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[Ed. Note: In our April Housing & Homecare Options section, we wrote about in-home aides, including companions and hands-on personal care aides, such as CFAs.  

Below is an article on aides who can provide various types of medical care, often called healthcare aides. They can be of help whether you remain in your home or move to a retirement community.]  

Home healthcare helps older adults live independently for as long as possible, even with an illness or injury. It covers a wide range of services and can often postpone the need for long-term nursing home care.  

Home healthcare may include occupational and physical therapy, speech therapy and skilled nursing. It may involve helping older adults with activities of daily living, such as bathing, dressing, and eating. It can also include assistance with cooking, cleaning, other housekeeping and monitoring one’s medication regimen. 

It is important to understand the difference between home healthcare and home care services. Although home healthcare may include some home care services, it is medical in nature.  

Home care services include chores and housecleaning, whereas home healthcare usually involves helping someone to recover from an illness or injury.  

Home healthcare professionals are often licensed practical nurses, therapists or home health aides. Most of them work for home health agencies, hospitals or public health departments licensed by the state. 

Although most states require home healthcare agencies to perform criminal background checks on their workers and carefully screen applicants, actual regulations will vary depending on where you live.  

Therefore, before contacting a home healthcare agency, you may want to call your local Area Agency on Aging (AAA) or department of public health to learn what laws apply in your state. 

Questions to ask an agency 

As with any important purchase, it is wise to talk with friends, neighbors, and your local AAA to learn more about the home healthcare agencies in your community. Consider using the following questions to guide your search: 

• How long has the agency served this community? 
• Does the agency have a brochure describing services and costs? If so, take or download it. 
• Is the agency an approved Medicare provider? 
• Does a national accrediting body, such as the Joint Commission for the Accreditation of Healthcare Organizations, certify the quality of care? 
• Does the agency have a current license to practice (if required by the state)? 
• Does the agency offer a “Bill of Rights” that describes the rights and responsibilities of both the agency and the person receiving care? 
• Does the agency prepare a care plan for the patient (with input from the patient, his or her doctor, and family members)? Will the agency update the plan as necessary? 
• How closely do supervisors oversee care to ensure quality? 
• Are agency staff members available around the clock, seven days a week, if necessary? 
• Does the agency have a nursing supervisor available for on-call assistance at all times? 
• Whom does the agency call if the home healthcare worker cannot come when scheduled? 
• How does the agency ensure patient confidentiality? 
• How are agency caregivers hired and trained? 
• How does the agency screen prospective employees? 
• Will the agency provide a list of references for its caregivers? 
• What is the procedure for resolving problems, if they occur? Whom can I call with questions or complaints? 
• Is there a sliding fee schedule based on ability to pay, and is financial assistance available to pay for services? 

Making a direct hire 

When purchasing home healthcare directly from an individual provider (instead of an agency), it is even more important to conduct thorough screening.  

This should include an interview with the caregiver. Prepare for the interview by making a list of the older adult’s special needs.  

For example, the patient may require help getting into or out of a wheelchair. If so, the caregiver must be able to provide appropriate assistance. 

You should also request references.  

What caregivers need to know 

Whether you arrange for home healthcare through an agency or hire an independent aide, it helps to spend time preparing the person who will provide care.  

Ideally, you will spend a day with the caregiver, before the job formally begins, to discuss what is involved in the daily routine. At a minimum, inform the caregiver (verbally and in writing) of the following things that he or she should know. 

• Health conditions, including illnesses and injuries 
• Signs of an emergency medical situation 
• General likes and dislikes 
• Medication, including how and when each must be taken 
• Need for dentures, eyeglasses, canes, walkers, hearing aids, etc. 
• Possible behavior problems and how best to handle them 
• Mobility issues (trouble walking, getting into or out of a wheelchair, etc.) 
• Allergies, special diets, or other nutritional needs 
• Therapeutic exercises with detailed instructions 

Paying for care 

The cost of home healthcare varies across and within states. In addition, costs will fluctuate based on the type of healthcare professional required.  

Home care services can be paid directly by patients and their families or through a variety of public and private sources.  

Sources for home healthcare funding include Medicare, Medicaid, the Older Americans Act, the Veterans Administration and private insurance. To learn more about paying for home care, visit acl.gov/ltc/costs-and-who-pays.     

To find out more about home healthcare programs where you live, contact your local aging information and assistance provider or AAA. For help connecting to these agencies, contact the Eldercare Locator at 1-800-677-1116 or eldercare.acl.gov.