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Understanding Different Home Care Options For Your Elder Family Member

Join us in thanking family caregivers this November by sharing resources and vital information with them. Your Turn To Care is happy to welcome guest columnists, Estee Bienstock RN, Chaplain Jim Johnston, and Gerontologist Mary Winners to share their personal and professional insights and advice for caregivers and their families.

Many families have strong feelings about how and where they want to care for their loved ones. Some families decide that when home care is more costly than placement, that is the time for a move away from home. Other families may decide they will keep their loved one at home no matter the expense, physically or financially. In most cases, there is no wrong answer, unless the caregiver is sacrificing their own well being.

When safety becomes an issue there is no question but to remove the senior from their environment, even if it's temporary. Some situations may include an overly cluttered home, a fire risk, or when vermin or pests take over. If proper care cannot be implemented at home, difficult behaviors emerge or night wandering is an issue for a caregiver, placement is an appropriate option.

Support for the caregiver is an additional factor to consider when determining the placement setting or amount of care for a senior. A frightening, but real statistic is 68% of well spouses will pass before the ill spouse. To avoid issues of caregiver burnout, depression and physical decline, caregivers must seek and be afforded support.

Sometimes beginning with a Geriatric Evaluation can assist in providing caregivers with the resources they will need. Understanding the options and how different services work and cost will also help.


Home Care is also known as custodial care or non-medical care. Home care is not covered by Medicare, but may be covered under a long term care insurance policy. Some seniors may be eligible for reimbursement of care at home through In Home Supportive Services (IHSS) or as a Veteran or Veteran's spouse. Most seniors will be responsible to pay for home care privately.

Agencies will usually require a minimum of four hours of care at a time. Often times when families are using care every day for a minimum of ten hours a day, it can be more cost effective to use "live-in" care. Live-in caregivers will remain in the home 24 hours, but must be able to sleep in the evening. A senior who requires 24 hour "awake" care will be required to pay at an hourly rate. More than one caregiver will be arranged in a 24 hour period.

The range of cost for a caregiver is $15-$25 per hour. Some families have the financial means to cover the cost of care at home. If a senior does not qualify for additional support, and financial resources are limited or not available, discuss your situation with a Geriatric Care Manager familiar with the ways to pay for care. Be certain to evaluate your choices and make a decision based on your specific needs.

Home Care agencies are not regulated under any licensing at this time in California, so it is important to make certain that the agency and its employees are bonded and insured.

Questions To Ask:

  • Do you fingerprint, drug test and run a background check on your caregivers?

  • How much training do you provide for your staff?

  • Have you trained your staff in dementia care or other specific care needs?

  • Who is responsible if a caregiver is injured on your property?

  • Who is available on a 24 hour basis if a caregiver does not show up?

  • Can your caregivers drive to doctor's appointments?

  • What should I expect from a caregiver in regard to responsibilities?


  • Do you have anyone for backup in the event the caregiver is sick or does not show up?
  • What references do you have to feel assured that the caregiver is safe to have in your home?
  • Are you creating an employee or independent contractor relationship?
  • Check with your accountant in regards to paying taxes or preparing a 1099 for the caregiver.
  • Check with your homeowner's insurance to be certain that you will be covered in the event that the caregiver is injured at your home or in the scope of caring for a family member.

Mary Winners GerontologistMary Winners is the founder of About Senior Solutions, a Geriatric Evaluation and referral organization. The company offers support to aging seniors and their loved ones to find the right direction for care and support tools. Mary has over a decade of experience in the business development aspect of healthcare. While physicians and nurses provide medical recommendations, Mary understands the other side of health care - the confusing maze of health care options and unknowns. She has extensive knowledge in acute care hospitalization, Gero-psychiatric issues, Alzheimer's and dementia care, hospice, assisted living and other senior care options. Mary is a strong advocate for seniors in the community and a member of several life enhancing senior programs in Los Angeles County.

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