Assessing the Quality of Care

Though the comfort and financial advantages of home care sound attractive, you may have some doubts about whether the quality of home care compares to the qualify of care in a nursing facility or other elder residence.

Medical and nursing care. The American Medical Association, the American Hospital Association, the American Nurses' Association, and the U.S. Department of Health and Human Services all stand behind the quality of medical and nursing care delivered by home care agencies that are certified by both Medicare and your state's home care licensing agency. So, when medical or nursing care -- as opposed to assistance with nonmedical activities of daily living -- is a significant part of the home care you need, you should seek help from certified agencies rather than independent caregivers. Also, ask your doctor whether the medical or nursing care you require can be safely and adequately delivered at home.

Nonmedical care. Most of the care people need at home is not medical or nursing care, but help with what are called the activities of daily living (ADLs). These include bathing, using the toilet, dressing, eating, getting in and out of bed or a chair, and walking around. For people with Alzheimer's or other cognitive impairment, home care may consist primarily of making sure that the person does not become lost, disoriented, or injured.

For these kinds of nonmedical assistance, home care is often better than residential care. Home care is provided one-on-one, whereas residential facilities have staff-to-resident ratios of one-to-ten or more. And by choosing and monitoring a home care agency or individual home care providers, you may be better able to control the quality of care you receive. On the other hand, tracking the effectiveness of home care is primarily up to the family, whereas residential facilities have professional staff members who are supposed to check regularly on the quality of nonmedical care provided.

Home Care May Not Last Forever

Even if home care is a workable alternative, it may not remain so. Physical needs change over time; home care that now works well may later become impractical. For this reason, you may want to begin planning for the possibility of residential care at some later date -- especially if you or your family member is facing Alzheimer's disease or some other form of dementia.

Your planning should take two forms. First, get to know the kinds of residential facilities in your area. At the same time, begin to consider how you might pay for residential care. If it appears that Medicaid may be an option, explore ways to protect some of your assets while still qualifying for Medicaid coverage.