In-Home Care

Seniors who need help with the activities of daily living (such as bathing and dressing), as well as those who need assistance with the instrumental activities of daily living (such as preparing meals), have a number of options. Some seniors choose to move into an assisted living facility where aides are available to help them with those tasks. Seniors who prefer to remain in their homes or to live with relatives can choose to get help from a service that provides homemakers and home health aides.

Homemaker and home health aide services send workers to the senior’s home. The assistance they provide allows seniors to maintain independence and a sense of dignity. Interaction with homemakers and aides often brightens a senior’s day and reduces feelings of loneliness. The services provided increase the senior’s comfort while reducing stress caused by their inability to take care of their own needs.

What services are provided?
Who are homemakers and home health aides?
How should seniors choose a homemaker and home health aide service?
How can seniors who receive services maximize their safety?

Related: For more on the cost of Homemaker and Home Health Aide services, see The Cost of Homemaker and Home Health Aide Services for Seniors. If you are a family caregiver in need of a break, see Respite Care: Temporary Care for the Caregiver

What services are provided?

Home health aides are sometimes called “personal care workers” or “home care attendants.” They provide “hands on” help with the activities of daily living. They may assist seniors with:

  • Bathing
  • Dressing
  • Eating
  • Using the toilet
  • Moving from one place to another

A home health aide might also help seniors manage their medications. Depending on state law, an aide may be limited to reminding seniors to take their medications, or may be allowed to count or measure the correct dosage and hand that dosage to the senior. Some states allow home health aides to administer medications or to check vital signs if they are working under the supervision of a licensed healthcare practitioner.

Homemakers are sometimes called “chore workers.” They help seniors with the instrumental activities of daily living. Those are the daily tasks that require dexterity, mobility, or cognitive abilities that may be impaired by the process of aging. Examples of the services that homemakers might perform include:

  • Meal preparation
  • Cleaning and housekeeping
  • Personal laundry
  • Shopping
  • Performing essential errands
  • Providing companionship

Unlike home health aides, a homemaker does not typically have physical contact with the senior.

In some cases, a single trained employee might be assigned to cover both the homemaker and the home health aide functions. Other services allocate tasks to different employees who receive different training.

Some homemaker and home health aide agencies take a “team” approach. They may assign a geriatric social worker to define and oversee the senior’s needs. For example, despite being homebound, some seniors maintain a social life by receiving regular visits from friends or family. Those seniors may not need additional companionship. Other seniors may be at risk of depression due to loneliness. When that is the case, a geriatric social worker might instruct a homemaker to spend additional time interacting with the senior.

Who are homemakers and home health aides?

Home health aides provide personal care services. Unlike visiting nurses who provide care for a specific health condition, home health aides are not licensed. Personal care services are classified as “nonmedical” services that do not require professional licensing. Many services have nurses on staff who supervise home health aides, but the supervision is not regularly provided in the senior’s home.

The training required for the position of home health aide is determined by state law. Those requirements vary from state to state. While all states offer certification of home health aides, they do not all require home health aides to be certified. Some states only require the employing agency to be certified. Those states leave it to the agency to decide upon the training and certification requirements of their employees. An agency employee who provides only homemaker services is typically not subject to any certification requirement.

Many agencies require their home health aide employees to be state certified even when certification is not legally required. State certification means that a home health aide has completed a minimum number of hours of training, often provided at the community college level. In addition to classroom education, certification typically requires a period of supervised or clinical training in which the home health aide is coached and evaluated during “hands on” interaction with patients. Training is particularly important to assure that aides know how to lift or move a senior without injuring the senior or the aide.

Not all homemakers or home health aides work for services. Some work independently. They may charge lower rates than homemakers and aides provided by agencies, but they may not be bonded or insured. Since they work without supervision and may not be as well trained as an agency employee, seniors need to give careful thought to whether the cost savings of hiring a private homemaker or aide outweighs the advantages of hiring a service.

Alert: The Institute of Medicine recommends that home health aides have at least 120 hours of training. That is more than the minimum required for certification by the law of most states. It is also more than the federal government requires for employees of Medicare-certified home healthcare agencies. Before hiring a home health aide service, compare how much training home health aides receive in different agencies within your community.

How should seniors choose a homemaker and home health aide service?

Start by learning about the certification requirements that apply to home health aide services in your state. Your state’s Department of Health or any state agency that provides services to the elderly can help you find the applicable certification requirements in your state.

Once you understand the certification requirements, determine whether the services you are considering comply with those laws. You can do that by checking with the state department or agency responsible for certifications. In some states, you may be able to find that information online.

If the law of your state does not require home health aides to be certified, find out whether the service you are considering requires its aides to be certified. Ask if the service is certified by Medicare. If it is, you know that the home health aides it employs meet the minimum certification standards that Medicare requires.

Since the minimum requirements imposed for certification by state law or by Medicare may not be adequate, you should also find out how many hours of training the service requires of its employees. Try to find a service that only hires home health aides who have received at least 120 hours of training.

After you are satisfied that the employees of a service are properly trained, ask these questions:

  • What services do your homemakers and home health aides provide?
  • Does the agency have a geriatric social worker who can evaluate your needs?
  • What times of the day and days of the week can services be made available?
  • If you require meal preparation, does the agency make homemakers available on weekends and holidays?
  • Will you have the flexibility to cancel services without charge if family members will be visiting or if you will be unavailable?
  • Is there a waiting list? When can services begin?
  • How long has the agency been in business?
  • How are employees supervised?
  • Are employees bonded? Is the agency insured?
  • What fees are charged for the services provided? Can the agency provide you with a written schedule of fees so you can decide which services you can afford? [Link “fees” with Cost of Homemaker and Home Health Aide Services article.]
  • Is there a minimum charge per visit regardless of the length of the visit?
  • How often does the agency bill and when does it expect payment?

You should also ask for a list of references. Contact those references to make sure that the service has satisfied its clients in the past. You might also obtain recommendations from social workers employed by the medical clinic you visit and from local government agencies or nonprofit organizations in your community that work with the elderly or that specialize in healthcare issues.

How can seniors who receive services maximize their safety?

Before you hire any homemaker or home health aide service, confirm that it screens employees before they are hired to assure that they do not have a criminal record. You also want to be sure that the service conducts periodic criminal record checks of employees during the course of their employment.

While crimes committed by homemakers and home health aides against their clients are not common, the elderly are particularly vulnerable. Theft and physical abuse are always a potential risk. Seniors should be encouraged to tell children, other relatives, or friends about any suspicion they have concerning a homemaker’s or health aide’s misconduct. Children and others who regularly visit a senior should also be alert for evidence of physical or psychological abuse. The police should be alerted if abuse is suspected or if property is missing after a visit by a homemaker or home health aide.

Other risks to seniors include:

  • Poorly trained health aides cause injuries by using improper lifting techniques or by dropping the senior.
  • Health aides may make errors if they dispense medication without appropriate training and supervision.
  • Homemakers and health aides may spread viruses and infections if they visit a senior while they are ill or after they have visited another client who is suffering from an illness.
  • The improper preparation of meals or inattention to a senior’s dietary needs or allergies may place a senior at risk of illness.
  • The risk of disease may also be enhanced by a homemaker’s failure to maintain a clean environment, particularly in the kitchen and bathroom, and to wash laundry properly.

A homebound senior may not be in a position to notice deficiencies in the job performance of homemakers or home health aides. Children, relatives, and friends of the senior who visit the home and who see problems with hygiene should complain to the homemaker and home health aide service. They might also encourage the senior to hire a different service.

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