When is the Right Time for In-home Care?

When is the Right Time for In-home Care?



Children with elderly parents or loved ones are often caught unprepared when it’s time for their parent/s to receive in-home care. Loved ones often wish to retain their independence though they are struggling to maintain activities of daily living (ADLs). They do not want others to know that they have been struggling and may not share their difficulties with the family. When calls are made to check on them you get the pat, “I’m fine.” answer.

Often, the need for in-home care arises quickly and unexpectedly (often an emergency precipitates the need such as a fall or an unexpected surgery) and it can be difficult to assess. While you do not want to force loved ones to make changes they are not comfortable making, still you need to be sure that they are safe and healthy in their current situation.

Recognizing when it’s time for in-home care and being prepared for it can help to reduce the stress on you and your loved ones resulting in the decision making being much less challenging.

Signs of the need for in-home care

Some of warning signs that it may be time for in-home care for your parent or loved one include:

Sudden weight loss:

This may indicate the elderly person is not able to provide enough nourishment to keep them at an ideal weight. Or is not motivated to cook nutritious meals for her or himself. This is especially true for someone whose spouse has died and now lives alone.

Injury marks:

Bruises or scrapes may be an indication that the individual is falling or may be unsteady on his or her own feet. We use three senses to keep our balance, our eyes, our inner ear, and our feet. All of these send signals to the brain keeping us balanced. Poor eyesight, hearing problems, or problems such as neuropathy affecting the feet cause the loss of balance. Falls are the number one reason for hospitalizations of seniors.


You may be concerned if your loved one is forgetting appointments, forgetting to pay bills, or consistently forgetting his or her address, phone number, etc. We all experience a momentary lapse of memory, but we don’t forget where we live, or what we ate for dinner last night, or whether or not we’ve been taking our medication. (Add some of the warning signs provided by the Alzheimer’s Association here.)

Lack of personal hygiene:

Some elderly people will stop bathing or brushing their hair or teeth regularly because they forget to do it or it becomes too difficult for them. Everyone needs to bathe regularly and take care of themselves. Our skin and hair needs regular cleaning in order to keep us healthy. Not doing so results in health problems such as skin rashes, possible infections, and other types of skin breakdown. Lack of oral hygiene is also a problem, resulting in tooth decay or gum disease. Both of which can have serious health consequences.

Household chores go undone:

If you notice dirty dishes stacked up, a lack of clean clothes and a dirty, unkempt home, this can be a sign that your loved one is having trouble completing their housework. This can cause remaining in the home to be unsafe. As we all know, a home needs at least light housekeeping done in order to keep in functioning properly. Having an aide who helps with these tasks can make difference between staying safely at home or not.

Disorientation or bizarre behavior:

If you notice unusual behavior from an elderly individual, do not ignore it. It could be the result of a health condition or possibly over or under medication. It is important to note that not drinking enough water frequently results in a urinary tract infection, particularly in women. A UTI causes the elderly to become emotionally upset and angry. A stroke or a “mini” stroke can also cause changes in behavior. These are serious signs that a doctor needs to check for in someone.

ADL/IADL Checklist

To further help make the determination, the attached ADL and IADL checklist provides a number of activities that parents and loved ones should be able to complete daily to ensure their ability to live independently. As their primary caregiver, assistance in completing theses tasks may start off small, but quickly escalate until servicing and assisting with all of their daily needs is no longer feasible. That is when seeking in-home care becomes a good choice for you and your loved one. Click here for Checklist:

Having the Conversation

Making the decision to move toward in-home care for a loved one is a delicate one that requires honest, careful conversation that adult children of elderly parents have to have. If you are the Health Care Power of Attorney or Legal Power of Attorney for someone then you have accepted the responsibility for ensuring their well-being when they can no longer do so. Though we want to do what’s best for our loved ones, remember it is their lives and they will be directly affected by the decisions. More often than not people want to stay in their own homes, choosing in-home care keeps them as independent as possible for as long as possible. Home care is less expensive on average than other options, and more importantly when you choose in-home care your loved one is getting one on one care, versus an assisted living or other type of facility where they will be one of many people that an aide has to assist that day or shift.

Financial Considerations

According to the Federal Long Term Care Insurance Program, the national average annual cost of in-home care is $19/hour or $29,630/year (based on 6 hours per day, 5 days per week). Yet this cost is significantly lower than the national average cost of either an assisted living facility ($41,124/year) or a nursing home with a semi-private room ($82,855/year). Studies have found, in fact, that in-home care is preferable to a loved one being placed in an assisted living facility or a nursing home. Of course, paying for care out-of-pocket ensures that loved ones can receive the exact services that they require.  Yet, the cost of in-home care can still be prohibitive for many families.

However, there are other ways to fund the cost of in home care such as:

  • Long Term Care Insurance
  • Medicaid and other public benefit programs (if eligible)
  • Program of All-Inclusive Care for the Elderly (PACE) which includes home care
  • Veteran’s benefits such as Aide and Attendant Care
  • Paying a family member to be the care giver (some Medicaid programs and home health care agencies allow this).
  • Adult Daycare Centers

Finally, consulting with an Elder Law attorney is an excellent way to help find the right solution for an elderly parent or loved one. Elder law attorneys are specifically trained to assist with estate and trust planning, applying for Medicaid, powers of attorney, assistance with VA benefits, Alzheimer’s planning and Hospice planning. Exploring all of your options before in-home care is necessary, will offer peace of mind and be a less stressful process for you and your loved ones.

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