Home Healthcare: Helping Older Adults Live at Home Longer

As people age, activities that were once simple to do—laundry, grocery shopping, yard work—can become more difficult to complete. Difficulty with certain tasks, however, does not mean that an older person is ready to move into an assisted living facility or a nursing home. An alternative that is growing in popularity is home healthcare.

Home healthcare describes a variety of health and social services provided in the home by trained professionals. The services can range from skilled care that is provided under the direction of your doctor and may include such services as dialysis or physical therapy to home support services like housecleaning or running errands. Home healthcare allows older adults to continue to live independently in their homes and get help with the tasks they cannot do on their own. One example of a home healthcare organization that many are familiar with is Meals on Wheels, a program that delivers hot meals to a person’s home.

Home Healthcare Services Available

Many different services can be provided in the home, from light housekeeping to meal delivery. The following table lists examples of services available in the home.

Home Health Care Service Available	Category
Bathing, hair washing, dressing	Personal care
Housecleaning, yard work, shopping, laundry	Homemaking
Grocery shopping, meal preparation, meal delivery	Meals
Bill paying/check writing, account management	Money management
Medication management, administration of intravenous drugs (eg, antibiotics or pain medications), dialysis, physical therapy, hospice care	Healthcare
To shop for food, clothes, necessities; to and from medical appointments, social engagements, church activities	Transportation
Daily/weekly visits, phone calls	Companionship

Paying for Home Healthcare Services

The cost of services will vary depending on where you live and the type of services you need. Some home healthcare agencies have sliding fee scales, so make sure to ask. Home healthcare services can be paid for privately, but there are also a number of public and private funding sources. Funding sources include the following:

Medicare
Medicaid
The Older Americans Act
The Veterans’ Administration
Private insurance

Deciding What Services You Need

The first step in finding appropriate home care service is talking to your doctor to determine what type of services you will need. You may only need help with preparing meals or you may require sophisticated medical care at home. Determining level of help required and type of services will help you find an appropriate agency.

It can be a daunting task. By contracting with an agency, you are allowing someone to come into your home or the home of someone you care about. To help ensure you are working with a reputable organization and that they provide quality care at a cost you can afford, research the organization extensively and prepare a list with important questions. In addition, your nurse, physician, hospital social worker, or discharge planner may recommend a reputable agency in your area.

If it is possible, anticipate what your possible needs may be and do some research in advance. Planning ahead is difficult because you cannot be sure about what types of services you will need, but it will help when it comes time to make a decision. To help inform your decisions, educate yourself on the concerns and issues that may affect older adults, taking into consideration your own financial and health issues, including any chronic health conditions.

Questions to Ask

The United States Department of Health and Human Services Administration on Aging provides the following 20 questions to help guide your search for a home health service provider:

How long has the agency been serving this community?
Does the agency have any printed brochures describing the services it offers and how much they cost? If so, get one.
Is the agency an approved Medicare provider?
Is the quality of care certified by a national accrediting body such as the Joint Commission for the Accreditation of Healthcare Organizations?
Does the agency have a current license to practice (if required in the state where you live)?
Does the agency offer seniors a “Patients’ Bill of Rights” that describes the rights and responsibilities of both the agency and the senior being cared for?
Does the agency write a plan of care for the patient (with input from the patient, his or her doctor, and family), and update the plan as necessary?
Does the care plan outline the patient’s course of treatment, describing the specific tasks to be performed by each caregiver?
How closely do supervisors oversee care to ensure quality?
Will agency caregivers keep family members informed about the kind of care their loved one is getting?
Are agency staff members available around the clock, seven days a week, if necessary?
Does the agency have a nursing supervisor available to provide on-call assistance 24 hours a day?
How does the agency ensure patient confidentiality?
How are agency caregivers hired and trained?
What is the procedure for resolving problems when they occur, and who can I call with questions or complaints?
How does the agency handle billing?
Is there a sliding fee schedule based on ability to pay, and is financial assistance available to pay for services?
Will the agency provide a list of references for its caregivers?
Who does the agency call if the home healthcare worker cannot come when scheduled?
What type of employee screening is done?

RESOURCES

Administration on Aging http://www.aoa.gov

American Academy of Home Care Physicians http://www.aahcp.org

Meals on Wheels Association of America http://www.mowaa.org

National Association for Home Care and Hospice http://www.nahc.org

National Institute on Aging http://www.nia.nih.gov

CANADIAN RESOURCES

Canadian Centre for Activity and Aging http://www.uwo.ca/actage/

Canadian Institutes of Health Research http://www.cihr-irsc.gc.ca/

References

Age page: There’s no place like home. National Institute on Aging website. Available at: http://www.niapublications.org/engagepages/home.asp. Accessed December 8, 2005.

Caregiving statistics. National Family Caregivers Association website. Available at: http://www.nfcacares.org/who/stats.cfm. Accessed November 27, 2005.

Characteristics of elderly home healthcare users: data from the 1996 National Home and Hospice Care Survey. Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/nchs/products/pubs/pubd/ad/301-310/ad309.htm. Accessed December 6, 2005.

Getting the most out of home healthcare. Yale-New Haven Hospital website. Available at: http://www.ynhh.org/choice/home%5Fhealth.html. Accessed December 6, 2005.

Home healthcare: a guide for families. United States Department of Health and Human Services Administration on Aging website. Available at: http://www.aoa.gov/aoaroot/Press%5FRoom/Products%5FMaterials/fact/pdf/Home%5FHealth%5FCare.pdf. Accessed November 17, 2011.

JAMA patient page: Home healthcare. The Journal of the American Medical Association website. Available at: http://jama.ama-assn.org/cgi/reprint/287/16/2168.pdf. Accessed November 27, 2005.

Revision Information

Reviewer: Brian Randall, MD
Review Date: 11/2011 -
Update Date: 11/17/2011 -

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.

Redmond Regional Medical Center