by Nolo.com
From the Nolo.com Retirement & Elder Care Center

The benefits of good home healthcare can be enormous, but it's not always the best solution.  

In recent years, more and more elders are turning to home care to meet their personal and healthcare needs. This trend is particularly welcome given the fact that public health surveys indicate up to half of all nursing facility residents could live independently if they had adequate and affordable home care services. And other studies have shown that the longer people remain independent from institutional care, the better it is for their overall physical and emotional health.

Unfortunately, though, long-term home care is not always a practical solution. Home care may be sufficient and affordable if one needs help with some physical movements around the home -- bathing and getting meals, for example -- or with exercise or physical therapy or monitoring a chronic health condition. But if one needs extensive medical treatment, or close monitoring for many hours each day, the difficulty of arranging different types of care may make home care impractical -- and the cost may become prohibitive. In most cases, long-term home care also requires family members who can fill in gaps that the outside care services do not cover. For many people without such family assistance, long-term home care is simply not an option.

Home Care Defined

Home care encompasses a multitude of medical and personal services provided at home to a partially or fully dependent elder. These services often make it possible for an older person to remain at home, or with a relative, rather than enter a residential facility for extended recovery or long-term care.

Depending on what is available in your community, home care and related supplemental services can include:

• healthcare -- nursing, physical and other rehabilitative therapy, medicating, monitoring and medical equipment
• personal care -- assistance with personal hygiene, dressing, getting in and out of a bed or chair, bathing and exercise
• nutrition -- meal planning, cooking, meal delivery or meals at outside meal sites
• homemaking -- housekeeping, shopping, home repair service, household paperwork, and
• social and safety needs -- escort and transportation services, companions, telephone check, overall planning and program coordination service.

Not everyone using home care will need all of the services available, not every community will have every possible service and no single program or agency can provide everything that might be required. Additional needs may have to be filled by community agencies or organizations, adult daycare or senior centers, individuals hired through informal networks, family and friends. Complications caused by the special mix that each person needs -- different services from different providers -- is one of the reasons many people use a geriatric care manager to help establish a home care program.

The Independence Advantage

One of the great advantages of home care is that it permits an older person to maintain a feeling of independence and comfort in a familiar home. Also, you and your family may be better able to control the care received and to avoid care that isn't needed or wanted.

On the other hand, for home care to work well, you and your family must take the initiative to find services, coordinate different programs and personnel, monitor home care needs and performance, figure costs and budgets and make changes when required. And the family will be making all these decisions without a professional institution to help. This decision-making responsibility can be a significant burden on top of helping to meet daily needs for physical care.

It is also true that for some people, remaining at home isolates them from social activity and limits mental stimulation. Although friends and family often intend to provide lots of companionship, too many elders wind up spending their days in bed asleep or watching television. An organized elder residence, on the other hand, offers both a community of people and a constant stream of activities.

The Possibility of Savings

In addition to the physical and emotional advantages of remaining at home, there can also be significant financial savings if the care required is not too complicated or frequent and family and friends supplement paid care. While residential care facilities average $30,000 to $100,000 a year, home care can average from 25% to 75% less, depending on what care is required. You save by not paying for unnecessary services or institutional overhead. The things you provide yourself at home -- food, drugs, supplies -- come without any nursing facility mark-up.

However, often home care starts out cheap and then becomes more expensive over time. This is because home care needs may become more extensive or complicated, and families may participate less, requiring paid help to fill in the gaps. Or, it may simply be that hidden expenses wind up making the true cost of home care too high. Families often fail to calculate peripheral expenses: the continued or expanded cost of running a home such as taxes, utilities, insurance, maintenance; the cost to family members of transport to help care for the elder and the cost of missing work; the repeated costs of workers to supplement family and regular care.

Assessing the Quality of Care

While the comfort and financial advantages of home care sound attractive, you may have some doubts about whether the quality of care at home is as high as in a nursing facility or other elder residence.

Medical and nursing care. The American Medical Association, the American Hospital Association, the American Nurses' Association and the U.S. Department of Health and Human Services all stand behind the quality of medical and nursing care delivered by home care agencies that are certified by both Medicare and your state's home care licensing agency. So, when medical or nursing care -- as opposed to assistance with non-medical activities of daily living -- is a significant part of the home care you need, you may do well to concentrate on certified agencies rather than on independent caregivers. It is also crucial to have your doctor participate in the decision about whether the medical or nursing care you require can be safely and adequately delivered at home.

Non-medical care. Most of the care people need at home is not medical or nursing care, but help with what are called the activities of daily living (ADLs). These include bathing, using the toilet, dressing, eating, getting in and out of bed or a chair and walking around. For people with Alzheimer's or other cognitive impairment, home care may consist primarily of making sure that the person does not become lost, disoriented or injured. For these kinds of non-medical assistance, home care is often better than residential care. That is because home care is provided one-on-one, whereas residential facilities have staff-to-resident ratios of one-to-ten or more. And by choosing and monitoring a home care agency or individual home care providers, you may be better able to control the quality of care you receive. On the other hand, tracking the effectiveness of home care is primarily up to the family, whereas residential facilities have professional staff members who are supposed to check regularly on the quality of non-medical care provided.