In-Home Care

In-Home Care

Before determining what type of care your loved one needs, having a basic understanding of activities of daily living (ADLs) is essential. Thinking about the activities of daily living will help you make a sound plan but more importantly, ADLs are the language used by medical professionals, insurance, and government programs so understanding the difference between an ADL and a medical need will help you navigate the various types of care and financial assistance offered.

What activities are crucial for living independently?

The basic tasks a person needs to be able to do on their own to live independently are called Activities of Daily Living (ADLs). Health issues and aging can make it difficult for seniors to take on certain everyday self-care tasks that are important to keeping them healthy and safe. If your loved one needs help with ADLs, a Care Companion or In-home Caregiver may help them age in place.

Medical care, in contrast, requires a higher level of licensure and is usually provided by a Home Health agency. The different types of care are discussed in more detail later in this article but this chart will give you an overview


Needs served by Companions vs. In-Home vs Home Health

  Care Companion In-Home Caregiver Home Health Care
Play cards or watch TV  
Grocery Shop  
Assist with Walking  
Prepare Meals  
Take to appointments  
Accompany to restaurants  
Take on an outing  
Manage finances    
Help pay bills    
Manage medication    
Assist with transfer  
Wound Care    
IV Management    
Catheter care    
Administer medications    
Swallowing therapy    
Balance training    


What are activities of daily living (ADLs) and instrumental activities of daily living (IADLs)?

Doctors, Occupational Therapists, and other clinicians use the Katz Index of Independence in Activities of Daily Living to assess the overall health and functional status of older adults and those with disabilities.
Basic ADLs include six essential skills:

    1. Bathing and showering: the ability to bathe oneself and maintain hair, dental, and nail hygiene
    2. Continence: having complete control of bowels and bladder
    3. Dressing: the ability to select appropriate clothes and to dress self independently
    4. Mobility: being able to walk or transfer from one place to another, specifically in and out of a bed or chair
    5. Feeding (excluding meal preparation): the ability to get food from plate to mouth, and to chew and swallow
    6. Toileting: the ability to get on and off the toilet and clean self without assistance

What are instrumental activities of daily living (IADLs)?

Another tool that is commonly used to determine if living independently is the right choice is the Instrumental Activities of Daily Living, or IADLs, which are more complex activities that often involve thinking and organizational skills. IADLs as outlined by the Lawton-Brody scale assessment covers:

    • Cleaning and housekeeping, including maintenance and other home care chores
    • Doing laundry
    • Managing finances
    • Managing medications and taking medicines as directed
    • Preparing meals
    • Shopping for groceries and other necessities
    • Transportation, including changing residences and moving
    • Using communication devices, including the telephone or computer

3 reasons ADLs and IADLs Are Important in Determining Level of Care

  1. 1. Insurance and government programs use ADLs to determine eligibility.
  2. 2. ADLs and IADLs help you determine what caregivers are needed
  3. 3. Monitoring ADLs and IADLs alerts you when the level of care should be increasedADLs represent everyday tasks that challenge both mental and physical capabilities when living independently. A person needs to have the physical ability to perform ADL tasks themselves, and the planning and mental capacity to conceptualize the tasks and understand what needs to be done.

    It’s a good idea to test ADLs as soon as possible while working with your, or your loved one’s doctor so that any decline in the ability to complete basic ADLs can be detected early. Setting a baseline will help in noticing the onset of dementia or physical limitations.

A good framework for tracking the status of ADL

  1. Keep these questions in mind:
  2. Do you or someone in your loved one’s social network need to check on your aging parent routinely?
  3. Does your aging loved one need physical therapy?
  4. Is your aging parent able to continue living independently?
  5. Is it time to reevaluate the plan to age in place and consider other options?

ADLs Instrumental in Deciding Course of Action for Aging in Place Plan

  1. Understanding ADLs is crucial to building an accurate care plan as it will help everyone in your, or your loved one’s care circle, including their doctor.

Signs that it’s time for an ADLs and IADLs assessment

  • Watching out for specific safety factors, including:
    • Finances: Are there problems paying bills? Are you concerned about scams?
    • Driving: Have there been any accidents or close calls?
    • Health: Has your loved one had any falls?
    • Elder abuse: Do you have any concerns about emotional, financial, physical, or verbal abuse?
    • Have there been trips to the ER?
    • Memory and thinking: Have there been problems with forgetting, getting lost, or wandering? Is there concern about poor awareness or poor judgment?
    • If you answered “yes” to any of the above questions, it may be time to assess your, or your loved one’s ADLs and IADLs.

Action: Call your doctor or your Area Agency on Aging and ask for an evaluation

As explained above, ADL’s are how insurance and government programs determine eligibility so getting an assessment is crucial and a prescription from your doctor is the first step. The evaluation is usually covered by insurance, Medicare, or local government programs so cost should not be a barrier. Also, the evaluation looks at the entire setting, including safety issues such as smoke detectors and fall hazards such as rugs or missing handrails, evidence of abuse or neglect, and undiagnosed medical conditions. If the evaluation is done by an Occupation Therapist, they can suggest equipment such as toilet risers or non-slip bowls to solve many problems without the need for ongoing care. So even if Home Health visits are not determined to be covered, the evaluation will give you and your family good information for planning.

Formal vs. Informal Caregiving

There are two main types of care for seniors who are aging in place and need help in caring for themselves. The first is formal, which means that a paid professional takes care of the older adult.

The second type is an informal caregiver, which covers many of the same responsibilities and, in many instances, more than a formal caregiver but is not paid for their caregiving duties. The typical informal caregiver for seniors is a family member, or someone in the older adult’s close social network, or in some cases a roommate. [Link to On-page menu section of “How do people get paid to take care of family member?”]

To find more about what benefits are available to you, the National Council on Aging (NCOA) provides a BenefitsCheckUp, which offers a comprehensive, free online tool that connects older adults with benefits they may qualify for.

Companions vs. In-Home caregivers vs. Home Health Care

To ensure that the home is safe for an older adult, the physical environment is not the only issue that needs to be addressed. For example, thinking through how social networks will communicate with each other, realistic transportation options, how grocery shopping will be done, as well as housekeeping, are just a few considerations that will need to be built into an Aging in Place plan.

The good news is that every county in Colorado has a network of resources that can help older adults to remain in their homes. Some resources are free community-based services available to all seniors regardless of income and some that you will need to pay for. In addition, there are resources just for those who are low-to-moderate income or disabled.

If an older adult needs a significant amount of care and there is not a network of family and friends to help out, consider hiring a professional caregiver. Here are the different kinds of in-home care options:

Care Companions: Provide company for an older adult who lives alone. These senior companions, as they are sometimes called, might spend time talking with or playing cards with their older adult clients. They can also take them out to enjoy a meal at a restaurant, bring them to a local museum, or even take them to a doctor’s appointment.

In-home caregivers: These caregivers are considered “non-skilled,” meaning they cannot provide medical care, but are available to help older adults with activities of daily living or ADLs, that includes everything from personal care like toileting to bathing to grocery shopping and house cleaning.

Home health care: These skilled caregivers are provided under a physician’s order. The care is short-term and is delivered or supervised by nurses and therapists (physical, occupational, and speech). This type of care is typically, but not exclusively provided while someone is recovering from a serious illness, surgery or accident.


In-Home Care Cost per Hour and Service Comparison

Care Companions

Who: Trained but not “certified” aides
Provide: Companionship plus errands, getting a meal ready, taking on outings, grocery shopping, etc
Get Started Look for companions; specify that you don’t need personal care such as toileting or bathing
Cost Average cost is $18 to $25 an hour if 3 or more hours are contracted for per day








In-Home Caregivers

Who: “Non-skilled” caregivers such as CNAs
Provide: Toileting, bathing, and personal care in addition to what a Care Companion does. Cannot provide medical services.
Get Started: Look for agencies that provide “Non-medical” care
Cost Average cost is $20 to $30 an hour if 3 or more hours are contracted for per day


Home Health Care

Who: Nurses and physical, occupational, and speech therapists
Provide: Evaluations and medical care or therapy under a physician’s order, usually for short term (6 – 8 weeks)
Get Started: Start with your doctor because you’ll need a prescription for both an evaluation and treatment
Cost Average cost is $22 to $35 an hour. Cost may be covered by insurance or veterans plan. The evaluation is often covered or free. 


Respite Care

Who: The qualifications of the respite caregiver will depend on the complexity of the situation
Provide: Relieve the caregiver for anything from a few hours to weeks
Get Started: Contact these organizations: Colorado Respite Coalition (CRC), National Respite Network and Resource Center (ARCH)
Cost Costs averages $100 to $250 per day, depending on the amount of care needed


Get paid to care for a loved one

Who: Once trained, you provide the same services as non-skilled care
Provide: Toileting, bathing, and personal care in addition to what a Care Companion does. Cannot provide medical services.
Get Started: Look for agencies that provide “Non-medical” care
Cost Training to become a CNA is $200 to $400 although some agencies provide the training. After training, salary is $12 – $20/hr. People needing care pay an average cost of $20 to $30 an hour if 3 or more hours are contracted for per day


Adult Daycare

Who: As an alternative to in-home care, provides services in their location
Provide: May include transportation, meals, socializing, exercise, and limited medical services
Get Started: Ask your Area Agency on Aging for local programs
Cost Approximately $25/day

In-home care vs Assisted living: A Cost Comparison

It’s also worth noting, that if an older adult needs professional caregiving it might make sense to do a cost comparison of in-home care vs. care in a senior living facility. A good resource to look at to understand the costs of higher levels of care is Genworth. Genworth sells long term care insurance and also provides a Cost of Care Survey tool that can calculate the cost of long term care across the U.S.

Knowing the cost is a first step to helping you plan for it. For example, according to Genworth, for 2019 the average cost of assisted living in Colorado was $4,095 per month, while a nursing home semi-private room was $8,197 a month. Understanding the cost of higher levels of care often helps an older person and their family get a better sense of what they can afford and therefore create a realistic plan as to how and where they want to live.

Informal Caregivers

Informal caregivers are people from all walks of life with many commonalities when it comes to the caregiver experience. For example, many face decision-making challenges stemming from financial stress and caregiver burnout are among the challenges that caregivers face.

Informal caregivers watching over seniors are far from alone. In fact, it’s estimated that over 40 million adults in the U.S. serve as caregivers: made up of relatives, friends, and neighbors who provide unpaid care to older adults in need.

In addition to your local Area Agency on Aging (AAA) there are other good resources to help you find the services you or your loved one need such as United Way 2-1-1, senior centers, and other local non-profit and for-profit organizations. Many professional in-home care companies can also provide resources regardless of whether they are doing the actual care.

How do people get paid to take care of a family member?

There are certain situations where an informal caregiver who is a family member can get paid for their work around caregiving. Payment may come from a long-term care insurance policy or the parent. However, in order to qualify the payment must be handled through an in-home care company that hires the family member as the caregiver.

If the parent or another family member is on Medicaid, and the adult child lives with them, then organizations such as PASCO, which provides comprehensive services to people needing assistance with ADLs, can help. To become eligible, the adult child is first trained to be a Certified Nursing Assistant or CNA, and then they are hired by PASCO or a similar organization to provide paid care to their loved one. For more information about how to get paid to be a caregiver for parents or another member of your family, visit PASCO.

There are also two waivers provided by Health First Colorado (Medicaid) that allows an individual to stay in their home and have a family member or non-related person become a paid provider to implement services as a Direct Service Provider.

Respite Care Offers Short-Term Relief to Help with Caregiver Burnout

Respite care provides short-term relief for primary caregivers. It can be for just a few hours, or even a few weeks. It can also be a planned or an emergency. It’s important for caregivers to have some time for themselves and respite care allows them to do so while at the same time ensuring that a loved one is being well cared for.

Fortunately, Colorado has a number of resources both free and paid that can help address caregiver burnout through respite services. These resources include:

Colorado Respite Coalition (CRC) is an allied group of families and community partners who have joined together to strengthen and preserve Colorado families who are caring for individuals with special needs. The CRC works to improve the lives of Colorado families by supporting current respite care options and facilitating the development of new, safe, and affordable respite care choices.

ARCH National Respite Network and Resource Center
The ARCH National Respite Network includes the National Respite Locator, a service to help caregivers and professionals locate respite services in their community, the National Respite Coalition, a service that advocates for preserving and promoting respite in policy and programs at the national, state, and local levels, and the Lifespan Respite Technical Assistance Center which is funded by the Administration for Community Living in the US Department of Health and Human Services.

Adult Daycare Can Provide a Nice Break for Caregivers and Older Adults Alike
For those that need an alternative to full-time in-home care, Adult Daycare Programs can fill the bill. They can offer supervised support to an older adult including those with dementia or who otherwise need additional care and attention.

Many adult day programs offer assisted transportation, at least one hot meal, and opportunities to socialize with others. They also provide for activities ranging from painting to trivia games to fitness and movement activities like stretching and chair exercises. Some centers even provide a limited range of health services. For more information (link to AWC XX page).

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