Home Care

Also known as: At-Home Care, In-Home Care, Unskilled Care

Last Updated: October 20, 2020

Written by the Open Caregiving Team. Editorial review by Joyce O. Murphy RN, MSN.

What is home care?

Home care allows people who are aging, chronically ill or disabled to receive personalized non-medical care in the comfort of their home. This is also known as “aging in place.”


Our page on home health care offers information about providing for people who require medical care to remain at home.

What services does home care provide?

Personal Care (also known as Senior Care, Custodial Care, Non-medical Care, Health Aide Services): This focuses on helping individuals with their daily activities, maintaining their household, and other non-medical supports. The home care may include:

  • Home-Health Aides (HHA): Help with activities of daily living, make medication reminders, take vital signs and may help with coordinating other aspects of care. HHAs are federally required to have 75 hours of training, and some states require additional certifications.
  • Personal Care Aids (PCAs): Also help with activities of daily living, housekeeping, meal prep and sometimes transportation. While there are no federal requirements to become a PCA, some states do require formal certification.
  • Homemaker Services: Assist in keeping the home neat and safe by helping with routine chores, cleaning, and meal preparation.
  • Social Worker Visits: A social worker makes regular visits to help individuals with counseling. Social workers assist with finding local resources to help with specific needs.
  • Companionship/Volunteers: They help to relieve isolation by offering socialization, supervision, and perhaps some help with chores and transportation.
  • Transportation Services: Will pick up individuals at their homes and bring them to appointments and other places they may need to go.

Who needs home care?

It may be time to research home care if your loved one:

  • Requires assistance with their activities of daily living (ADLs).
  • Has common accidents at home.
  • Does not keep their house clean.
  • Develops poor eating habits.
  • Is unsafe staying home alone for extended periods of time.
  • Becomes forgetful or commonly gets lost.
  • Prefer to age at home rather than a long-term care facility.

If you as the primary caregiver:

  • Are no longer equipped to offer the care they require.
  • Feel burned out, depressed, or are suffering from physical strain.
  • Feel like your relationship with the person you are caring for is negatively impacted by the current arrangement.
  • Can no longer uphold your personal obligations like employment or caring for your children.

What are the pros and cons of home care?

We outline the pros and cons of home care on our page for Home Health Care.

How much does home care cost?

We outline the costs of home care on our page for Home Health Care.

Does Medicaid or Medicare pay for home care?

Medicaid

Based on your loved one’s eligibility, Medicaid will pay for your home care services through either your state’s:

  • Medicaid plan
  • Home and Community-Based Services (HCBS)
  • Medicaid Waivers or Section 1115 Demonstration Waivers.

Medical Eligibility: Your loved one will need an evaluation by a medical professional to determine what level of care they need and which home care service may apply. Although state eligibility varies, a person needing help with ADLs may be medically medically eligible for Medicaid-covered home care.

Financial Eligibility: This differs greatly from state to state. Contact your state’s Medicaid office or your local Area Agency on Aging for details about financial eligibility in your state.

Medicaid Covered Services:

  • In-home health care
  • Homemaker services
  • Meal prep
  • Personal care
  • Family caregiver support
  • Respite care
  • Transportation to and from doctors appointments
  • Some home modifications for accessibility purposes
  • Medical equipment and supplies
  • Personal Emergency Response Services (PERS)

Keep reading how Medicaid can help you pay for home care on the American Council on Aging Medicaid planning site.

Medicare

Medicare will not cover home care services but will cover specific home health care services.

How to find affordable home care services

Should I hire a home care agency or private caregiver?

Home care agencies

Home care agencies employ caregivers who provide non-medical care to meet your loved one’s needs while they stay in the comfort of their home.

Pros of home care agencies:

  • Screening: The agency will do the background check, interview, and skill verification for you.
  • Ease of Finding and Matching: It is much faster to find and match with a trained caregiver that fits your needs through an agency.
  • Backup Coverage: The agency will offer a backup caregiver if your primary one is sick or has an emergency.
  • Certification/Insurance: Home care agencies often will need to be certified in their state or region which adds another level of oversight. This varies by state. Most will also have professional liability insurance.
  • Agency Handles Payroll: Since the agency employs the caregiver, they will manage payroll, taxes and benefits.
  • Licensed Professional Staff: Many home care agencies employ registered nurses who help to develop a plan of home care for your loved one.
    • They assess when a person’s care needs are becoming more complex.
    • Professional staff assure that their agency’s caregivers provide quality care.

Cons of home care agencies:

  • Often More Expensive: Since the agency takes the burden of qualifying, paying and managing the caregiver, you will most likely pay more by going through an agency.
  • Limited to Agency Options: While some agencies have a great selection, you are limited to the caregivers they send you.
  • Changing Caregivers: There is no guarantee that you keep the same caregiver for any extended period of time.
  • Strict Support Coverage: Most states restrict what tasks agency caregivers are allowed to perform.

Private caregivers (independent caregivers)

Private caregivers are employed directly by you or the care recipient, meaning there is no agency managing the process. Although some private caregivers provide medical care, they usually provide custodial or personal care by helping with ADLs.

Pros of private caregivers (independent caregivers):

  • Save Money: You’ll most likely save about 20-30% of costs because you’re doing the selection, hiring, scheduling, and paying a private caregiver.
  • Be More Selective: You get to choose who to interview and hire. You’re likely to have a larger pool of potential caregivers, helping you to find a good match for your family’s needs.
  • Direct Relationship With Caregiver: Since there is no middle person managing the caregiver, you can communicate directly. This means that you supervise by addressing any concerns, changes, or needs directly with the person you’ve hired.
  • Flexible Support: Unlike agency caregivers, you get to specifically decide which tasks the caregiver is responsible for.

Cons of private caregivers (independent caregivers):

  • Considerable Effort/Time Commitment: You will have to put in a lot more effort finding someone who’s a good match, with the right skills and qualifications. You may need to train them, based on your loved one’s needs and what you expect.
  • Managing Benefits & Payroll: You have to manage payroll through a 3rd party payroll system, plus handle all the mandatory state employer documents. Paying a private caregiver under the table is illegal.
  • No Insurance: Most private caregivers do not have private liability insurance in case something goes wrong.
  • No Backup Coverage: If your private caregiver is sick or has a family emergency you will most likely be the one covering for them.

Questions to ask when hiring a home care agency

  • We outline questions to ask on our Home Health Care page.
  • You can ask these same questions when searching out home care.

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Related Topics To Learn About

Home Health Care

Home health care allows people who require medical care or are recovering from a hospitalization to remain at home.

Assisted Living

Assisted living is for people with disabilities or older adults who need assistance with their daily activities but don't need around the clock nursing care.

Custodial Care

Custodial care is caregiving provided alongside skilled services, such as those ordered by a doctor.