Best Home Care Services

Older adults and those with disabilities typically benefit most from home care — the assistance with ADLs helps them continue to live independently in their own homes. People who are recovering from a medical procedure or who have long-term health issues, such as dementia or congestive heart failure, may also benefit from home care services.

At some point, your loved one might need more help than home care can provide. If you find your loved one needs more continuous care or your budget doesn’t allow for round-the-clock services at home, it may be time to think about an assisted living facility or long-term care residence. Your loved one’s health care professional, social worker or geriatric care manager can advise your family on the best option.

» MORE: Assisted living vs. nursing home vs. home care

When looking at different options for in-home care providers, it’s important to consider the provider’s availability and qualifications as well as the level of communication you need from the agency.

Service availability

Care provider schedules vary between agencies. The following can affect affordability and convenience:

• Home for the holidays: Does the agency offer holiday service? Many older individuals celebrate in their own homes, which may or may not include hosting family members. This makes it crucial for an assistant to be available during these days.
• Part-time option: Not all older adults need round-the-clock care, so a part-time option helps reduce costs.
• Overtime service: Family members who care for their loved one when a provider isn’t there may face having to stay late at the office, slow traffic or other factors that could leave them running late. Make sure you know what you can expect from providers working overtime to ensure that your loved one isn’t home alone. Some agencies can’t guarantee a provider can stay late in an emergency.
• Respite care: Family caregivers need breaks from time to time to tend to their own needs. Home health aides can fill in so that the care recipient remains safe while the family caregiver is away.

Clear communication and flexibility

Communication between the family and the provider organization is critical to creating a schedule and plan of care. Slow response times could put your loved one in danger by delaying reports on issues that could affect their health.

• Health reporting: How often does the service provider give a comprehensive report about your loved one’s continued ability to live alone?
• Schedule changes: Realistically, caring for an older parent does not reduce other demands on your time, leaving you to schedule around child care, nights out with friends and work functions. Flexible and emergency scheduling is a must when working with a home care provider. Look for providers who will be flexible and help out without too much notice.
• Live operators: As effective as voicemail or texting can be, waiting for a message back can be nerve-wracking. Make sure your service provider will actually answer the phone or return your call, rather than only communicating by voice or text message. You can ask if your agency provides an on-call nurse to answer the phone and respond to messages off-hours.

Provider screening

It can be a big step to allow someone into your or your loved one’s home. Older adults can be particularly at risk for abuse and neglect, so it’s important to make sure that any providers entering the home pass screening and background checks. Ask the agency you decide to work with about the following:

• Background checks: A credit check and scan of criminal history could provide a sense of security.
• Reference checks: Reference checks are a quick and easy way to find out whether someone has a history of quality performance. Ask the agency to provide you with a list of references (or, if you’re hiring someone privately, ask potential caregivers for references). Consider actually calling and not just emailing or texting the reference.
• Caregiver interview: Instead of simply assigning someone to a case, the agency should let the caregiver, your loved one and any involved family members meet in an informal environment. Compatibility is a foundation for building trust.

After you’ve hired someone, it’s important to stay vigilant. Monitor for potential elder abuse throughout the time your loved one is receiving care.

Absentee policies

Everyone needs a day off occasionally, so what happens when a caregiver calls out sick or requests a personal day off? There are a few different standards:

• Immediate notification: Before sending a replacement, the agency should notify you of the conflict. You or your loved one might prefer to go without a caregiver that day rather than have a stranger take on the job.
• Available replacement: If they call out, and you agree to work with a new provider, find out whether the agency can send out someone else without missing the service window.
• Permanent replacement option: While occasional call-offs are inevitable, if your care provider misses work shifts regularly, this inconsistency can become a major issue. It is important to know how many you might deal with that scenario if it arises.

According to the Genworth Cost of Care survey, one of the most thorough in its category, home care services cost about $28 an hour on average in 2023. How much you’ll pay for home care service varies based on where you live, how much care is needed and how many hours per day you need in-home care. It also depends on if you’re paying entirely out of pocket or if you have insurance benefits that can offset some or all of the cost.

Medicare will pay for some types of home health services, but it doesn’t cover personal care or companion services. Medicaid does provide some coverage, but this will vary depending on which state you live in. Long-term care insurance and Medicare supplemental insurance might be viable options to help cover costs. If your loved one has private health insurance, ask about their coverage.

Depending on your loved one’s specific needs and situation, home care services can range from skilled nursing care to companionship to meal delivery.

Home health aides

Home health aides are professionals who can help with self-care, housework, cooking and more. They might also perform some basic medical tasks. Home health aides sometimes have medical training, so they might be certified nursing assistants (CNAs) or licensed practical nurses (LPNs).

However, there aren’t any specific requirements for a home health aide to have particular training or certification. If you’re looking for someone to help with any medical-related tasks, ask about a caregiver’s certifications (like the Home Health Aide certification). Medicare or Medicaid might pay for help from a home health aide.

Personal care assistants

Personal care assistants, or PCAs, typically have fewer training hours than home health aides, but they have more formalized training than a companion.

The Paraprofessional Healthcare Institute (PHI) has a summary of training guidelines for each state. PCAs don’t provide any medical tasks, but they can help a person with dressing, grooming and mobility. They can also help with housekeeping, cooking and running errands.

If your loved one qualifies for Medicaid, they may get personal care services covered. However, Medicare doesn’t cover personal care services unless you also need skilled nursing care.

Nurses

Home care nurses often handle the basic medical needs of those aging in place, like tracking their vital signs, giving them IV medications and changing bandages. These professionals could either be licensed practical nurses (LPNs) or registered nurses (RNs).

The higher the level of care a person needs, the more likely their nurse will be an RN. An RN’s education is more extensive and includes overseeing the care that LPNs and home health aides provide. RNs typically hold an associate’s or bachelor's degree, whereas LPNs move through a diploma program that takes as little as a year to complete.

Sometimes, a nurse will visit a patient less frequently but will manage a team of home health aides that visit the person every day. Medicare or Medicaid might pay for help from a home care nurse.

Geriatric care managers

Geriatric care managers are usually RNs or social workers who have specialized knowledge and training in working with older adults. They work as advocates, helping caregivers figure out how much care their loved one needs and what living situation might be best for them. They also help caregivers and families navigate the medical system, how to pay for care and how to hire home care professionals.

Medicare, Medicaid and most private insurance won’t pay for geriatric care managers. Sometimes, long-term care insurance might help offset the cost, but often, you’ll pay out-of-pocket to hire a care manager. Still, it could be worth the investment if they help you save money in other ways.

Companion services

Companion services vary in what they provide. Companions might just be someone who keeps your loved one company by playing cards, going on walks or socializing with them. They may be a personal care assistant (PCA) that helps with more tasks around the house or offers transportation and housekeeping services. Companions don’t handle any medical tasks, and they don’t usually help with bathing, grooming or other ADLs.

Because these individuals don’t provide medical care, Medicaid and Medicare won’t pay for them. You may find a community service organization, like Volunteers of America, that provides these services for free.

Meals on Wheels

Meals on Wheels is a nonprofit organization that operates in most communities in the U.S. It works with local businesses and volunteers to serve meals to people over 60. The organization delivers meals to people in their homes, and the volunteers who drop meals off provide some companionship to older adults.

The group also serves meals in local community centers, so people who can drive can get out of the house to socialize. These services are free or low-cost, depending on where you live.

Community villages

Villages are nonprofit organizations designed to help people age in place. Villages coordinate volunteers and paid workers to organize social and educational activities. They typically offer transportation services and limited in-home help as well as discounted services from health professionals.

Each village is independently operated, so the services offered in your area will vary. To find out about a village near you and learn more about these organizations, visit the Village to Village Network’s website.

PACE programs

Programs of All-Inclusive Care for the Elderly, or PACE, is a part of Medicare and Medicaid. The programs provide as much care as feasibly possible to people 55 and older in their own homes. For example, someone in a state with PACE might be eligible for in-home care, social work counseling and many other services.

Programs in different parts of the country have slightly different offerings, but the overall goal is to keep people in their own homes as long as possible. These programs currently exist in 32 states, but they don’t necessarily cover the entire state. To find out about PACE programs in your area, visit the PACE page on the Medicare website.

Picking the right provider is crucial to your loved one’s well-being. Follow the steps below to ensure you get just the right person for the job.

1. Write down all the care services needed

Start by making a complete list of all the tasks you or your loved one needs help doing. Once you have this list, you can decide whether you need one provider or a few with different specialties, such as a home health aide and a live-in companion.

2. Consider your budget

Review how much you can spend on services, especially if you’re planning on paying out of pocket. You might have coverage from long-term care insurance, Medicare, Medicaid or another insurer, or you may be able to get financial assistance from the Department of Veterans Affairs.

3. Screen the potential provider over the phone first

Next, call the companies that advertise the services you need and confirm that their employees can do everything you need. Eldercare.acl.gov provides a list of questions you can use as a guide to ensure your loved one will receive quality care.

Consider asking the following:

• How long has your agency been in business?
• Are you an approved Medicare provider?
• How closely do supervisors oversee care?
• Do you run background checks on all your employees?
• Is there a nursing supervisor available at all times for on-call assistance?
• How are the caregivers hired and trained?
• Who do I call with questions or concerns?

4. Interview in the resident’s home

If a provider meets your standards after talking to them on the phone, ask for an in-home interview with the people who will work with your loved one. This is a great time to see how personalities match between the provider and your loved one, as well as how comfortable you and the care recipient are with that person.

Ask about the caregiver’s qualifications and experience level so you can feel confident making a decision.

5. Call the provider’s references

Anyone who works in your loved one’s home should give you a list of references upon your request, including current clients. Call these people to learn more about the provider and ensure they’re someone you want to hire.

6. Run a background check

Not all home care agencies are required by law to perform employee background checks. However, many reputable home care agencies choose to run background checks on anyone they hire who is involved in direct care.

If the agency you choose doesn’t have this requirement of their providers, you can run one yourself of the individuals using a background check company.