by Attorney Joseph L. Matthews

The benefits of home health care are great, but it's not always practical.

In recent years, more and more elders are turning to home care to meet their personal and health care needs. This trend is particularly welcome in light of public health surveys indicating that up to half of all nursing facility residents could live independently if they had adequate and affordable home care services. And other studies have shown that the longer people remain independent from institutional care, the better their overall physical and emotional health.

Home care may be adequate and affordable for an elder who needs help with some physical movements around the home -- bathing and getting meals, for example -- or with exercise, physical therapy, or monitoring a chronic health condition.

Unfortunately, though, long-term home care is not always a practical solution. If the elder needs extensive medical treatment or close monitoring for many hours each day, the difficulty of arranging different types of care may make home care impractical -- and the cost may become prohibitive. In most cases, long-term home care also requires family members to fill in gaps that the outside care services do not cover. For many people without such family assistance, long-term home care is simply not an option.

Not everyone using home care will need all of the services available. And of course, not every community will offer every possible service. Even if they do, a single program or agency might not provide everything the elder will require. Additional needs may have to be filled by community agencies or organizations, adult daycare or senior centers, individuals hired through informal networks, and family and friends. Geriatric care managers can help establish a home care program for elders who require a mix of different types of care -- different services from different providers.

On the other hand, for home care to work well, you and your family must take the initiative to find services, coordinate different programs and personnel, monitor home care needs and performance, figure costs and budgets, and make changes when required. And you and your family will be making all these decisions without a professional institution to help. This decision-making responsibility can add an extra burden to the daily task of meeting the elder's needs for physical care.

For some people, remaining at home isolates them from social activity and limits mental stimulation. Although friends and family often intend to provide lots of companionship, too many elders wind up spending their days in bed asleep or watching television. An organized elder residence, on the other hand, offers both a community of people and a constant stream of activities.

However, home care often becomes more expensive over time. Home care needs may become more extensive or complicated, and family members may not be able to pick up the slack, which could require additional paid care and services. Sometimes, hidden expenses make the true cost of home care too high. Families often fail to calculate peripheral expenses: the continued or expanded cost of running a home (such as taxes, utilities, insurance, and maintenance); the cost to family members of transportation and missed work; and the costs of temporary workers to fill in when family members can't make it or when regular care falls through.