   • Start date
   • Time off and other benefits
   • Termination policy
4. Consider hiring a backup worker. You are hiring a human, not a superhuman! Be prepared to cover home care without stressing in case the employee falls ill or otherwise needs to skip a visit.
5. Check in during home care. When the work arrangement is new, spend time at the senior’s home to familiarize the caregiver with the senior’s needs. Periodically drop by unannounced during a shift to ensure that all is well.
6. Schedule a regular time to meet with the employee. You can use this time to address concerns about the job duties or the senior’s status.

How to Find a Home Health Agency Near Me

Locating a trusted nearby home health agency is more straightforward than you’d think. Talk to your loved one’s care team about local agencies. Are you planning to use insurance or Veteran’s benefits to pay for the care? Call to find out what your local options are. Or, if you want to kickstart your search online, use our care provider directory to find local agencies offering the services your loved one needs.