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WHILE most of us want to maintain our independence in our own home as we age, if you need help caring for yourself but you’re not ready to move to an assisted living facility, the answer for many individuals is to have someone come to the home and provide that care, says the January 2014 issue of the Harvard Medical School’s Harvard Health Letter.

“We always make an effort to keep people in their homes when it’s appropriate. It’s less expensive, provides more freedom, and keeps people from being exposed to infections in institutional settings,” says Dr. Eric Weil, director of the program that manages high-risk Medicare patients at Harvard-affiliated Massachusetts General  Hospital.

The options for home care are private duty care and home health care - they have two different purposes:

• Home health care - This is a temporary service that brings nurses and therapists into your home to provide treatment.

Home health care is intended for individuals recovering from illness, injury or surgery, with the goal of helping you get better and regain your independence.

The professional who visits will provide only a specific skilled service - for instance, a physical therapist can visit if you’ve had a stroke or joint replacement surgery, or a nurse can come to help with wound care but will not cook, perform light housework or shop for you.

Home health care is covered by Medicare provided certain eligibility requirements are met - a doctor must certify that:

• you need the service

• you are home-bound - you are unable to get to an appointment on your own

• a doctor must review your home health care plan regularly

• the home health care agency must be Medicare-certified

You can still qualify for home health care if you attend adult day care or if you have a caregiver who lives with you.

• Private duty care - Available for a few hours up to 24 hours per day, private duty care provides the day-to-day help most individuals need to remain in their homes.

Private duty care workers fall into two categories:

1) Licensed or 2) Registered.

While both are able to offer homemaker services, such as housework, cooking, shopping, overseeing medication routines, and transportation, a licensed worker, such as a home health aide, will also be trained in body mechanics and able to provide hands-on physical care such as help bathing, eating, brushing teeth, and using the bathroom.

Although Medicare does not pay for private duty care, some long-term care insurance policies do - costs range from $15 to $25 per hour, and most agencies require at least three hours per week, adds the health letter.

When choosing a private duty service, the health letter offers these precautions:

If you work with an independent contractor or a registry that simply acts as an employment agency that matches workers with clients, you’ll:

1) be the only one supervising the caregiver,

2) pay the worker  directly,

3) be responsible for all payroll taxes and social security withholding.  

On the other hand, it’s easier to go with a company that employs its workers because:

1) you won’t be responsible for the caregiver’s taxes and

2) you’ll have the assurance that the caregiver’s company is monitoring his/her performance, as well as the care you receive.

Thus, when shopping for a home care company, one should ask:

• how long the agency been in business

• which certifications it has from your state

• what kind of background checks are performed on caregivers

• what kind of training is required for caregivers

• who will handle payments to the caregiver

• whether a customized care plan will be created or updated

• how closely the quality of care is supervised

• who will be coming into the home - a team or just one person

Dr. Weil concludes, “Make sure the person or company has a reasonable understanding of basic health issues, and is comfortable reaching out to your health professionals, if you need additional care.”