The Right Way to Find Homecare for a Senior

An adult child who is caring for an aging parent may suddenly find that the job of caregiving is too much to handle. The senior parent, who is living at home, may abruptly need someone with them during longer periods of the day and night, or the senior may require skilled personnel. In this situation, the adult child often seeks a person to provide home health care assistance.

Assessing the type of home care a senior parent needs

To determine the kind of home care that is essential for the senior, the adult child can first observe the senior parent. Watch how the senior handles routine Activities of Daily Living (ADLs) such as bathing and dressing. Also, note any housekeeping or errands that are difficult for the senior to accomplish. Make a list of all of the areas that the senior requires help, or if the senior had assistance, where their life would be better.

The Family Caregiver Alliance offers these guidelines for assessing the home care needs of a senior and for indicating where the caregiver needs support:

How Do I Qualify For Home Health Care Coverage Under Medicare?

To qualify for Medicare home health coverage, you must meet all four of the following conditions:

  • Your doctor must have determined that you need medical care in your home, and the doctor must prepare a plan for your care at home. Your doctor and home health agency personnel must review your plan at least every 60 days.
  • You must need at least one of the following: intermittent (not full-time) skilled nursing care, physical therapy, speech language pathology services or occupational therapy.
  • You must be homebound. Your home can be a house or apartment, a relative's home or even a home for the aged, but a hospital or other facility that mainly provides skilled nursing or rehabilitation services does not qualify as a home. You may be considered homebound if you leave home only with considerable effort. Absences from home must be infrequent, or of short duration, to get medical care or to attend religious services.
  • Medicare must approve the home health agency caring for you.

Source: AARP.
Find out more information on Medicare and what is covered in the webinar from the Society of Certified Senior Advisors titled, More About Medicare and Changes in 2012.
Click here to access this video.

  • Personal Care: bathing, eating, dressing, toileting
  • Household Care: cooking, cleaning, laundry, shopping
  • Health Care: medication management, physician's appointments, physical therapy
  • Emotional Care: companionship, meaningful activities, conversation

By assessing each area, the adult child can begin to align support for each need. For example, a friend or neighbor may be able to cover some of the areas of need, or community services, such as Meals on Wheels, can offer aid with other care requirements. If the senior parent has medical needs or requires constant supervision, hiring a home care worker is a viable alternative.

Sure-fire warning signs that a senior needs more help
Agingcare.com suggests that if an adult child or caregiver notices certain warning signs, the senior probably requires assistance on a more regular basis. Some signs to look for are:

  • Spoiled food that doesn't get thrown away
  • Missing important appointments
  • Difficulty with walking, balance and mobility
  • Uncertainty and confusion when performing once-familiar tasks
  • Forgetfulness
  • Unpleasant body odor or noticeable decline in grooming habits and personal care
  • Dirty house, extreme clutter and dirty laundry piling up
  • Stacks of unopened mail or an overflowing mailbox
  • Late payment notices, bounced checks and calls from bill collectors
  • Poor diet or weight loss
  • Loss of interest in hobbies and activities
  • Changes in mood or extreme mood swings
  • Forgetting to take medications – or taking more than the prescribed dosage
  • Diagnosis of dementia or early onset Alzheimer's
  • Unexplained dents and scratches on a car

Where to start looking for home care
Once it is apparent that the senior needs a home care worker or a home health care worker to help them around the house, locating the appropriate individual may present a challenge. Begin by asking people and organizations in the community – friends, local clergy, geriatric care managers or hospitals – if they could recommend a home care worker or a reputable home care agency. Community and local government resources, such as the local Area Agency on Aging, can often give advice on many good options for in-home care. The Eldercare Locator is a great federal resource.

Whether you're planning to enlist the help of a home care services agency or hire a personal home health aide, knowing what questions to ask is key to receiving quality assistance. The Society of Certified Senior Advisors has a great list of questions to ask when choosing a home care provider. Click here to read the article.

Understanding what services are offered
Home health care workers provide in-home medically necessary services, such as administering medicine, while home care workers provide in-home, non-medical services such as preparing meals, assisting with hygiene and housekeeping. Either an agency or an independent provider can supply these kinds of services in a senior’s home.

A good assessment by the adult child or caregiver will help align appropriate services, and by not paying for aid that isn’t needed, this assessment can also help keep costs down.

Starting a conversation with a senior parent about home health care
Before approaching a senior parent to discuss bringing in a home health care worker, put yourself in that senior’s shoes. Think about what that senior is most frustrated about and be empathetic. Understanding the situation is extremely important in relating to the senior’s emotions, and timing is crucial in setting the stage. Choose a time when tensions are low and there is plenty of time for a discussion.

To make the conversation the most productive, focus on the senior’s safety and helping them maintain independence. Concentrate on why and how an in-home health care worker can actually make life easier and safer. The Society of Certified Senior Advisors has a comprehensive guide to creating a safe and functional home environment for your loved ones that includes recommendation for home safety changes for each room in the house, what equipment is covered by Medicare and tips for finding the right contractor. Click here to read it.

Jake Harwood, Ph.D., the former director of the University of Arizona’s Graduate Program in Gerontology and the author of Understanding Communication and Aging (2007, Sage Publications), offers tips to help family caregivers communicate with their aging parents on sensitive subjects.

  • Get started. Start observing the senior loved one and gather information carefully and thoughtfully. Don’t reach a conclusion from a single observation and decide unilaterally on the best solution. Base the conversation on multiple observations that are gathered with an open mind.
  • Talk it out. Approach the senior parent with a conversation. Discuss your observations and ask the senior for their opinion about what is going on. If the senior parent acknowledges the situation, ask for their opinion about what would be good solutions. If the senior parent doesn’t recognize a problem, use concrete examples to support the case.
  • Sooner is better. Talk sooner rather than later when a crisis has occurred. If the senior has poor eyesight or has trouble driving at night, begin to address those issues before a problem arises.
  • Maximize independence. Always try to move toward solutions that provide the maximum amount of independence for the older person. Look for answers that optimize strengths and compensate for problems. For instance, if your loved one needs assistance at home, look for tools that can help them maintain their strengths.

Recognize the senior’s right to make their own life choices, especially if a home care worker is coming to the house. The senior is likely to be more agreeable if their concerns or wishes are respected during the decision-making process. The sooner you begin conversations with an aging parent about how they can remain safe and maintain independence by using home care, the easier it will be to approach the topic over the long-term, before any major safety concerns are presented.