Home Health Care: Finding the Right Help for Seniors

When it comes to home-care workers—the aides who provide in-home personal assistance and health care support to seniors—Brenda Case has seen it all. Case, age 55, a real estate agent in Grand Junction, Colo., was for several years a full-time caregiver for her mother, who had severe rheumatoid arthritis. And in that time, a constantly rotating cast of home care workers came in and out of the home that Case shared with her mother.

There was a nurse who was wonderful. There was a bath aide who never came to work at all. And there was an occupational therapist who insisted that Case’s mother should practice job skills such as moving coins from one bucket to another—even though the patient had no intention of returning to work. “My 70-year-old mother didn’t need to go out and get a job—she needed to lift her arms to the microwave and get a cup of tea,” Case says. “But that was never part of the regime.”

Turnover was high, Case says, and she sometimes switched agencies in order to retain the aides she liked—or avoid the ones she didn’t. In the three years leading up to her mother’s death in 2015, she says, she worked with seven different home care agencies.

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Seniors and their families are struggling to find in-home help as an aging population, combined with the low pay, physical demands and irregular hours of home care jobs, have led to a severe shortage of home care workers. Between 2016 and 2026, home care work is projected to be the fastest-growing occupation, with more than 1 million new jobs expected, according to PHI, a research and consulting organization focused on the direct-care workforce. Yet home care agencies are already having trouble hiring and retaining enough workers to meet the demand.

“The impact on families is enormous,” says Robert Espinoza, vice president of policy at PHI. Even if they surmount the initial challenge of finding a worker who can meet their specific needs, consumers face low odds of hanging on to that worker for any length of time, Espinoza says, because turnover in the industry tends to hover around 60%. All too often, family members have to cut back their work hours or quit their jobs completely to fill in the gaps. Case, for example, saw her income drop to about $10,000 annually, from $120,000 previously, as she stepped back from work to care for her mother.

To navigate the home-care-worker shortage, you’ll need to be clear and specific about your needs, use multiple resources to identify qualified candidates and adroitly manage communications with workers. Here are four steps to help you find and retain the right in-home help.

Pin down your caregiving requirements. Before you start your search, “it’s so important to take a step back and think about what you really need,” says Leah Eskenazi, operations director at the Family Caregiver Alliance. If your mother would feel most comfortable with a female, Spanish-speaking caregiver who has a driver’s license and experience in dealing with dementia patients, for example, it’s best to be clear about that at the outset.

For seniors who primarily need companionship and basic help around the house, a personal care worker—who may have minimal training—may be the right fit.

If you need a worker who can perform some clinical tasks such as wound care, however, look for a home health aide who has more training. Training requirements can vary from state to state, but home health aides working for agencies that accept Medicare must have at least 75 hours of training.

Weigh an agency versus direct hire. A home health agency can offer some key advantages. If the worker gets sick, an agency will send over a replacement, whereas if you hire someone directly you’re on your own. If you need a variety of skills—perhaps a worker with nursing skills for a short period but a personal care aide thereafter—an agency will make it easier to coordinate that. An agency will also check the worker’s background, verify his or her training and handle the employment paperwork—taking some administrative tasks off your hands.

You’ll need to work with a Medicare-certified home health agency if you want Medicare to cover your care. To qualify for that coverage, you must need skilled services such as nursing or physical therapy and be “homebound,” meaning leaving home is difficult or not recommended because of your condition.

For consumers paying out of pocket, however, the higher cost of an agency may be a deal-breaker. If you go through an agency, you may pay $20 to $40 an hour, depending on where you live, whereas if you hire someone directly you’ll negotiate the wage, which in many cases is about $10 to $15 an hour, Espinoza says.

Start your search engine. To find home health agencies, contact your Area Agency on Aging or use Medicare’s Home Health Compare. Caregiver support groups and local chapters of organizations focused on specific conditions, such as the Alzheimer’s Association and American Cancer Society, may offer referrals to home health agencies.

Consumers hiring workers directly often rely on recommendations from friends and co-workers—but technology can make the search process a bit more sophisticated. Care.com and CareLinx, for example, connect consumers with home care workers in their areas. And in 19 states, “matching service registries” match consumers with home care workers based on needs and availability. Some registries require workers to have a background check and a certain level of training, while others have no such requirements. You can find details and links to the registries at phinational.org.

No matter how you find your in-home help, check candidates’ background and references, “preferably from past employment situations or people who have been under the individual’s care,” says William Dombi, president of the National Association for Home Care and Hospice. For tips on checking an aide’s background, see the Family Caregiver Alliance’s fact sheet

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Monitor the situation. When you’ve found the right caregiver, check in frequently to make sure the relationship is working for both parties. Lynette Whiteman, executive director of Caregiver Volunteers of Central Jersey, has engaged multiple in-home workers for her mother, who has Alzheimer’s. She had to let go of one aide who was caring for her mother overnight, after her mother said the worker had slapped her. Another aide repeatedly asked her mother for money, saying she needed cash for car repairs or to buy a new watch. “If we were not on top of this, I don’t know how much money would have gone out the door,” Whiteman says.

Technology can help far-flung family members check in on their loved ones—and ease the burden on caregivers, Eskenazi says. “Smart home” technology, including smart speakers, can provide medication reminders and reassure families that a senior is getting proper care. Or you can go the low-tech route: “Have a neighbor or friend stop in unannounced,” Whiteman says. “Make sure someone is checking in on the situation, if you can’t be there.”