How to Keep Your Loved One at Home—Part II: Picking the Right Home Care Service

Keeping your aging loved one independent as long as possible is a goal that many of us share. Hiring qualified, reputable caregivers is key to helping him or her remain at home in safety and comfort.

Short-term Home Care Services
There are several different types of home care services. Skilled nursing and therapeutic care, such as physical, occupational and/or speech therapies, are provided by visiting nurse agencies and are generally paid for by insurance (Medicare and other supplemental policies).

But these services are usually very brief in nature. It’s common for someone to be released from a hospital or rehabilitation center and receive visiting nurse services for only a few weeks.

State-Subsidized Home Care
Care can be supplemented by private home health aides and personal care assistants or through services under some of the state-subsidized programs. For general information about the state programs, visit or call 1-800-243-4636. Note that there are limits to the amount and type of home care services provided through the subsidy programs.

Some specialized, subsidized home care programs do provide more intensive services. However, the rules for qualifying for these services can be complicated, as your loved one must meet both clinical and financial guidelines. If you chose to go this route, it’s best to get professional guidance to help you work through the qualification process.

Long-term Private Home Care
Private home care, while it provides the most comprehensive and personalized support, is not covered by most health insurance programs. Some long term care insurance may cover the services if your loved one meets the care “triggers.”

Private home care can be scheduled from 1-24 hours per day; the cost averages $23 per hour. There are often price breaks when the caregiver lives in the home (and can sleep there at night). Under a private home care arrangement, your loved one and family retain the most control over schedules, tasks to be completed and choice of home care aide.

Choosing the Best Home Care Solution for Your Loved One
Bringing someone into the home to care for your loved one is an important step, and there are several issues to keep in mind:

  • First, determine what your loved one needs and best care options. (Please see Part 1.)
  • Determine if you are going to hire someone on your own and become an “employer,” or if you are going to go through an agency.
  • If you are going to hire someone independently, be sure to check the worker’s certificates, licenses, references and criminal background. Consider the legal status of the worker.
  • Explore how the aides are to be paid and whether or not they are insured. While privately hired aides may be less expensive (at least at the outset), they are often not insured against injury or bonded for damages. Homeowner’s insurance policies generally exclude coverage for in-home workers.
  • There are responsibilities as an employer that your loved one, as the care recipient, must consider if hiring aides from outside of an agency. Be sure to consult first with your attorney and accountant.

You can avoid some of these issues by working with a professional home care agency. Agencies are responsible for background checks, taxes and insurance liabilities. Ask around to get references on the agency. Meet with representatives from several agencies to get a sense of how each works.

With a well-researched care plan and the right professional support from your care team, including an elder law attorney, financial adviser, elder care manager and care provider, you can rest assured that your loved one will remain safe and independent for as long as possible.

A version of this article originally appeared on

President of Deborah Fins Associates, PC, since 1995, Deborah Liss Fins is a licensed independent clinical social worker and certified geriatric care manager. Drawing on more than 30 years of professional experience in geriatric care management, DFA offers comprehensive assessments and planning, guidance in selecting appropriate care, help identifying resources for financial support and professional consulting.

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