Caregivers face many decisions in today’s environment because becoming a family caregiver is something that no one aspires to be when they grow up. There’s no planning or education to prepare that can prepare someone for the emotional, financial, and physical challenges that accompany caring for another adult or someone with special needs.

If you rewind the clock, three to four decades, we were looking at a very different landscape. Primarily family members were taken care of at home by other family members. This has changed drastically. Today, for the most part, families are hiring professionals to provide care or looking into assisted living or nursing facilities at a much earlier stage than they have ever before.

The multitude of questions that families face today can lead them down an often confusing, and typically challenging path.

Comparing the care options that are available always begins with finding out what level of care is needed. Sometimes that can be done by a professional assessment, sometimes it’s the family coming together to determine those decisions.

Determining care for a loved one requires an assessment and evaluation for physical and support needs. Assessing if the care situation will be more physical, leaning toward the need for licensed home care, or certified home health, hospice, or nursing; or toward the more social or homemaker type of things like transportation, or meal planning that would lead more toward companion level care. Skilled needs, which would require nursing and finding out what, if any, modifications, durable medical equipment are needed, and determining the cost of those things and how they will affect the family as a whole.

A Certified Home Health Agency, which is sometimes known as a CHHA, is covered by Medicare for a limited assistance for a short-term while a patient is rehabilitating. Many seniors today, and their families think before they get to that place, that Medicare will cover it and it’ll take care of those costs and they don’t need to worry. 

They come to a rude awakening at some point when they realize that when their loved one is coming out of a hospital or rehab facility and needing assistance such as bathing and dressing and toileting, that those things are not covered by Medicare; unless there is an exception for patient who is going to need physical therapy, wound care, or skilled nursing services in the home.  They can offset the need for some home care for a brief time while the patient is getting better. Once there’s no improvement, that coverage stops. There is a specified timeframe that will stop it as well.

Companion Care is really the first level when someone is doing okay but is needing support and guidance. Someone with no physical needs, but having Alzheimer’s and Dementia issues, forgetfulness, wandering, the risk that they may leave on the stove or forget to shut off another appliance. As well as isolation and loneliness which can cause depression. These things are the concerns that might create a need for companion care.

Companion Care can provide transportation, socialization, mental stimulation, Alzheimer’s and Dementia behavior care, cooking, meal planning and preparation, hygiene monitoring and encouragement, balance assistance, safety monitoring, light housekeeping, laundry/linen changes and plant and pet care.

It’s not limited to those things so sitting down and putting together a full care plan is required to make sure that the loved-one’s needs are met.

Once someone is unable to take care of their activities of daily living, dressing, toileting, bathing, feeding, and transferring, those types of needs would require a Licensed Home Health Aid, an HHA or a Certified Nurses Assistant, a CNA.  One of the primary ways to tell if someone needs a Companion or a Licensed Home Health Aid would be if they can self-propel themselves out of a chair or out of bed without anything more than maybe balance assistance.

If they need to be lifted or require any weight bearing, then a Licensed Home Health Aid will be needed. Also, if they need to be fed or physically bathed, this would require a Licensed Home Health Care Worker who could also do light housekeeping, plant and pet care, medication reminders, shaving, hygiene and skin care, as well as some stimulation.

The costs that are associated with home care can be exorbitant, at best. The average cost of a Home Health Aid or a Companion on a national level is $19 per hour. In New York State, we see rates as high as $30 per hour, and we’ve seen higher rates in some areas depending on the care that’s needed. For clients who require 24-hour care, this can run in excess of $1,300 per month.  These high costs sometimes forces a move to an Assisted Living Community or Facility, even when staying at home might have been the first choice for the family.

There are very limited payment options for home care.  Either Private Pay, Long-Term Care Insurance, or something like a Veteran’s Aid and Attendance Program which is a New York-based program may be of assistance. There are similar programs in other states but, depending on where your state is you would need to reach out to your Veterans Administration to find out if they have a similar program and if it would provide a certain amount of money.

There are Respite Grants by organizations on a national level such as the Alzheimer’s Association and there may be other grants in your area. You’ll need to investigate to see if there are any Respite Grants that the loved-one would qualify for. This would give a certain amount of money to caregivers who are living with an afflicted person with Alzheimer’s or Dementia or certain other diagnoses.

A Reverse Mortgage is another way that seniors may be able to stay at home and it’s an often overlooked option. Home Equity Loans is another. Sale of Personal Property, Liquidating Assets, stocks bonds, etc. Another way that home care can be paid for is by family financial support. The idea is that mom and dad took care of you, now it’s your time to take care of them. Medicaid would be another New York, community-based program. Other states have similar programs, you would have to again, reach out to the Office for the Aging in your state to find out what might be available.

Aging in place can often require home modifications or equipment to maintain someone living safely at home. Some home modifications may range on average, anywhere from $500 to install a grab-bar and do minor modifications, to upwards of $100,000 in major construction costs to make kitchens and bathrooms handicap accessible. Widening doorways, installing ramps, stair lifts, possible furniture modifications, such as low profile box springs and lift chairs. All of these things have to be taken into consideration for the cost of aging in place.