Paid Home-Care Workers
Professionals Fulfill a Range of Needs
Home-care services range from simple companionship for isolated or homebound seniors to full-scale nursing or hospice care. The services enable many seniors to remain comfortable in their homes longer than would be possible on their own and also allow caregivers some time off to recharge their emotional batteries.
Hospital discharge planners often arrange for home care when a senior leaves a medical facility after an illness or injury, but caregivers or seniors themselves can also contract for services privately or through home health agencies. Agencies provide an extra level of screening but may cost more than finding someone through a classified ad or personal referral. Public and private insurance programs may cover some medical services ordered by a doctor but only if they are provided by home health agencies.
Home companions provide stimulation and company to isolated or homebound seniors. They may help with minor tasks but do not generally do housework or any of the chores performed by homemakers or home health aides. Companions are often retired elderly volunteers provided by nonprofit agencies and community organizations. Home health agencies can also supply paid companions for seniors.
Also known as choreworkers and housekeepers, homemakers cook, do laundry and perform other light housework. They can often help seniors with some activities of daily living such as bathing, dressing, eating and getting around the house. They can also shop or accompany clients on errands and appointments. In some cases, they can keep an eye on Alzheimer's or dementia patients who can't be left alone.
Homemakers generally have no formal training. Some contract their services independently; many work through home health agencies or nonprofit organizations.
Also known as home care aides, home health aides provide personal care, especially help with activities of daily living such as bathing, dressing, eating and moving about the house. They also cook, perform light housekeeping duties and escort seniors on shopping trips and appointments. Depending upon their training, they sometimes check temperature and blood pressure, help with exercises, supervise an individual with dementia and ensure a client follows a prescribed drug regimen.
Some home health aides contract their services independently; many others work for home health agencies. Training and certification of home health aides vary from state to state. However, they must pass a competency test if the agency employing them receives reimbursement from Medicare. When working through a home health agency, home health aides are generally supervised by a nurse or physician. Reputable agencies require aides to report at least once a week on the patient's condition.
Home nurses are often called in during the acute phase of an illness or after a hospitalization. Most work through home health agencies, and Medicare often covers some services they provide. Nurses' duties vary depending upon their training. Registered nurses (RNs) receive more training than licensed practical nurses (LPNs), also known as licensed vocational nurses (LVNs), but licensing requirements and skill levels for both categories vary from state to state.
RNs work under the supervision of a physician and can coordinate the work of LPNs, home health aides and other in-home care providers. They perform such tasks as inserting and monitoring IVs, measuring out medications, giving injections, dressing wounds and monitoring vital signs. To reduce the need for costly professional help in the home, RNs may train caregivers in certain medical activities. LPNs work under the supervision of physicians or RNs.
Speech therapists, occupational therapists and physical therapists all work with individuals to maximize their abilities, often after an illness or the onset of a debilitating medical condition. States have varying licensing requirements for rehabilitation specialists, who are generally referred by home care agencies. Medicare frequently covers these services.
Speech therapists work with stroke victims and others having difficulty speaking and communicating. Occupational therapists train people with disabilities or injuries how to perform activities of daily living, such as dressing, eating, going to the bathroom and walking. They suggest special devices the senior can use to help with tasks and advise on home adaptations. Physical therapists demonstrate and prescribe exercises to increase the strength and flexibility of joints and muscles.
When a person has been diagnosed with a terminal illness and wishes to stay at home, nurses, social workers and home health aides trained in hospice care help keep the patient comfortable and free of pain. Hospice workers also provide emotional support to caregivers and family members.
For patients to qualify for hospice care, a doctor must certify that they are likely to die within six months. Medicare helps cover the cost of home hospice care. Home health agencies generally provide hospice services.