In-Home Health Care: What To Look For

In-home health care is often cited as one of the fastest growing industries in the economy. Researchers from the Bureau of Labor Statistics have pointed out that the number of home health care workers is expected to grow by 70 percent by 2014.

For caregivers like us, this means that many of us are having to make some very important decisions about who is caring for our elders — and in what setting. Here is what you need to know to make responsible and informed decisions about in-home health care.

Joe’s In-Home Health Care Story

Years ago, my 86-year-old next door neighbor Joe, for whom I’d been caring, took one of his many falls. This time he was injured – he had dislocated his shoulder. We rode the ambulance and got the shoulder fixed up, but he needed some aftercare. The hospital suggested their in-home health care business, which was fairly new, back in 1989. I haven't used this agency for care since, but I did use another one for my uncle. The services were comparable in quality and followed the same procedures for billing. I was wiser, however, the second time with my uncle, and knew what questions to ask.

Immediately following the shoulder incident, Joe and I thought the hospitals' in-home health care service sounded good. The hospital-appointed in-home health care workers could fill in for some of the time I couldn’t be there. We were really new at this, how to evaluate and pay for caregiving, and didn’t understand that all of the care wasn’t covered by Medicare. Only the nursing care was covered. The rest was considered custodial. As I recall, Joe had about three weeks of aftercare. It took a couple of months for the bills to arrive. When they did, we were shocked to see he owed over $600 out-of-pocket. Fortunately, Joe could afford to pay the bill.

Producer's Note: A Florida newspaper recently reported on how common it is for people to be shocked financially when it comes to paying for nursing home and extended care. The St. Petersburg Times wrote: "Americans are woefully unaware of the cost of care at a nursing home or assisted living home. Many people think they have insurance coverage when they do not."

Read additional reporting in the New York Times: Elder-Care Costs Deplete Savings of a Generation

Aside from the financial shock, this experience gave me some insight into in-home health care. Joe’s biggest complaint was the people who came to care for him. Some he liked. Some he didn’t. One woman he wouldn’t let in the door. One young man he wanted to stay all day. It was all about the people.

My Uncle’s Custodial In-Home Care Story

My uncle had custodial in-home care for eight hours each day for over a year through Oasis Health Care, which was connected with a local nursing facility. He liked the women who came to care for him, and it worked out okay. They didn’t really need to do much – just keep him company. He did have his favorites, and there were a couple of people he didn’t like too well, but my uncle could afford to pay the more than $4000 a month it cost for a full day of care, and he liked most the people, so it was a good solution for him.