A Guide to the Best Choices for Older Adults
As our population ages, many of us face important decisions about care and living arrangements. For the majority of older adults, staying at home is more than just a preference—it's essential for maintaining a sense of independence, comfort, and dignity. As there are several options for home care, understanding which is right for you and recognizing when additional help is needed can help enhance quality of life and ease the concerns and burden of family caregivers.
Understanding Home Care
Let’s start by defining what home care is. There are two primary types of services tailored to meet specific needs.
In-Home Care
focuses on everyday support, offering personal care, companionship, and help around the house from trained caregivers. Home care is particularly vital for older adults to sustain quality of life, focusing on tasks like eating, bathing, mobility, housekeeping, meal prep, and medication reminders.
Home Health Care
is provided by licensed medical professionals, often under a healthcare provider’s order or prescription, to help with medical needs like wound care, therapy, or monitoring health conditions.
Why Choose Home Care?
Most older adults prefer staying in their own homes, with 86% expressing a desire to age in place. In-home care offers critical support to achieve this goal, particularly when facing challenges like loneliness, reduced mobility, memory loss, or managing daily tasks.
Sometimes, the need for extra help becomes clear over time. But often, it happens all at once. Recognizing these signs isn’t about taking away independence—it’s about preserving it with the right kind of support. Whether you’re noticing changes in a loved one—or in yourself—here are some signs that it may be time for a helping hand:
Unopened mail or unpaid bills
Feeling overwhelmed by managing daily tasks like paying bills or responding to mail.
Social withdrawal
Mobility challenges, memory loss, or hearing difficulties can make it harder to stay engaged, leading to loneliness and isolation.
Loss of interest in meals
Cooking for one, grief, or physical limitations can lead to skipping meals or poor nutrition.
Changes in personal hygiene
Unkempt hair, body odor, or wearing the same clothes for days could indicate difficulty with self-care.
Declining driving skills
Unexplained dents, traffic tickets, or hesitation behind the wheel might be signs of unsafe driving.
Scorched pots and pans
Forgetting to turn off the stove could signal memory concerns.
Signs of depression
Lack of interest in hobbies, trouble sleeping, or withdrawing from family and friends may indicate emotional distress.
Missing appointments
Forgetfulness or lack of reliable transportation can lead to skipped commitments.
Messy or neglected home
Difficulty keeping up with household tasks may be due to fatigue, mobility challenges, or depression.
Trouble managing medications
Keeping track of multiple prescriptions can be confusing and may lead to missed doses or medication mix-ups.
In-Home Care
In-Home Care can be the perfect solution in a number of different situations, including for someone recovering from an illness or surgery, as a supplement to medical care. It can also be perfect for someone who simply needs help with daily tasks like cooking, cleaning, and getting around.
Support is important for emotional well-being, too. The loss of a spouse, for example, can lead to loneliness and depression, which can take a toll on health. A widower struggling with forgetfulness might not just miss bills—he might forget to take his medications.
Enhancing Lives
The right care goes beyond physical support—it's about meaningful connections, engaging conversations, and one-on-one interactions. Engaging activities like gardening, baking, or simply enjoying companionship on outings help maintain mental sharpness and emotional well-being.
Many older adults benefit from gentle daily support, such as assistance with showering, meals, and medication reminders. Evening and overnight care can also ease anxiety, particularly for those with Alzheimer’s Disease or other forms of dementia.
Quality in-home care providers carefully match caregivers to individual needs, ensuring consistent support whether at home or in a care community.
Because great care isn’t just about where you live—it’s about how you live.
- Eating
- Dressing
- Bathing
- Toileting
- Transferring
- Continence
- Companionship
- Meal Prep
- Light Housekeeping
- Medication Reminders
- Errands/Shopping
- Transportation
- Hobbies
- Laundry
- End-of-Life Care
- Chronic Condition Support
How to Discuss In-Home Care
Needing more help at home doesn’t mean it’s time for a move—it simply means it’s time to find the right support. Many older adults want to stay in their homes, and with the right care, they can do so more safely and comfortably.
The first step is understanding and discussing needs and wishes. While these conversations aren’t always easy, it’s important to start by acknowledging the older adult’s desire to remain at home.
“Mom, I want you to stay at home, too. But if you were to fall or get sick, that could make things harder. A little extra help could keep you safer and independent at home for even longer.”
Paying for In-Home Care
There are several ways to pay for in-home care, and it’s important to explore all options. Start by checking if the individual has a long-term care insurance policy, qualifies for Veterans benefits, or has a Medicare Advantage plan that covers in-home care. If these options aren’t available, care can also be paid for privately by the older adult and/or their family.
With 70% of adults over 65 needing some form of assistance at some point, the demand for care is growing.* But beyond necessity, personal preference matters. If home is where someone feels happiest and most comfortable, investing in the right support can be invaluable—helping them maintain their independence and quality of life.
Home Health Care
In the past, a medical crisis often meant leaving home for good. But today, even those living with chronic conditions or serious illnesses can remain safer at home with the right care. Advances in technology, medical equipment, and home health care services have made it possible for older adults to continue living where they feel most comfortable.
Home health care agencies provide licensed medical professionals who can deliver a wide range of skilled services right in an older adult’s home, which is ideal as recovering at home can often be a better experience. For example, individuals with dementia may feel more secure and less disoriented in a familiar environment.
When Home Care Can Make a Difference
- Post-Op Rehabilitation
- Occupational Therapy
- Speech Therapy
- Wound Care
- Mobility Training
- Pain Management
- IV Therapy/Injections
Paying for Home Health Care
Medicare and private insurance may cover certain medical services such as nursing visits, speech therapy, and occupational therapy. If an older adult is discharged from a hospital, Medicare may pay for home-based nursing care and therapy—but only when prescribed by a healthcare provider as part of a care plan.
A Team Approach to Care
In-home care and home health care can work together, providing a well-rounded support system for older adults. While both services focus on safety, well-being, and healing, each plays a distinct role in the care journey.
A licensed medical professional—such as a nurse or therapist—provides short-term, specialized medical care, like wound care or rehabilitation after surgery. In contrast, an in-home caregiver offers ongoing, personalized support, helping with daily activities, providing companionship, and building a trusted relationship over time.
For example, an older adult recovering from heart surgery may receive visits from a nurse to monitor their health while also relying on an in-home caregiver for help with meals, mobility, and daily routines. Together, this team approach ensures they can recover safely and comfortably at home.
Choosing the Right In-Home Caregiver
When seeking in-home care, caregivers generally fall into three types: agency employees, independent contractors through registries, or independent caregivers. Each has unique structures and responsibilities. Always consult directly to understand their policies.
Agency Employees (recommended)
Agency-employed caregivers are commonly screened, trained, bonded, and insured. The agency handles payroll, taxes, workers’ compensation, liability coverage, and performance management. They also provide a structured support system, ensuring families have a point of contact and backup care when needed.
Independent Contractor with a Registry
Registries screen caregivers but usually don't employ them directly. Families often become the employer, managing hiring, scheduling, payroll, taxes, and insurance. Some registries provide backup caregivers, while others do not. Since independent contractors work on their own, they may not receive ongoing training or supervision.
Independent Caregivers
Independent caregivers work directly for families without agency oversight. Families must take on full employer responsibilities, including background checks, payroll, taxes, and liability coverage. Families must also arrange backup care if the caregiver becomes unavailable.
Caregiver Marketplaces
Caregiver marketplaces offer convenience, flexibility, and can be more affordable. However, there are significant drawbacks. Vetting and background checks can be inconsistent or optional, raising concerns about reliability and safety. High caregiver turnover rates can also lead to disruptions in care. And most leave it to the families to take on full employer responsibilities.
Questions to ask an in-home care provider:
Caregiver Qualifications & Training
- Is the caregiver an agency employee (recommended arrangement), an independent contractor, or privately hired?
- What training do caregivers receive? Is ongoing education provided?
- Does the training include specialized dementia or Alzheimer’s care training?
- Is the agency licensed?
Background & Security
- Have caregivers undergone criminal background checks, drug testing and reference checks?
- Are they bonded and insured to protect against liability? (This means the company covers claims and insurance, so the home owner is not liable should something happen.)
- Do they have workers’ compensation coverage in case of injury on the job?
- Can the company provide references from past clients?
Caregiver Availability & Support
- Does the agency or registry provide backup caregivers if the primary caregiver is unavailable?
- How much input do families have in selecting a caregiver?
- What restrictions, if any, apply to services (e.g., lifting limits, available hours)?
- Does the home care agency or registry offer the personal care services needed, such as bathing, dressing, and using the bathroom?
- Are older adult’s special needs accommodated?
Financial & Contract Considerations
- Who handles payroll and tax reporting?
- How flexible is scheduling? Can the family adjust care hours as needed?
- Is there a contract commitment (e.g., minimum months required)? Is there a penalty for early cancellation?
- What are the costs, including minimum service hours and special overnight rates?
- Is a service deposit required, and if so, how much?
Quality & Communication Practices
- Does the agency or registry maintain a quality assurance or supervisory program?
- What is the agency’s or registry’s communication plan to keep families informed?
Choosing the Right Home Health Caregiver
When considering home health care services, it’s important to choose a licensed and reputable provider. A caregiver designated as a “Home Health Agency” often indicates they are a Medicare-certified home health agency and has met federal requirements for patient care and management.
Remember, home health care is designed for individuals recovering from illness or surgery, living with chronic conditions, or in need of medical, nursing, or therapeutic support at home. When interviewing an agency, make sure you understand exactly what services they provide—and what they don’t. Some medical procedures, such as injections or feeding tube maintenance, typically require a licensed nurse or doctor and cannot be performed by non-medical caregivers. Knowing these limitations upfront can help you make the best decision.
Additional questions to ask a home health care provider:
- Is the home health provider with an agency (recommended agreement), an independent contractor, or privately hired?
- If with an agency, is the agency Medicare-certified? This can impact what services are covered under Medicare.
- Can the company provide references from past clients or recent customer satisfaction surveys?
- Does the agency coordinate with other services if additional care is needed (e.g., in-home care)?
- Which insurance plans do you accept? How is payment handled?
- How much notice is needed to begin or cancel services?
- Does the agency or registry maintain a quality assurance or supervisory program?
- What is the agency’s or registry’s communication plan to keep families informed?
Resources
Find even more information about your home care options with these trusted resources.
Home Care Association of America
Canadian Home Care Association
Centers for Medicare and Medicaid
Government of Canada - Programs and Services for Seniors
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