If you have a parent or spouse nearing retirement age, chances are good that at some point you’ll be in the market for home health care.
Most Americans can expect to need some help as they age, and more than half of people (56 percent) turning 65 today are predicted to need significant long-term health services, according to a 2022 U.S. Department of Health and Human Services brief.
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As your loved one ages, watch for these signs. The behavior may be obvious or subtle, but they signal that it's time to talk to him or her about their living situation:
You may get some pushback from your loved ones who say they don’t want or need assistance. While every situation is unique and everyone’s needs are different, if you feel your loved one is not safe without help you should discuss the options and allow the care recipient to determine what he or she is most comfortable doing.
People who provide paid care for older, ill or disabled people at home are often referred to generally as home health aides, but there are actually several classes of home health workers with varying duties and with levels of professional training requirements differing by state. They include:
Personal Care Aide (PCA)
Home Health Aide (HHA)
Certified Nursing Assistant (CNA)
If you are not able to meet your loved one's caregiving needs due to distance, job or family demands, or if you are experiencing symptoms of caregiver burnout, you may be considering hiring caregiving help, such as an aide.
Home health aides are considered health care paraprofessionals and must meet set training requirements, which vary widely from state to state. (Other types of home health workers are sometimes lumped together under the title of home health aides; see the box.)
Under federal law, home health aides must get at least 75 hours of training through a state-approved program, including at least 16 hours of hands on practical and clinical training and 12 hours of continuing education per each 12-month period.
Most states follow that standard, but some set a higher bar. Thirteen states require at least 100 hours of training and 11 states and the District of Columbia exceed the federal minimum and mandate at least 30 hours of clinical training.
According to PHI, a New York City-based nonprofit organization that works to improve direct-care services for older and disabled people, only six states and the District of Columbia meet or exceed the standard suggested by the National Academy of Medicine of 120 hours of training.
Helpers without special training such as certification or licensing are technically not home health aides. They are companions who can carry out routine tasks your loved one can no longer manage such as laundry, cooking, shopping, running errands and light housekeeping. They can also take your family member to the doctor and other appointments.
Skilled home health aides should be able to do the following:
Home health aides do not provide services such as physical and occupational therapy or skilled nursing care, but they are often tasked with observing your loved one’s health, and reporting on conditions to a registered nurse or other health care professional.
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Traits to look for in a home health aide include compassion, good communication skills and attention to detail, says Christian Steiner, owner and operator of the Manhattan office of Home Instead Senior Care, a national provider of home health services.
Flexibility, honesty, patience, physical stamina and some medical knowledge also are required to do the job well.
“The most important traits of a good home health aide are skills and experience,” says Nancy Avitabile, who owns and runs Home Care Match, an employment agency that works with caregivers.
Health & Wellness Dental insurance plans for members and their families See more Health & Wellness offers > There are at least three ways to find and hire caregivers:An agency should handle hiring and human-resource matters such as background checks, payroll, taxes and insurance. They should also handle any mishaps or complaints and are responsible for monitoring and supervising the home health aides.
If a particular health aide isn’t working out or there is change in the care recipient’s condition requiring a more skilled aide, an agency will find a replacement. It also can provide substitute aides when your regular aide is ill or needs time off.
Look for an agency that has been licensed by the state where it operates. Your local Area Agency on Aging may be able to guide you to resources. Medicare rates private home-care services and has a searchable directory at its website. AARP has links to each state's caregiving resources as well as a checklist of questions that can help you evaluate in-home care agencies.
Direct-hire agencies, also known private care agencies, maintain networks of independent caregivers and facilitate their introduction to clients looking for help, taking into consideration clients' personal needs. These caregivers are paid directly by the family and the families set the terms of the arrangement.
"Direct hire agencies give families the opportunity to pick the candidate for their loved one and specifically match [caregiver] responsibilities to their loved one’s needs," says Avitabile.
After all, “Home health aides are not interchangeable. Each has his or her own skill set, experiences with different patient conditions, personality and cultural background,” says Betsy Gold, cofounder of the caregiver network Lean On We, which advises families about their options and matches them with caregivers. “Be sure to specify your specific needs so you can hire somebody who is a good fit.”
Some direct-hire firms charge a one-time finder’s fee, normally a percentage of the aide’s gross pay, says Avitabile. They may be able to refer you to third party providers for payroll and benefit services, as well as provide a substitute aide to cover an emergency or the regular aide's scheduled vacation, she adds. Families should also inquire about background checks.
