Some writings about Elder Care and projections into the future.  You can find this post on

From Jim Miller, the author of “The Savvy Senior” book, advice about

How to find home care

Finding a good in-home caregiver that’s dependable, likeable, trustworthy and affordable can be challenging, to say the least. Here are some tips and resources that can help.

Know Your Needs

Before you start the task of looking for a caregiver, your first step is to determine the level of care your mom needs (see for a checklist). If, for example, she only needs help with activities of daily living like preparing meals, doing laundry, bathing or dressing, a “homemaker” or “personal care aide” will do.

But, if she needs health care services, there are “home health aides” that may do all the things a homemaker does, plus they also have training in administering medications, changing wound dressings and other medically-related duties. Home health aides often work under a nurse’s supervision.

Once you settle on a level of care, you then need to decide how many hours of assistance she’ll need. For example, does your mom need someone to come in just a few mornings a week to help her cook, clean, run errands or perhaps bathe? Or does she need more continuous care that requires daily visits or a full-time aide?

After you determine her needs, there are two ways in which you can go about hiring someone. Either through a home health agency, or you can hire someone directly on your own.

Home Health Agencies

Hiring a certified home health agency to supply and manage your mom’s care is the easiest but most expensive option of the two. Costs run anywhere from $12 up to $40 an hour depending on where you live and the qualification of the aide. This is also usually a better way to go if your mom requires a lot of in-home health care.

How it works is you pay the agency, and they handle everything including an assessment of your mom’s needs, assigning appropriately trained and pre-screened staff to care for her and finding a fill-in on days her aide cannot come.

Some of the drawbacks, however, are that you may not have much input into the selection of the caregiver, and the caregivers may change or alternate, which can cause a disruption in care and confusion.

You also need to know that while Medicare does cover some in-home health care services if it’s ordered by a doctor, they don’t cover homemaker services, nor will they cover personal care services such as bathing and dressing provided by a home health aide if that is the only care required. But, if your mom is low-income and qualifies for Medicaid, some services are covered.

To locate and compare Medicare-approved home health agencies visit /hhcompare , and see the “Medicare and Home Health Care” online publication at /Pubs/pdf/ that explains coverage and how to choose an agency.

Hiring Directly

Hiring an independent caregiver on your own is the other option, and it’s less expensive. Costs typically range between $10 and $20 per hour. Hiring directly also gives you more control over who you hire so you can choose someone who you feel is right for your mom.

But, be aware that if you do hire someone on your own, you become the employer, so there’s no agency support to fall back on if a problem occurs or if the aide doesn’t show up. You’re also responsible for paying payroll taxes and any worker-related injuries that may happen. If you choose this option, make sure you check the aide’s references thoroughly, and do a criminal background check.


In Consumer Reports there was an article about

The costs of assisted living care

While the vast majority of older adults would like to live out their lives in their own homes, it isn’t always a practical option. If in-home care isn’t possible, and a parent doesn’t need round-the-clock skilled nursing services, assisted living might be the right solution.

The problem, though, is that assisted living can be expensive, and the quality of facilities can vary.

To make the process easier, start looking for a facility six months to a year before your parent needs to move. It takes time to vet facilities properly, and you don’t want to be rushed into a decision because of a medical emergency.

Here’s what you need to think about to handle the financial expense.

The kind of care offered and the costs. The average monthly cost of a private room in an assisted living facility is $3,600, according to Genworth , but that can vary substantially depending on where your parents live. Most assisted living centers have a base rate for room and board. If a parent needs additional services, such as help with bathing, medication management, eating or getting dressed you’ll have to pay extra. If your parent suffers from dementia, the costs will likely be even higher, especially since dementia is a progressive disease and patients need to be reassessed regularly.

If you’re working with a tight budget, it’s better to choose a facility that might cost a little less in the beginning, so that you have a cushion if your parents need a different level of care in a few years,” says Linda Fodrini-Johnson, a geriatric care manager in San Francisco, California.

A long-term plan for payment. Most people pay for assisted living out of pocket, relying on their savings, Social Security, or a pension, and long-term-care insurance if they have it. Many seniors who own a home opt to fund the move by selling their home.

While Medicare doesn’t cover the costs of assisted living, there are some resources that can help. Veterans and their spouses are eligible for Aid and Attendance benefits that can be worth up to $1,800 per month, and some community organizations might also provide assistance. Search at to see which benefits you qualify for.

Forty-six states provide some form of help via their Medicaid programs, for those who have exhausted their resources. The rules vary from state to state depending on the care your parents need and their income, so look for details on your state from the American Elder Care Research Organization. Keep in mind, though, that the number of facilities that accept Medicaid as payment is extremely limited. In many states, you either are able to pay for assisted living out of pocket, or you end up in a nursing home,” Gray says.

The services and the staff, rather than the amenities. Some of the newer assisted living facilities give off a five-star hotel vibe with amenities like on-site spas and movie theaters. The fancy and upscale places are more focused on marketing to the adult children,” says Jullie Gray, a care manager with Aging Wisdom in Seattle. But the parents, even if they have means, may not be as comfortable in a place like that.”

Instead, focus on how clean the facility is, how friendly the staff is, and whether there is a focus on socialization. For seniors with mobility issues, look for smaller centers, where it will be easier for them to get from their apartment to the dining room or other common areas.

Ask (and check) references, and call your county’s long-term-care ombudsman, who can tell you whether the center has been the target of many complaints. Look for a facility that has at least one licensed nurse on-site around the clock, even if state regulations don’t require one.

If the process feels overwhelming, you can hire a professional care manager for a few hundred dollars (find one at ), who can help find a center that’s the right fit for your family’s needs. You can also get help through a free placement agency, but keep in mind that they’re paid by assisted living facilities for placing people with them.


Another opinion that appeared in the Huffington Post about

Home Care Disrupting Innovation For Elder Caregiving

Welcome to 21st century America – where we have longer lives than ever before, and more hopes for healthy aging. We are, happily, the beneficiaries of medical and scientific breakthroughs that have given us life spans that not long ago would have been the stuff of science fiction.

But we also face serious challenges, such as a growing number of seniors struggling to find and afford much-needed care. The well of healthy aging that is giving us vitality later into life too often eventually runs dry. When it does, we need care. This is why home care must continue to disrupt the elder care industry and provide value to seniors, families, and society. Along the way it is also disrupting healthcare itself as quality elder caregiving has a profoundly important role to play on the health management and cost savings sides.

Enter the Value of Home Care Report launched last week at a briefing on Capitol Hill that included Senator Joni Ernst (R-IA) and Congressman Tom Reed (R-NY-23) who joined the Home Care Association of America (HCAOA) and the Global Coalition on Aging (GCOA) who collaborated on the report. The key take-away is the role of home care has as an essential solution for the nations’ elder caregiving crisis.

The Ernst and and Reed Bills, create a tax credit for long-term family caregivers. This credit would take a huge burden off the backs of tens of millions of family caregivers, who suffer from high rates of depression and declining physical health. As documented in the Value of Home Care Report, working family caregivers are 50% more likely than their non-caregiver colleagues to experience daily physical pain. They also suffer from subtle but equally intrusive bouts of mental and emotional anguish.

Furthermore, the report highlights the growing importance of the solution of formal elder caregiving, needed even more as demographic and cultural changes increases the burden on family caregivers. As in the report, “The ratio of potential family caregivers to those over 80 will steeply decline from 7:1 today to 4:1 by 2030, and seniors live an average of more than 280 miles from their nearest (adult) child.” Mobility is a fact of modern American life; let’s now build that into a more reality based elder caregiving model.

The new report describes how home care connects dedicated profession with aging Americans in need of care: helping maintain more active and therefore healthier lifestyles, as well as providing cost effective daily support for those suffering from multiple chronic diseases. Alzheimer’s, non-communicable diseases, the deterioration of skin, bone, and muscle mass, and aging’s oral and vision conditions all lead to elder care needs, which can be efficiently provided through home care.

The elder caregiving story on Capitol Hill this week also revealed insights about the best of American innovation. In the process of improving lives, this uniquely American form of innovation – home care – is creating U.S. jobs, while exporting this quality care model across the planet. Wednesday’s briefing shattered the myth that innovation is somehow the domain of tech startups and billion-dollar unicorns. Instead, it underscored that the home care sector is developing new solutions and shaking up outdated approaches, even if that innovation is low-tech or no-tech. For example, Home Instead Senior Care, hardly an Apple or a Google, has just won Queen Elizabeth’s Award for Innovation because they’re changing the way we provide care to those who need it.

By disrupting the way care is provided seniors, home care is improving quality of life even as it is generating economic benefits for all of society. Elderly Americans receiving home care generally need fewer trips to the doctor and are admitted to hospitals at a lower rate. As the HCAOA reported, in 2008 alone, home cares services saved the United States $25 billion in hospital costs. No doubt that with updated reporting and analysis we will find that number and others like it exploding.

Additionally, over the next decade, home care jobs will be a major economic driver, increasing at a rate four times the cross-sector average to reach 2.3 million by 2024. Further, seniors and their families will largely pay for this growth, rather than government funding. And perhaps the biggest innovative disruption is that this industry allows seniors to age where nine out of ten want to – at home. As Peter Ross, HCAOA President and CEO of Senior Helpers said at the Hill Briefing, “Home care enables people to remain in their homes for as long as possible, exactly where they want to be.”

Nor is it coincidental that the innovative home care industry is changing who works and how. The report takes note, providing a voice to often-overlooked family and professional caregivers, ranging in age from 26 to 92. Take Mary Hartsock a caregiver for Right at Home In-Home Care & Assistance and profiled in the report – who chose a second (or was it a third?) career in home care, and continues to work in the field into her 90s. Or 26 year-old Patty Meadows of Homewatch CareGivers International, who switched to home care from an institutional setting, citing a sense of connection with her home care clients. The report also spotlights Lynn Wright, who says that her mother’s home care aide, Tracey Read of BAYADA Home Health Care became more like a family member than an employee.

These are the faces of the home care revolution. The compassionate, enterprising individuals on the front lines of the longevity and aging mega-trend. At a time of great need they are the innovators literally creating a new market – one that reflects the best values of the society we want for our children and theirs’. They are re-writing the rules for how we provide elder care, launching a cottage industry, and improving lives across the nation and world.


As we can see, the area of elder care bring challenges and changes to it on a regular basis.