IN-HOME CARE FOR SENIORS

By Barney Freiberg-Dale
Originally published in Our Town Brookline magazine, May 2006

As seniors become less able to care for their daily needs, many families are faced with difficult choices about how to insure the safety and well-being of their loved ones.  Signs that an elder needs care include physical limitations, lapses in memory, failure to take medications, and recent hospitalization.  Also, fall risk is not to be underestimated, since even a minor fall can produce orthopedic problems that lead to long-term, radically reduced independence and quality of life.  The demands of family and career leave responsible adult relatives unavailable for all or part of the day.  Sometimes they are far removed geographically.  One of the most popular options is to have paid in-home caregivers, either part-time or full-time.

Q:  What are the advantages of providing paid care at home, rather than placement in a retirement community or nursing home?
A: First of all, there is the expense.  In Massachusetts it is common to find monthly costs of $4000 - $6000 for assisted living centers, and nursing homes are usually over $300 per day.  Even live-in care at home can be less expensive than that.  More importantly, if a senior wishes to remain in familiar surroundings, the disruption of a forced relocation often leads to disorientation or deteriorations in health.

Q: What are the advantages of using an agency versus a private individual to provide home care?
A: In the short run, private individuals are often less expensive than an agency, although not always. But they often don’t have backup coverage in case of their own absence, so reliability can be an issue.  Also, you have no assurance that they are trustworthy.  Agencies can get a criminal record check and do other background checks, and some agencies are bonded against theft.  There are other ways in which paid caregivers can abuse or take advantage of an elder, and a good agency is your best protection against that.  Finally, some agencies take care of the worries of worker’s compensation insurance, payroll taxes, and so on, which are legally required.

Q: What are some of the important things to consider in choosing an agency?
A: Look for the personal attention of a home visit.  Judge the management on their experience, knowledge of aging issues, thoughtful questions, and their caring, respectful attitudes. Ask whether they guarantee coverage, and whether they provide on-going case management to assure that things are going well.  You must be able to trust them to provide caring, qualified and reliable caregivers. 

Q: What is the difference between agencies that use employees versus independent contractors? 
A: Employee agencies assume all the responsibilities of the employer, and take that burden off the family, whereas independent contractor agencies shift that back to the family, just as if the worker were privately hired.  That means the family is liable for worker’s compensation insurance, payroll taxes, unemployment insurance, and so on.  Failure to take care of these myriad details can lead to very high financial exposure. Homeowner’s insurance specifically does not cover injuries of the worker, and later social security claims by the worker can come back to haunt a family. The family’s real estate and other assets can even be jeopardized. Most professional advisors now recommend that families stick with employer agencies.

Q: Is price the best determinant of quality care?
A: As with most things, price is not the only thing you should look at.  If an agency’s lower fees are reflected in lower pay to their workers, they will not likely attract the best caregivers.  Each family has to judge the quality of the whole package, and many find that it is worthwhile to pay a little more if the quality of service and caregivers is better.

Q: Is there any available financial help for home care?
A: Only to a limited extent, and it usually depends on the circumstances of the individual.  The state will provide some limited assistance to help keep an elder at home if he/she qualifies financially and in other ways.  Brookline’s local agency to inquire about subsidized services is Springwell, at (617) 926-4100.  Veterans or spouses of veterans who served during wartime also can qualify for some help from the VA.  But medical plans, including Medicare, do not pay for non-medical home care, except for very short-term and limited care following a hospitalization.  Long-term care insurance will often pay for home care, depending on the terms of a policy.

Barney Freiberg-Dale has been a rehabilitation counselor and administrator for thirty years, and is now director of Visiting Angels in Newton.  His e-mail address is freibergdale@rcn.com.