The realities of aging mean that most older adults will require some level of health and/or personal care assistance at some point during their senior years. Even independent seniors can require assistance after an acute care stay, with the onset or progression of dementia, or as aging limits functionality.
Seniors may require:
- assistance with bathing, dressing, grooming, toileting, eating, mobility or transferring (referred to as activities of daily living, or ADLs)
- assistance with shopping and meal preparation, housekeeping, transportation, or communication
- assistance with medications: reminders, management, teaching, and/or monitoring (It is estimated that nearly one-third of hospital readmissions for patients with chronic medical illnesses is caused by the lack of adherence to a prescribed medication regimen—not taking them, not taking the right ones, not taking them at the right times or in the right dosage)
- skilled nursing for wound care, IV insertions and changes, feeding tubes, catheters, injections and infusion therapy, or diabetes management
- therapy services such as physical therapy, occupational therapy, or speech pathology
The Benefits of Aging in Place with Home Care
“Aging in Place” refers to older adults continuing to live at home for as long as possible as they age. The term has been around for several years, and the concept for even longer. According to AARP, as many as nine out of ten seniors over the age of 65 would prefer to stay in their homes. This isn’t surprising, as the health and quality of life benefits can be significant.
Older adults who age in place can:
- maintain their independence and a sense of control over their lives through familiar schedules and routines, which has been shown to positively affect personal dignity, health, and well-being
- maintain social and spiritual connections to family, friends, neighbors, and faith communities
- maintain their connections to familiar caregivers, health care professionals, and other service providers
- remain in the comfort of familiar surroundings—in their home and in the community (particularly valuable for individuals with Alzheimer’s or other dementia disorders)
- own a pet, which has been shown to ease loneliness and depression; relieve stress, anxiety, and pain; increase physical activity and social interaction; and even lower blood pressure and cholesterol levels.
- benefit from personalized, one-on-one care that is tailored and responsive to their individual needs
In addition, older adults who stay in their homes may experience faster recovery from illness and injury, decreased healing time, fewer annual MD visits, increased mental health status, and an increase in overall quality of life throughout their aging years.
A 2017 study published in the American Journal of Medicine showed that home health care “independently decreased the hazard of follow-up readmission and death.” According to William A. Dombi, President of the National Association for Home Care & Hospice (NAHC), “This important study clearly demonstrates that home health care has significant dynamic value in controlling care costs and achieving better patient outcomes.”
Home Care Encompasses a Wide Range of Services
While there are many factors that determine whether an older adult can safely choose to stay at home, the wide array of home care services available makes it possible for seniors to “Age in Place” regardless of their individual health and/or personal care requirements. Home care services can range from companion care, to personal care services (assistance with ADLs), to skilled medical and therapeutic care (RNs and therapists).
Technological advances mean that more and more health care procedures can be performed at home. Skilled home care services already include complex wound care, remote patient monitoring of vital signs and pulse oximetry, home infusion therapy, telemedicine, and even EKG and X-ray services.
There are two basic categories of home care, and the costs and services associated with each vary significantly.
Home Health Agencies (HHAs):
- Offer the skilled services of clinicians under the direction of a licensed physician for a limited period of time
- Can provide services on a temporary basis only, usually after an illness or injury, until the individual has returned to baseline or until no further improvement is likely
- Have skilled clinicians who can assess, treat, manage, and monitor care and implement changes to the care plan as necessary
- Offer an alternative to inpatient rehabilitation facilities
- Can offer an alternative to skilled nursing facilities (SNF) and even acute care, with a viable support network at home
Non-Medical Home Care Agencies:
- Offer personal care and companion services
- Are NOT Medicare-certified, and Medicare cannot be billed for services
- Are licensed by the U.S. Department of Health
- Offer an alternative to assisted living facilities (ALF)
- Can provide skilled care (RNs and LPNs), but cannot bill Medicare
- Can offer palliative and respite care
The Cost of Home Care
Home Care can be an effective way of controlling overall health care costs by reducing the need for more costly inpatient hospital services. A 2017 study looked at more than 64,000 patients over a one-year period post-discharge from a hospital, and concluded that patients who received home health care during that period saved the system about $6,500. “The study proves that a strong investment in the expanded use of home health care by Medicare, Medicaid and other payment programs would save billions in unnecessary health care spending,” said NAHC president William A. Dombi.
The savings are there for individuals, as well, although average costs for home care, ALFs and SNFs vary greatly by state and region, and with the quality of services provided. Costs also vary with factors such as the type and number of service hours that an individual requires. In general, the less help a senior needs, the greater the savings home care can offer.
Skilled services are much more costly than personal care services, but they are covered by Medicare when provided by certified HHAs on a short-term, temporary basis (usually 60 days at a time). Medicare does not cover personal or chronic home care. In general, skilled care for chronic conditions is private pay (or it may be covered by an individual’s private health or long-term care insurance), although some states–New York is one–may offer subsidized long term home healthcare for individuals who would otherwise qualify for nursing home placement.
Most individuals receive 44 hours per week or less of home care services, but many require as few as four hours per day. From a straight costs perspective, the cutoff for home care savings seems to be at around 40 hours per week. If an individual requires much more than 40 hours per week of services, then ALF will probably be the less expensive alternative. A straight financial perspective, however, ignores several important factors:
- ALF services are limited to personal care only
- Home care offers more individualized, one-on-one care
- Home care and aging in place have been shown to have multiple health and wellness benefits
- The individual’s preference for remaining at home can be a significant factor in health and wellness outcomes
- The availability of Meals on Wheels or similar nutrition programs and free or affordable senior transportation options within the community can help to reduce the costs of aging in place
- Many individuals enter an ALF only to find that they require additional services, and end up paying for home care in addition to ALF costs
The Growing Home Care Market
Home care is a cost-effective alternative to assisted living facilities and inpatient rehabilitation facilities. For individuals with a willing and able support system of family, friends and/or caregivers, home care can also be a viable alternative to skilled nursing and even acute care facilities. While the feasibility and affordability of home care varies with the individual, about 20% of adults over aged 65 own their own homes, which can make home care an even more attractive option.
The home care market is expanding. Home care is and will continue to be a cost-effective service option for the aging population. Consider this:
- The aging U.S. population (adults 65 and older) will make up more than 20 percent of the U.S. population by 2030
- An increasing number of seniors are expressing their desire to Age in Place
- The home care service options continue to expand with advances in technology
- Home care is a cost-effective alternative to ALF or SNF
- Home care is associated with better quality of life and clinical outcomes
- Medicare is increasingly focused on quality over quantity
Considering these factors, it is easy to see how the need for quality home care services will only increase over the coming decades.
Resources for Seniors Who Want to Age in Place
Seniors who are aging in place can take advantage of free community support such as Meals on Wheels or similar local nutrition programs; senior transportation services for rides to appointments and shopping; and senior centers for socialization.
Local Agencies on Aging are a good resource. Seniors or caregivers can also consider private grants (religious or community), private insurance, long term care insurance, HUD senior housing benefits, and mortgage leveraging.
- Centers for Medicare & Medicaid Services: CMS.gov
- Medicare: medicare.gov
- Medicaid: medicaid.gov
- National Council on Aging Benefits CheckUp: programsforelderly.com/health-benefits-checkup.php
- SSI/Disability Benefits: ssa.gov/benefits/ssi/
- U.S. Department of Veterans Affairs: va.gov/service-member-benefits/
- U.S. Government Benefit Finder: benefits.gov
- U.S. Veterans Aid and Attendance: va.gov/pension/aid-attendance-housebound/