Choosing Homecare for Seniors

Denise ran into the house. "Hi Mom, gonna throw a load in the washer and get the dishwasher started. Have you eaten yet? I brought over chicken and potatoes if you haven't. Sorry I'm late—only have a couple minutes before I pick up the boys from school. I'll try to stop by later to switch the laundry, or tomorrow otherwise. Did you take your pills?" She paused. "Mom… you're not dressed yet. Are you okay?"

Jerry's meeting ran long, so he can't do the lawn tonight. I'll try to get Randy or Justin over to mow it. While they're here, I can refill your prescriptions and grab groceries. Pizza tonight, I guess. I have to go, but I'll see you soon.

• Senior caregivers
• The case for homecare
• Transitioning to homecare
• Talk about homecare
• Interviewing the homecare company

Senior caregivers

If that scene feels familiar, you're not alone. More than 1 in 5 people who live near their parents are currently caring for at least one aging parent. Another 1 in 5 has done so in the past.

A 2023 survey found that over 97% of people over 50 prefer to stay at home with care services rather than move to an assisted living facility. This preference holds even as assisted living centers have changed considerably in recent decades.

When self-care becomes impossible, outside help becomes necessary. Family members are usually the first to step in.

Family caregivers often handle household tasks for aging parents. But consistency is hard. Running two households while caregiving is exhausting.

Many aging parents also have adult children living too far away to help regularly. Fifteen miles across a busy city can take an hour each way. Driving that distance daily, on top of your commute home, adds up fast—just in travel time, before any actual caregiving.

The case for homecare

When staying at home alone becomes difficult or family caregivers can't provide enough support, homecare is an alternative to moving to a facility. It frees family members from daily care tasks so you can spend time together doing things you both enjoy, not just managing chores.

Homecare is easier and faster to arrange than a facility move. It also lets seniors stay in familiar, comfortable surroundings. Your visits can be about enjoying each other's company instead of rushing through chores or making your parent feel like a burden.

Don't confuse homecare with home healthcare. Some home care workers can record vital signs. While some companies offer both, most home care companies aren't licensed for medical tasks beyond basic vital sign recording. If you need more than personal care, talk to a home healthcare company. You can sometimes mix both services at lower cost. Some providers offer both; others specialize in one.

If your parent needs help with medication levels, wound dressing, or other medical tasks, you need home healthcare, not homecare. Home healthcare is provided by trained medical personnel and costs more. Know exactly what you need, or use a geriatric care manager to help figure it out.

Homecare companies offer non-medical personal services, including:

• Bathing, dressing, and personal hygiene
• Vital sign recording
• Bathroom assistance
• Light housekeeping
• Meal preparation
• Companionship
• Health monitoring
• Grocery shopping and pharmacy trips
• Home safety checks
• Medication reminders
• Laundry
• Transportation

Transitioning to homecare

Bringing a stranger into your home is hard. Aging parents sometimes feel abandoned when a caregiver is hired, as though you don't care. They may also feel like a burden and worry you want to "pass them off."

Move to homecare slowly if possible. A home care worker can lighten your load, but the change may feel uncomfortable at first for your parent. They're used to you, not a stranger. Consider hiring a geriatric care manager to help. They're good organizers and understand the emotions both of you may feel. A GCM can guide you both through this.

Over time, your parent will likely adjust and may even enjoy having home care staff around. They can ask the aide for help with tasks they wouldn't ask you for. Your visits become time together, not a checklist of chores.

People often say that in old age, parent and child switch roles. Usually it's because of the need for physical help. Homecare can help restore an adult-to-adult relationship.

Talk about homecare

Before hiring homecare, sit down and discuss it with your parent. Explain that while you want to help, there aren't enough hours in the day to do it right and still have quality time together.

Reactions vary. Some parents accept it easily. Others argue, guilt-trip, or simply refuse.

If your parent pushes back, explain your concerns again and ask for alternatives. It's frustrating and may take time, but most eventually agree. Don't force it, but stay consistent.

Slow transitioning

Start with non-personal tasks. Light housekeeping is a good entry point—it helps your parent adjust to the idea and get comfortable with the worker, while also easing your burden.

Many people dislike the idea of someone helping with bathing or laundry. They're less bothered by someone preparing dinner, dusting, or driving them to the doctor. Those feel less personal.

Add services gradually as you need them.

Interviewing the homecare company

Choosing a homecare provider is personal. You and your parent need to find a company and caregiver that feel right.

Take time with the initial phone interview. Ask whatever questions come to mind, including hypotheticals. The company exists to serve you, and you'll pay for what you agree to. Don't rush. It's fair to understand exactly what you're getting.

Most families are new to homecare, and companies expect that. They should be easy to talk to.

Be sure to ask:

1. How long has the company been in business?
2. Do they have complaints with the BBB or any licensing agency?
3. Do they run background checks on workers?
4. Do they do drug screening?
5. Do they check driving records? (Important if transportation is involved)
6. Have they ever had charges of elder abuse?
7. Do they hire workers as employees or independent contractors?

If the worker is an independent contractor, you may become their employer and need to file employment taxes. Independent contractors typically don't carry workers' compensation insurance, which creates a liability problem if they're injured on your property. You're not protected if they cause damage unless they carry their own liability insurance. If the worker is an employee of the agency, this isn't your concern.

1. What duties can they perform?
2. Can you add duties later?
3. Do they work on your schedule, or do you need to fit theirs?
4. Can you meet the worker before signing?
5. Can you switch workers if there's a problem?
6. What happens if your worker gets sick or quits?
7. What feedback will you get from the worker?
8. What evaluation services do they offer to assess needs and track changes?
9. What are the costs?
10. Understand how homecare bills are calculated. In-home and facility care use different billing methods: hourly rates, package deals, or flat fees for specific services. For example, a caregiver might charge hourly for companionship and personal care, while a facility charges a monthly rate covering room, meals, and a certain level of medical care. Billing varies by service type, provider, and location. Ask about the full billing structure upfront so there are no surprises.
11. How are payments made?
12. Are emergency call services available?

Check with your local BBB and any relevant licensing agency. Most homecare companies hire carefully, but you want to avoid the rare one that hasn't.

The personal meeting

Arrange a home visit with your parent and the caregiver. It doesn't need to be long, but it breaks the ice before the first full day, especially if you won't be there to get things started.

Show the aide where cleaning and other supplies are kept. Go over any questions the aide or your parent has. This helps everyone feel comfortable.

Leave your contact information with the aide so they can call with questions. This ensures everyone understands the tasks and the first day goes smoothly.

Mutual courtesy, respect, and professionalism

Strange dynamics sometimes emerge in homecare situations. Occasionally someone hires a caregiver for limited tasks but then expects the aide to do more unpaid work without warning.

While rare, remember that mutual respect is essential. It helps everyone understand boundaries and build a positive working relationship.

Setting boundaries

Be clear about what services are included in your agreement and what you've both agreed to. Don't add duties without notice or payment. You'd expect to be paid for extra work; your caregiver should be too.

Remember what homecare is for: helping your family member, not cleaning the house. While light tidying is reasonable, it's not the main job. Don't expect the aide to do deep cleaning tasks like getting under the refrigerator.