Caregiving Challenges, Deciding What Type of Home Care to Hire

Once you have determined that your loved one needs help, the next step is deciding if a companion, a homemaker, or a home health aide is best.

Helpful Highlights

  • There are many different types of home care: companions, homemakers, home health aides, and private duty nursing (see TITLE for more on nursing).

  • There are important considerations when choosing whether to hire home care through an agency or privately, namely around employment matters.

  • Determining the needs of your loved one will guide you in determining what type and level of home care will be most helpful.

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You have decided to hire help for your loved one so they can remain safe and independent at home, whether that is their home or your home. The next decision to make – is a companion, homemaker, or home health aide needed?

Roles and limitations, in brief

Companion - A companion fulfills a purely social responsibility. They visit to do the things your loved one enjoys doing and keep them company. Talk, read, play games, play music, go for walks, do crafts, or garden together. Companions can also take your loved one out - for meals, movies, community events, to visit parks and monuments, and other activities. (Note that for companion care, your loved one must be able to transfer, as well as get in and out of a vehicle, unassisted. When traveling, the companion can fold and store walking aids such as walkers and rollators.) Companions do not serve as homemakers or home health aides, and they do not put their hands on your loved one.

Homemaker - A homemaker fulfills household responsibilities. They visit to assist with the chores and errands that your loved one can no longer do by themselves. They will do light housekeeping, laundry, change linens, do dishes, shop, pick up prescriptions, and prepare meals. Provided that your loved one can transfer, as well as get in and out of a vehicle, unassisted, a homemaker can transport your loved one while running errands. For example, if your loved one wants to personally select items from the grocery store. Homemakers can also serve in the role of companion, and like companions, homemakers do not put their hands on your loved one. Homemakers do not serve as home health aides.

Home health aide - A home health aide can provide all the services of a companion and homemaker, in addition to hands-on (personal) care. This is the only role that will put hands on your loved one to help them with things like transfers, bathing/showering, toileting, personal hygiene, dressing, and eating. They are also able to assist your loved one in and out of a vehicle. Home health aides receive training in hands-on care that companions and homemakers do not. However, it is important to remember that home health aides do not provide skilled care (in some states they can provide very limited skilled care by nurse delegation). They do not take the place of a licensed nurse or other licensed professional.

*Note that most home care agencies will not provide just transportation services alone. Transportation is combined with another care delivery service.

See also: Caregiving Challenges: Differences in Sources of In-Home Care, Caregiving Challenges: Companion & Homemaker vs. Home Health Aide, and Caregiving Challenges: What are ADLs and IADLs? content

Key points for consideration

  • Companion and homemaker services may cost less because neither provides any hands-on (personal) care.

  • Home health aides typically cost more because they require training to provide hands-on (personal) care. Home health aides can perform the services of a companion and homemaker, as well, but will still charge the same hourly rate.

  • If you hire a homemaker, and later need a home health aide, it may mean a change in the person(s) visiting your loved one.

    • While you can hire both a homemaker and a home health aide, a home health aide can also provide homemaking services, utilizing only one person and one cost instead of two.

  • Will you hire privately? Or through a home care agency?

Companion advantages

  • Ideal if you're just worried about isolation or boredom, and the impact those can have on your loved one's well-being (loneliness, depression, decline in communication skills, decline in mental and physical function)

  • Works well if you just need someone to spend quality time with your loved one while you step away to take care of other things

  • Can be a way to get them to try new things

Homemaker advantages

  • Lower hourly rate than a home health aide

  • May be scheduled less often than a home health aide

  • Helps your loved one adjust to assistance from someone other than family

  • Can also serve as a companion

Home health aide advantages

  • Can do everything a companion or homemaker does, plus hands-on (personal) care

  • Can report back to you on issues they observe with toileting, hygiene, and skin (areas that companions and homemakers do not see)

  • If you bring in a home health aide initially, rather than progressing up to one, you may not have to change personnel as your loved one continues aging and needs increase

Differences between private and agency employees

Private

  • You find the employees and hire them.

    • How do you locate them? 

    • How do you check their background, references, training, or competency?

    • What happens when they get sick?

    • Do you take care of payroll taxes?

    • Do you provide worker’s compensation if they are hurt?

    • Are you liable for employment / lost wages benefits?

  • If your loved one has long-term care insurance (LTCI), it may not cover private care.

Agency

  • You choose an agency and the agency finds the employee. (Most work to match your loved one with one or more employees that appear to be a good fit.)

  • Your loved one's long-term care insurance (LTCI) typically covers services provided through a home care agency.

  • Good questions to ask the agency:

    • Are you licensed by the state?

    • Do you have a nurse on staff?

    • How are your staff trained?

    • How are your staff supervised?

    • Is there a difference in hourly rates between companion, homemaker, and home health aide?

    • Is there a minimum number of hours required?

    • Are your staff employed or contracted by the agency?  

    • What happens if the employee is more than 30 minutes late, calls in sick, leaves a shift early, or goes on vacation?

No content in this app, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician.

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