By Clare Absher RN BSN Updated: 09/12/2019 Need help finding care?
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“How much does home care cost?” is the most popular question asked by families who contact us at CarePathways.com. After all, Mom and Dad have clearly expressed their desire to age in place and now it is up to you to determine if it’s an affordable option. Remember that most non-medical care such as personal care, meal preparation, medication reminders, and transport to appointments is paid for out-of-pocket. Self-funding calls for close scrutiny of your budget and funds allocated for home care. Spend your money wisely by choosing the right agency.
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At CarePathways, we strongly support aging in place and family caregivers. Consequently, we believe that in-home care agencies must work together with families to find ways to make home care a viable option. Regrettably we have found that much too often many agencies are unwilling to negotiate pricing, be creative with scheduling, or offer flexibility with staffing. Indeed, this short-sightedness often leads to failure in their businesses. On the other hand, we have discovered that more successful agencies adopt strategies to accommodate the budgets of individual families.
The Genworth Cost of Care Survey reports the current cost of home care throughout the nation. Currently the national median cost for a home health aide is $22/hour, $138/day, and $4,195/month (based on 44 hours a week).1 The national median for a homemaker is $21/hour, $132/day, and $4,004/month.2 Although these numbers may surprise you, it may be more shocking to learn that other eldercare options often demand even greater out-of-pocket expenses.
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Genworth’s comprehensive Genworth Cost of Care Tool allows you to find the cost of a homemaker and/or home health aide in your area by the hour, day, month, or year. Take notice that home care rates are based on geographic location and level of care. Observe the wide range of costs for a home health aide at the low end in the state of Louisiana at $16/hour whereas at the high end in Hawaii is $30/hour.3
Good ole fashioned leg work is the only means of getting answers from agencies about hourly rates, minimum shift hours, and of course flexibility. Families need to explore both general pricing of agencies in their area and also whether the agency will work with them to make services affordable. For example, is the agency agreeable to two short intervals of staffing every morning and again each evening? Many older folks living alone need only a few hours of morning personal care such as bathing, dressing, and a hot meal with no further help until bedtime. In this scenario the agency supplies a total of 4-6 hours daily as opposed to 8-10 hours of staffing in the home all day resulting in big savings.
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Take the case of both parents living in the home needing varying amounts of assistance. Perhaps your mom needs help bathing while dad just wants a hot cooked breakfast and help reminding him to take his meds. Some agencies charge double for two clients in the same home by demanding staffing by two caregivers. Conversely, other agencies may understand that one caregiver can easily manage the care of both parents and charge accordingly. In this example, a more reasonable agency with fair rates makes home care affordable and consequently a more attainable option.
Another example of flexibility and affordability is scheduling the appropriate type of caregiver for services needed. If your Mom is lonely, doesn’t drive anymore, and wants to go shopping understand that you do not need a CNA (certified nurse assistant) when a companion will fill the role. Companion services usually run at least a dollar or two less than a nurse assistant. Similarly, should your dad need a housekeeper and laundry once a week then by all means request a homemaker and do not accept a more costly CNA. Be sure to investigate which agencies offer CNAs, homemakers, and companions to find best the fit and least expensive caregiver.
While not your first choice it may be your only one should Mom or Dad require around the clock care. Note that when 24/7 care is clearly needed, assisted living may be a less costly option. However, when your parent is adamant about remaining home you will likely be motivated to find a way to honor his or her preference.
First and foremost, negotiate the daily rate that is quoted to you. These cases are very profitable to agencies; as the consumer this means the agency should be flexible with rates and willing to negotiate. Also consider getting commitments from family members, friends, and local volunteers to take on some of the time to reduce paid hours. Lastly, seriously consider adult daycare during the daytime hours of 9-5 and hiring care only for evening (after 5) and night-time hours. Adult day care will stretch your budget substantially as it is typically less than half the cost of in-home care.
Keep in mind that the bulk of the caregiving often falls upon the family caregivers and the home care agency’s role often is to supplement them. Competent agencies will understand the importance of scheduling services to best fit the families’ busy schedules and not their own. When an agency does not make genuine efforts to accommodate your family’s schedule then it’s best to move on and find another agency that does. An agency’s commitment to work efficiently in conjunction with your family will ease stress on your family and the demands on your budget.
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Clare Absher is a Registered Nurse with 45 years of experience. Most of her experience is in home health serving as a caregiver, educator, patient advocate, and liaison between families and community resources. She has also worked in acute care, assisted living, and retirement settings. She is passionate about helping families care for their elderly loved ones at home.
