THE
ESSENTIALS
RECEIVING CARE
AT HOME
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The Essentials: Receiving Care At Home
This guide is intended for anyone needing care at home, whether it be for you, or for someone
you are caring for who needs assistance with day-to-day activities of daily living (ADLs). The
need for care at home may become necessary at any age. It may be needed for a short time or
for an extended duration. An older adult may find it increasingly difficult to manage without
help or may develop Alzheimer’s disease, while a younger person could have a disabling
accident or develop Parkinson’s disease.
Paying for care at home depends on whether the care is considered medically necessary, or
custodial in nature. Since the need for ongoing care at home to assist with ADLs is generally
considered custodial, it is likely that it will not be covered by private medical insurance or
Medicare. Long-term care insurance is one option that can help provide a way for you to pay
for this care. If you need to receive care at home, there may be community services available
that will supplement in-home care and help you make the most of your assets and income.
This guide is a general introduction to the services available for care at home. It defines the
terms used, and helps clarify the basic issues at hand, while providing answers to frequently
asked questions. Since the issues for families caring for someone in the home vary, these
concerns will be addressed in a separate section for family caregivers.
3
Table of Contents
General Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
› What Type of Care Do I Need? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
› What Is Custodial Care?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
› What Is Skilled Care?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
› When the Need for Skilled Care Ends, How Will I Continue to Receive Care
in the Home?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
› What Are the Different Types of Home Care Agencies That Provide
Custodial Care? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
› What Are the Different Types of Home Care Workers?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Paying for Home Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
› What Is the Current Cost for Home Care?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
› Is There a Minimum Charge Per Visit?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
› Does Private Insurance Cover Home Care?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
› Does Medicare Pay for Home Care Costs?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
› Does Medicaid Cover Home Care Costs?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
› Do Veterans Receive Home Care Benefits? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
› Are There Other Organizations That Will Help Defray Costs?. . . . . . . . . . . . . . . . . . . . . . . . . . . 10
› What Does Long-Term Care Insurance Cover?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
Choosing a Home Care Provider. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
› How Do I Choose a Home Care Agency?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
› What Are the Advantages and Disadvantages of Using a Home Care Agency?. . . . . . . . . . . . . 11
› What Are the Advantages and Disadvantages of Hiring Privately? . . . . . . . . . . . . . . . . . . . . . . . 11
› How Do I Find an Independent Caregiver?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
› Are There Government Resources to Assist with Finding a Caregiver?. . . . . . . . . . . . . . . . . . . . 12
› Are There Professionals to Assist with the Process?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
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Table of Contents
› What Questions Would I Need to Ask a Potential Caregiver?. . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
› How Could I Do a Background Check?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
› How Do I Ensure That the Caregiver Understands and Agrees to the Responsibilities?. . . . . . 14
› What Else Can I Do to Prepare for Having a Caregiver in the Home?. . . . . . . . . . . . . . . . . . . . . 14
› What Community Resources Might Be Available to Supplement In-home Care?. . . . . . . . . . . 16
Information for the Caregiver. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
› What Is the First Step?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
› How Can I Get Help with Assessments?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
› How Can I Find Other Family Caregivers in the Same Situation?. . . . . . . . . . . . . . . . . . . . . . . . 17
› What Do I Do if My Relative Is Resistant to Having Help at Home?. . . . . . . . . . . . . . . . . . . . . . 17
Resources to Get You Started. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
› Books and Publications. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
› Internet Sites. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
5
General Information
Q. What Type of Care Do I Need?
A. Care in the home is divided into two areas—custodial and skilled. It is important to understand
this distinction as it will determine your choice of service providers as well as the reimbursement and
payment options available to you.
Q. What Is Custodial Care?
A. Custodial care includes assistance with activities of daily living (ADLs), which range from shopping,
light housekeeping, laundry, and similar tasks to eating, dressing, bathing, toileting, and transferring to
or from a chair or bed. It does not require the skills of a nurse, and is provided by paraprofessionals such
as companions, home health aides and/or nursing assistants. It also includes the companionship and
supervision of someone with a cognitive impairment. It is not considered “skilled or medically necessary”
care and it is not covered by Medicare or most private health insurance.
Q. What Is Skilled Care?
A. Skilled care is a type of care usually provided by licensed professionals such as nurses, physical therapists,
and occupational therapists and may include social workers, some laboratory services, medical services, and
equipment. These services provided under the supervision of a physician are deemed “medically necessary.”
Often these services are provided in the home when an individual has returned home from a hospitalization
or has had a significant change in health status that requires evaluation and skilled services.
Q. When the Need for Skilled Care Ends, How Will I Continue to Receive Care in
the Home?
A. When you need custodial care to help with ADLs, such as bathing, dressing, and assistance with
household chores, you will have a choice between hiring through an agency or hiring an independent
caregiver on your own. There are pros and cons of each, and you will want to consider the different
options in your community.
Q. What Are the Different Types of Home Care Agencies That Provide
Custodial Care?
A. There are a number of different types of agencies that provide custodial care.
› Medicare-Certified Agencies
S
. ometimes, the Medicare-certified agency that provided the skilled care will have another side that is
non-Medicare-certified, or private-pay. This side of the agency provides services to those individuals
who no longer require skilled care, but continue to have ongoing personal, custodial care needs.
› Home Care Agency/Private-Pay Home Care Agency
A private-pay home care agency provides services that are not reimbursable under Medicare. The
services offered may range from companion care to assistance with personal care functions
6
General Information
such as bathing and dressing. These agencies may or may not be licensed and regulated
depending on each state’s requirements and legislation. Most of these agencies provide nurses
who supervise and monitor their employees and are responsible for the care they provide.
The care is paid for privately by the client or in some instances by private insurance, such as
long-term care insurance.
› Registry
A registry is an agency that functions primarily as an employment service for home health
aides and nurses. Some registries may employ nurses to assess care needs, formulate a care
plan, and oversee workers, but this is not usually the case. When using a registry, the person
employing the provider becomes the supervisor of care delivered, pays the provider directly,
and becomes responsible for all state and federal payroll taxes. Private duty nurse registries can
frequently be found through your area hospitals.
› Companionship/Non-Medical Home Care Services Agency
A companionship/non-medical home care services agency provides companionship and
assistance with light housekeeping, errands, supervision for those who cannot be left alone,
and sometimes transportation. The agency serves to prevent isolation and the companions do
not usually provide personal or hands-on assistance. Most agencies do background checks,
manage payroll taxes, and provide periodic supervision of the worker.
› Hospice Care Agencies
Hospice care agencies provide care for anyone, whether covered by Medicare or private
health insurance, whose physician certifies that he or she has a life expectancy of six months
or less. Hospice is a model of care that can be delivered in the home and that focuses on
pain and symptom management, providing comfort, and incorporating the spiritual,
emotional, and psychological aspects into end of life care. A hospice care agency will
provide a team approach utilizing physicians, nurses, social workers, aides, and may also
provide therapists, chaplains, and trained volunteers as needed. If you or your loved one
have a terminal illness such as the end stages of cancer, Parkinson’s, Alzheimer’s, or heart
disease, and meet the criteria for hospice care, you may want to initiate the discussion with
your doctor.
Q..What Are the Different Types of Home Care Workers?
A. . rofessionals and paraprofessionals provide care in the home.
P
Professionals
› Registered Nurses usually provide skilled services, such as wound care, injections, or similar
services. They have received at least two or more years of specialized nursing education and are
licensed by the state in which they practice. They often supervise those individuals providing
personal care through an agency.
7
General Information
› Licensed Practical Nurses can provide some skilled services under the supervision of a registered
nurse. They have at least one year of specialized education and are licensed by the state in which
they practice.
› Therapists (physical, speech, and occupational) assist in the restoration of mobility, strength, dexterity,
communication skills, and ADLs to individuals who are disabled by physical injuries or disease.
› Social Workers assist in the evaluation of social, emotional, and environmental factors affecting the
ill and disabled, may provide family or individual counseling, and help identify and secure
community resources.
Paraprofessionals
› Certified Nursing Assistants (CNA) and Home Health Aides (HHA), Personal Care Aides (PCA) are
titles used to describe individuals who can help with ADLs, such as bathing, dressing, toileting, and
other activities such as laundry and shopping. Some aides have specialized training and can also take
blood pressures, temperatures, and pulses.
› Homemakers perform light household duties, meal preparation, laundry, and other similar tasks.
They do not provide direct personal care.
› Companions provide comfort and companionship to those people who cannot be left alone and need
supervision. They usually do not perform any direct personal care.
8
Paying for Home Care
Q. What Is the Current Cost for Home Care?
A. The cost depends on a number of factors including where you live and the type of care you
need. Based on the 2012 MetLife Market Survey of Nursing Home, Assisted Living, Adult Day
Services and Home Care Costs, the average cost of a home health aide from an agency is $21 per
hour, while a homemaker averages $19 per hour. Because agency rates can vary, it is best to call
multiple agencies and get quotes regarding billing and rate structures, such as hourly or shift rates
or minimum hourly requirements.
Q. Is There a Minimum Charge Per Visit?
A. Ask the agencies whether they provide a set fee per visit for a specific care task, such as a bath
visit. A regular visit might require a four-hour minimum at $21 an hour, but the agency may
also provide bath visits. These typically last between 45 minutes and 2 hours and might include
bathing, dressing, and routine daily and personal care for a set fee.
Q. Does Private Insurance Cover Home Care?
A. Health insurance and managed care organizations will pay for certain home care services, but
this varies from plan to plan. Services usually need to be medically necessary or skilled, sometimes
need pre-approval, and may or may not cover general personal care.
Q. Does Medicare Pay for Home Care?
A. Yes, however the care being provided must be skilled and intermittent, and the individual
must be homebound1 while receiving services under a plan of care by a physician. The services
must be provided by a Medicare-certified home health agency. If the person meets all of these
criteria, Medicare will pay for home health care services and 80% of pre-approved durable
medical equipment needs. The home health aides who provide care under Medicare need to have
specialized training to provide Medicare home care services.
Q. Does Medicaid Cover Home Care Costs?
A. Medicaid, a joint federal-state assistance program for low-income individuals covers medically
necessary care, long-term care, and some other personal and homemaking care at home
depending on the situation. Each state has individual requirements and individuals should check
with their local Medicaid office.
Q. Do Veterans Receive Home Care Benefits?
A. Some veterans may be eligible to apply for benefits called the Aid and Attendance (A&A) Special
Pension. Veterans and surviving spouses who require assistance with eating, bathing, dressing, or
toileting, and who are eligible both medically and financially can apply for this special assistance.
9
Paying for Home Care
Q. Are There Other Organizations That Will Help Defray Costs?
A. Local chapters of organizations such as the American Cancer Society, Multiple Sclerosis
Society, or Alzheimer’s Association may sometimes assist with funding for home care services.
Some local Area Agencies on Aging may provide funding for respite services to support family caregivers.
www.BenefitsCheckUp.org is a free online resource developed by the National Council on Aging that can
help you find federal, state, local, and private programs that help pay for a variety of services at home.
Q. What Does Long-Term Care Insurance Cover?
A. Long-term care insurance is private-pay insurance that can assist in reimbursement for home care
costs if an individual meets the eligibility criteria in the policy. The insurance must be purchased before
the care is needed, for example, before long-term care becomes necessary. There are many different plans
and it is always prudent to check with your carrier regarding eligibility criteria, deductibles,
and reimbursement.
10
Choosing a Home Care Provider
Q. How Do I Choose a Home Care Agency?
A. With the number of agencies available, you may want to compare one to another. Ask for referrals
from friends who may have used an agency. Check for quality of services and possible infractions. You
can also check with the Chamber of Commerce or Better Business Bureau, which will have a record of
any specific complaint lodged against an agency.
You may find some of these questions helpful in narrowing down your choices:
› Is the agency licensed by the state?
› Does it provide both nursing and non-medical/personal care?
› What are the qualifications and training of the workers?
› Are the workers supervised and if so, by whom?
› Are there a minimum number of hours required?
› Is there a written description of services and fees?
Q. What Are the Advantages and Disadvantages of Using a Home Care Agency?
A. The home health agency provides you with a number of advantages. The agency will create and
implement a comprehensive care plan and coordinate this with you and the physician, and manage the
administrative details such as payroll, (including state, federal, unemployment, social security, disability
taxes, workers’ compensation, and paperwork like the I-9 employment eligibility form) screening, and
supervisory oversight. One advantage of hiring through an agency is that they can provide you with a
variety of caregivers for back-up coverage so that, in most instances, you will not be without care, should
one caregiver be unavailable. A commonly cited disadvantage is the cost. The home care agency is usually
more expensive than hiring a person privately.
Q. What Are the Advantages and Disadvantages of Hiring Privately?
A. When you hire a person privately, you become the employer and take on those additional
responsibilities of the administrative and supervisory roles. Because the nature of the work is very
personal, and the relationship is key, some people prefer to search for an individual whose temperament
will be most compatible with their own. The other reasons that you may choose to hire privately include:
› You have more control over the duties and responsibilities.
› The cost is typically lower than that of an agency.
› You will determine the scheduling.
If you decide to hire an independent caregiver you should be prepared to:
› Locate potential caregivers
› Screen applicants
11
Choosing a Home Care Provider
› Conduct interviews
› Run background checks
› Administer payroll, including social security and other taxes.
Q. How Do I Find an Independent Caregiver?
A. Getting referrals from people you trust will be your first step. People in your community, church,
synagogue, or spiritual affiliation may be able to assist you in your search for a caregiver. Your primary
care physician may have recommendations for caregivers. Disease-specific organizations such as the ALS
Association, the Alzheimer’s Association, Parkinson’s Disease Association, American Heart Association,
and others may know of independent caregivers who are looking for work. They may also come with
recommendations from families who have used them in the past. Check with your local senior center or
senior clubs as they may have a list of individual caregivers. Word of mouth can often be your best route
for finding the right person.
Q. Are There Government Resources to Assist with Finding a Caregiver?
A. Another source is the ElderCare Locator, a free public service from the U. S. Administration on
Aging that will help you find your local Area Agency on Aging. The Area Agency on Aging provides
information about state and local resources. The number is located in the back of this guide.
Q. Are There Professionals Who Can Assist with This Process?
A. If you are having difficulty finding a caregiver to meet your needs you might want to consider using
a Geriatric Care Manager (GCM) to assist you. This is usually a nurse or a social worker who can assist
with evaluation and overseeing a care plan. A care manager would be able to assist you in the hiring and
interviewing process, as well as ongoing monitoring once you have a caregiver in place. This is especially
helpful if you are a family member of someone who needs care and you live a distance from your family
member. Some care managers work independently and others may work through an agency. In either
instance the amount the care manager would charge for services and costs would vary based on the type
and amount of service you require. Prior to enlisting the services of a GCM you should ask for a fee
schedule for his or her services. See the resources at the back of this guide.
Q. What Questions Would I Need Ask a Potential Caregiver?
A. Once you have candidates for the position, you will need to conduct interviews. You can narrow the
field by first conducting a telephone interview. During the conversation confirm:
› Number of days per week and hours per day you will expect them to work
› Caregiving duties and expectations
› Salary and benefits
› Valid driver’s license
› Smoking policy
12
Choosing a Home Care Provider
After successfully screening applicants over the phone, you will want to meet them for a more indepth interview.
Each caregiving situation is unique, so your questions should reflect your needs and preferences and the
requirements related to the work. Having another person with you at the time of the interview will help
you compare observations and notes once the meeting is over. Here are some examples of some questions
that you may want to include in the discussion:
› What has been your prior work experience?
› What are your qualifications?
› Have you worked with people with similar impairments?
› How did you decide to work in this field?
› Do you have a resume and/or references that can be contacted?
› Do you have any health restrictions that would limit your ability to do the job?
› Do you own a car and have a valid driver’s license?
› Are you able to prepare meals? (based on your preferences)
› Can you commit to the days and hours required?
When the meeting comes to an end, you will want to let the individual know that you will need to
conduct a background check and that you will call them as soon as it is complete. While you may feel
uncomfortable asking for this, it may be useful to know that this is a routine process used by home health
agencies and nursing homes. Confirm a telephone number and address where the individual can be
reached for follow up.
Q. How Could I Do a Background Check?
A. It is always advisable to conduct a background check to verify past employment, check references, and
verify credentials that they say they have.
Call the past employers that the candidates listed as references. Ask:
› How long was the person employed?
› Why were their services terminated?
› Were they dependable?
› Would you rehire them?
If you have Internet access, you may be able to locate a company that will perform a background check
online for you for a minimal fee. Examples of such companies are:
› www.knowx.com
› www.backgroundcheckgateway.com
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Choosing a Home Care Provider
Additional information beyond the basic search is sometimes offered at an additional cost.
If the candidate states they are a certified nurse’s aide (CNA), confirm in which state they hold the
certificate. Obtain the certificate number and Social Security number of the candidate and call the state’s
Department of Health to confirm certification. *Note: You will need a signed release from potential
employees stating that they agree to a background check. There should also be a place for their Social
Security number on the release.
Q. How Do I Ensure That the Caregiver Understands and Agrees to the
Responsibilities?
A. Once you have reviewed all of the interview material, completed background checks, and contacted
references, you can make your decision. Call the person as soon as possible to confirm the job position.
You should make an appointment to meet with him or her to review the job responsibilities.
You may want to sign a written contract. Prepare two copies of the contract so you each retain a signed
original. In this written contract be sure to clearly explain the following items:
› Starting date of position
› The hours and days of employment
› Time off/vacation policy
› Pay scale, benefits, and pay periods
› The person responsible for supervision and job performance monitoring.
Q. What Else Can I Do to Prepare for Having a Caregiver in the Home
A. Here are some items that should be reviewed with caregivers when they begin their employment:
› In a notebook placed next to the phone, list the name of current doctors, pharmacies, local hospital,
cell phone, and work numbers for close family members, and the name, address, and phone number
of a neighbor or friend.
› In the notebook, include a local street map and write down the phone number, street address, and
directions to your home.
› Note the location of your home’s water shut off, breaker boxes, smoke alarms, and fire extinguishers
in the notebook and acquaint the caregiver with their locations.
› Prepare a list of important health-related information and include location of important health-related
documents such as a living will and power of attorney for health care should the care recipient (either
you or a family member if you are a family caregiver) need emergency care or is visiting a new doctor.
14
Choosing a Home Care Provider
The documents below from the MetLife Mature Market Institute can be downloaded to your computer,
completed, and updated as needed to assist you in providing information for those providing care to you or
a loved one. The third document is intended for family caregivers so they will have important information
available should they be contacted regarding a health-related or home-related (e.g., plumbing) concern.
Personal Health Information – This tool provides important health information about an individual and
can be used in an emergency or when seeing a new health care provider.
https://www.metlife.com/assets/cao/mmi/publications/Tools/mmi-personal-health-information-fillable.pdf
Important Information for Caregivers – This tool is intended to provide important information to
individuals who are giving care to you or a family member.
https://www.metlife.com/assets/cao/mmi/publications/Tools/mmi-information-caregivers-fillable.pdf
Family Caregiver Emergency Information – This tool includes important contact information and is
intended to be kept at the home or office of a family caregiver in the event that they are called by their
family member or someone caring for their family member with a home- or health-related concern that
needs attention.
https://www.metlife.com/assets/cao/mmi/publications/Tools/mmi-family-caregiver-information-fillable.pdf
These tools may also be accessed at www.maturemarketinstitute.com. Click on Consumer Advice, then
click on Guides and Tools.
Some items to remember as an employer are:
› Protect all valuables by moving them to less conspicuous places or placing them in a safe. Make an
inventory list with pictures and dates for future reference.
› Be sure that payroll records, which include social security and other taxes, are kept current and
accurate. You may want to consult your attorney or tax advisor for payroll requirements.
› If you are a family caregiver, be prepared to make unannounced and unexpected visits to the home
when the caregiver is there. Watch for any signs of abuse or neglect, and take action immediately.
All the checklists, interviews, and resumés cannot ensure safe, quality care. Personal references from other
caregivers and your own instincts are ultimately the best indicators of the appropriate person for you. Even
so, once the caregiver is in your home, it may take some time before you are able to determine whether the
caregiver meets your needs, and you may have to hire a number of people before you find the perfect fit.
15
Choosing a Home Care Provider
Q. What Community Resources Might Be Available to Supplement In-home Care?
A. Here are some types of resources that you may find in your community:
› Friendly Visitors and Telephone Monitoring
This service is usually provided on a volunteer basis through programs in the community. Often this
type of service provides the individual with a social visit from a volunteer interested in helping the
disabled or the elderly. Churches, senior centers, or organizations such as the United Way or the local
Area Agency on Aging often sponsor such programs.
› Nutrition Programs
Programs such as Meals-On-Wheels (MOW) deliver lunchtime and dinnertime meals for
homebound individuals. Some MOW can accommodate special dietary needs and can provide
an additional way to check daily on a secluded individual. Information for these programs can be
obtained from local Area Agencies on Aging, senior centers, or churches. The meals may be free or
based on a sliding scale, requiring a small fee depending on the financial situation of the individual.
› Adult Day Services (ADS)
Adult day services centers provide social and health programs for the physically frail, disabled, and
cognitively impaired adult. Some adult day services focus on the social aspects of day-to-day activities
and provide supervision and assistance with ADLs, as needed. Others are more medically focused
and are geared to those with severe health problems. Most programs offer transportation to and from
the center, in addition to meals, nursing supervision, therapeutic, recreational, and social activities,
and health oversight. Adult day services can supplement care at home, and provide socialization in a
supportive setting.
› Transportation
Many communities offer some sort of transportation assistance for older or disabled adults. The
transportation may be public or privately hired. The cost may be a set amount or a sliding fee scale
based on the individual’s resources. Some communities have arrangements with local taxi services
to offer older adults reduced rates for pre-scheduled appointments. Your local senior center or Area
Agency on Aging is the best place to check for this referral.
› Personal Emergency Response (PERS) or Medical Emergency Response System
This is an in-home system that allows a person to obtain assistance in the event of a situation such
as a fall, heart attack, or accident in the home. The individual wears a pendant or bracelet that is
pressed when there is an emergency. The person is then connected to a central monitoring station
that contacts the local police or ambulance and a designated family member to go and check on
the individual. There is a fee for this service. This service may not be appropriate for a cognitively
impaired person, because it requires that an individual is able to activate the system.
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Information for the Caregiver
Caregiving can cause stress in relationships and at work, and it can add to financial obligations. If you are
caring for a loved one, know that you are not alone, and there are resources available.
Q. What Is the First Step?
A. The first step will involve determining what kind of care may be needed.
› Does your family member need help with bathing, dressing, and other hands-on-care and/or
activities such as shopping and cleaning?
› Does he or she have cognitive problems that pose a safety risk?
› Will your family member accept help?
› Will the home need modification?
These questions and many others will need to be addressed. Determine the amount of time and number
of days that help will be needed. This will help you when you begin the process of choosing an in-home
care provider.
Q. How Can I Get Help with Assessments?
A. As listed above, a geriatric care manager or your Area Agency on Aging is a good place to start.
Q. How Can I Find Other Family Caregivers in the Same Situation?
A. Many caregivers participate in support groups that provide them with not only emotional support,
but also useful tips, when it comes to navigating the challenges of caregiving. In support groups, people
often share solutions to common problems, such as hiring an independent caregiver. There are several
organizations dedicated to family caregivers that offer group discussions—either online, over the
telephone, or in-person. Hospitals and adult day services also frequently offer support groups to the
community. In many communities, the Area Agency on Aging offers services for family caregivers.
Q. What Do I Do if My Older Relative Is Resistant to Having Help at Home?
A. While older adults may recognize the need for care, they may feel fearful that they will be giving up
their independence to a stranger. So it is important to involve your family member in care planning
discussions and decision making if he or she is able to participate. A geriatric care manager or social
worker can help with these kinds of discussions.
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Resources to Get You Started
BOOKS AND PUBLICATIONS
Caring for Your Parents: The Complete AARP Guide
This book discusses innovative ways that others have approached caregiving issues and concerns. It
explores a variety of caregiving topics, includes many helpful tips and contains a listing of resources
related to each chapter. The book looks at ways to find quality care and also to help provide for safety in
the home. Delahanty, H., Ginzler, E. and Pipher, M. (2005). AARP.
The Comfort of Home, 3rd edition: A Complete Guide for Caregivers
This guide contains information that caregivers can use at all stages of caregiving. It discusses working
with home care services and provides guidance on how to think through the issues in choosing the care
to best meet your loved one’s needs. Meyer, M. M. with Derr, P. (2007). CareTrust Publications, LLC.
This guide is available through bookstores but may be ordered by mail with order forms available
through the Comfort of Home™ at http://www.comfortofhome.com/bk/.
The Complete Eldercare Planner: Where to Start, What Questions to Ask, and
How to Find Help
This guide contains information on many aspects of caregiving, including locating resources and
providing care in the home setting. It also includes helpful checklists and an extensive listing of
additional resources. Loverde, J. (Revised and Updated Version 2009). Three Rivers Press.
How to Care for Aging Parents
This book is a useful starting point for those finding themselves in a caregiver’s role for parents or any
other older relative. It provides information on health care issues, caregiver concerns, communityand facility-based services as well as an extensive listing of helpful agencies and organizations, with
contact information that assists caregivers. It contains information specific to home care services and
provides guidance surrounding the questions to ask and what to look for when you are selecting services.
Morris, V., (2004). Workman Publishing Company.
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Resources to Get You Started
INTERNET SITES
BenefitsCheckUp.org
www.benefitscheckup.org
A free online service developed and maintained by the National Council on Aging where you can find
and enroll in federal, state, local and private programs that help pay for prescription drugs, utility bills,
meals, health care, and other needs. It includes more than 1,800 public and private benefits programs
from all 50 states and the District of Columbia.
Eldercare Locator
www.eldercare.gov
A service administered by the National Association of Area Agencies on Aging (N4A) gives information
to callers about state and community resources that provide assistance to older persons and their
caregivers. You may call 1-800-677-1116.
Family Caregiver Alliance (FCA)
www.caregiver.org
A comprehensive support organization for caregivers. Its Website offers information, advice, tips,
resources, research, and support for family caregivers of older or disabled adults. The Family Care
Navigator is a state-by-state guide that you can use to identify government health and disability
programs, legal resources, disease-specific organizations and much more.
National Association for Home Care and Hospice (NAHC)
www.nahc.org
The trade association for home care agencies, hospices, home care aide organizations, and medical
equipment suppliers. NAHC has a consumer section devoted to choosing a home care provider.
National Association of Professional Geriatric Care Managers (GCM)
www.caremanager.org
A national membership association of professional geriatric care managers. Their Website provides
information related to care management for consumers, including a description of services they provide,
frequently asked questions and questions to ask when looking for a geriatric care manger. The site also
provides links to other care management resources and the ability to search for a geriatric care manager
in your local area. The organization can be contacted by telephone at (520) 881-8008.
National Hospice & Palliative Care Organization (NHPCO)
www.nhpco.org
The largest non-profit hospice and palliative care organization representing programs and professionals
in the United States. The site contains a wealth of information, provides links to other resources and has a
database that allows you to search for a local hospice provider.
19
MetLife Mature Market Institute
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New York, NY 10166
MatureMarketInstitute@MetLife.com
www.MatureMarketInstitute.com
200 Park Avenue, New York, NY 10166
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