3 things to know when hiring home health aide

Carol Blackwell prepares to fill a bird feeder with her husband, Bob, during her daily visit to see him at the Great Falls Assisted Living facility in Herndon, Va., on Sept. 25, 2012.(Photo: Doug Kapustin for USA TODAY)

Story Highlights

• Figure out if you need an assistant or a home health aide
• Home health will cost a great deal of money
• Always have a backup plan if your provider can't make it

In 2012, some 58,500 paid, regulated long-term care companies served about 8 million people in the U.S., some 4.7 million of whom received that care in their home. And more often than not, experts say those receiving that care – be it one, two or all of the basic activities of daily living – didn't know the first thing about hiring a home health care provider.

So what do you need to know should you ever need the services of a home health care provider?

Get smart

First, knowing whether you need home health care is a good start. Licensed home health aides provide hands-on personal care, but not medical care, in the home – activities such as bathing and dressing. If all you need is help with cooking and running errands, you might be better off hiring homemaker services, also referred to as personal care assistants or companions.

If you do need a home health care provider, consider this hurdle. Thousands upon thousands of firms provide licensed services, not to mention many firms providing unlicensed services. There are at least 12,206 home health agencies in the U.S., about 76.1% of these agencies were Medicare- and Medicaid-certified, 22.5% were Medicare-certified only, and 1.4% were Medicaid-certified only, according to the National Center for Health Statistics' report, Long-Term Care Services in the United States: 2013 Overview.

When searching for in-home care for yourself or an aging family member, Linda Fodrini-Johnson, the founder and executive director of Eldercare Services, a Walnut Creek, Calif.-based home care company, recommends applying this screen: Look for a licensed care agency that has at least five years' experience and meets all the state's licensing laws.And, she says, "Be sure they have a clear agreement for services to sign before starting services."

When vetting an agency, also ask about the training that staffers receive, Fodrini-Johnson says. "Ask if the agency provides training and if you have a family member with dementia – are the care providers trained on how to work with someone with memory and behavioral issues?"

Several resources to use when searching for a home health care provider include Medicare and Home Health Care, a pdf published by the Centers for Medicaid and Medicare Services, and the consumer resource section of National Association of Professional Geriatric Care Managers' website (www.caremanager.org).

Make sure you have enough money

Medicare, assuming you're a beneficiary, will pay for you to get certain health care services in your home if you meet certain eligibility criteria and if the services are considered reasonable and necessary for the treatment of your illness or injury. But Medicare won't pay for personal care given by home health aides such as bathing, dressing and using the bathroom when this is the only care you need.

Given that, you'll likely have to use cash flow, or assets, or both to pay for home health care. And that can get to be expensive. "Extensive home care services are very costly and can easily exceed the cost of care in assisted living and skilled nursing facilities" says Dr. Katy Votava, the president of GOODCARE.com, a Rochester, N.Y.-based consulting firm that specializes in the economics of health care.

For instance, you'll pay on average $19 an hour, or $44,479 per year, for licensed home health aide services, according to the Genworth 2013 Cost of Care Survey. But hourly rates do vary from state to state, and even in-state. Consider: In Florida, home health services range anywhere from $12 to $28 per hour, but in California, the range is from $16 to $30, according to Genworth's survey.

Note carefully: You'll likely pay less per hour if you hire from an agency that doesn't pay all the taxes and insurances for its home health aides. But if you go that route, know this: "You have liabilities," Fodrini-Johnson says. "Your employee is actually a 1099 employee so you should provide some type of 'Worker's Compensation' insurance through your homeowners' insurance policy, for which you would incur a small additional charge."

If, by the way, you have and plan to use your long-term care insurance policy to cover home health care costs, Fodrini-Johnson recommends that you ask whether they have standards for the agencies they will reimburse you for. "Some have terms that say "home health;" others are much less rigid," she says.

It takes time

Even with adequate funds, Votava says home care takes time and effort to organize and manage the services. "Make sure you have someone who is willing and able to coordinate care on your behalf," she said.

If you don't have someone willing to coordinate care, and even if you do, Fodrini-Johnson says it's best to hire an agency with professional staff managing the in-home care workers, be they nurses, social workers and/or family therapists. "So, ask about the background of the owners and who is supervising the care providers," she says.

Establishing a backup plan for your home care services is another essential task for those hiring home health aides. Votava said one question to answer is this: If the home care worker is unavailable at the last minute, how will the person needing care get by?

Robert Powell is editor of Retirement Weekly. Email him at This email address is being protected from spambots. You need JavaScript enabled to view it..