Most older Americans want to live in their own home as long as possible, but finding and getting the help they need is often not easy. There are serious shortages of home care workers in many parts of the country. Hiring them is expensive. And most middle-class people will have to pay for home care themselves if they need it long-term. Here is a guide to locating home care for a senior.

After a fall or surgery, some seniors will need short-term at-home care from a nurse or therapist to help them recover. Medicare, the federal insurance program for people 65 and older, generally covers this type of home health care. A nurse can make sure a wound heals properly, for example, while a physical therapist can help a person get back on their feet after a knee replacement.

But millions of older Americans need help for months or years to stay safely in their homes instead of moving to an assisted living or nursing home. They may need help getting out of bed, taking a shower or going to the toilet; go to the doctor; shopping or preparing meals. They need a home health aide or personal care assistant, who may not have much, if any, medical training.

A wide range of services are available, from light housekeeping to hiring a private nurse. Monica Moreno, senior director of care and support at the Alzheimer’s Association, suggests starting by making a simple list of the type of help you or your loved one needs and the number of hours needed each day or week.

To identify agencies and services available in your area, Ms. Moreno recommends consulting a database of community resources provided jointly by the association and AARP, the nonprofit group representing older Americans, searchable by location. A list of agencies and a brief description of what they offer can be found in the home care category. AARP also has a guide to find help at home.

While Medicare certifies and awards stars to home health agencies, businesses that provide home health care services are not subject to federal oversight or required to be licensed in each state. But a good agency will conduct background checks on its employees and provide training and support. If an assistant calls in sick or resigns, the agency can find a replacement. Some companies also bond and insure their caregivers.

When choosing an agency, Jennifer Battista, director of operations for the Home Care Association of America, suggests several in your home to conduct an assessment. Ask them how they screen their employees, whether they conduct criminal background checks, and whether their employees are required to know how to perform CPR or provide first aid. Be sure to ask for referrals for individual aides and talk to families who have already employed them.

Once you’ve chosen an agency, you may want to try a few caregivers before finding the right one. The more information you share about your loved ones’ needs, the better the agency will be able to find help that’s right for them. “It’s a lot like matchmaking,” Ms. Battista said.

Many families find a caregiver by asking people they trust for recommendations, said Nicole Jorwic, an attorney and advocacy manager for Caring Across Generations, an advocacy organization. “Cast wide, post on private social media and ask family and friends,” she said, noting that she found caregivers for her grandparents by asking people in her community.

Churches and other religious institutions, local charities and community organizations may also have suggestions. A primary care physician or local medical practice may have experience with specific home care agencies or know individual caregivers. If you decide to hire someone privately, you should be sure to conduct a thorough background check and talk to families who have previously employed this person. Family Caregiver Alliance, a California nonprofit group, offers a guide.

Many foster agencies falsely say they cannot send in-home help and will tell the doctor’s office or patient that Medicare will not pay for in-home help. “This is a long-standing problem,” said Judith A. Stein, executive director of the Center for Medicare Advocacy, a nonprofit legal group.

While it is true that Medicare does not pay for long-term care, it may pay for assistance as part of a patient’s care plan if that person also qualifies for an in-home nurse or therapist for a certain period of time. time. Agencies often refuse to provide someone because Medicare pays a flat fee per patient, meaning the agency doesn’t get paid more for sending help beyond the nurse or therapist. Discuss with the doctor whether assistance is needed so that it is specified in the care plan presented to the agency.

Medicare patients receive fewer visits from an aide today than they did 25 years ago, and the center is now appealing a judge’s rejection of a trial claiming that Medicare, under the U.S. Department of Health and Human Services, was discouraging the use of aid for thousands of people. The judge made recognize that many people were not receiving care.

Under Medicaid, the federal-state program for the poor that provides long-term care, the cost of assistance is often covered as an alternative to a nursing home. But the shortage of workers can make it difficult to find one, even if you qualify. Families complain of frequent absences, and the low wages paid under the program mean agencies often experience high staff turnover.

Some private Medicare Advantage plans offer in-home care as an additional benefit, and some of the help may be covered by a long-term care insurance policy. If you or a loved one is a veteran, it’s worth checking with Veterans Affairs to see if they will pay for in-home care.

If you decide to pay privately, the hourly rates agencies charge vary widely and some agencies may not be able to fill a position for only a few hours per week. In San Jose, California, half of the agencies charged more than $37 an hour for a home health aide in 2021, according to Genworth, the long-term care insurer. Nationwide, agencies charge about $27 an hour, with a little more than half going to pay their employees.

There is no precise estimate of the number of people who are self-employed. You might save money because no middleman takes a cut, but some independent caregivers charge about the same as an agency.

If the agency you’re using is licensed by your state, you can check with the government office that oversees it if you have a problem. You can also file a complaint with various state agencies, including the state Department of Health.

State or local government agencies that focus on aging groups or nonprofits can provide information. You can also try the aged care locator. The Alzheimer’s Association also has some advice advice to find caregivers, and it offers a 24-hour helpline, 1-800-272-3900.

Family caregivers should also consider taking advantage of respite care to give themselves a break from time to time. Depending on the circumstances, insurance may cover the cost, and some local authorities and community groups will also pay for assistance for a brief period. Churches and other organizations may also provide respite care.

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