About stealing: Working with a licensed and bonded agency may help in vetting caregivers... and I've been presented with some very marginal candidates, and at a high cost. Many come from very difficult situations and are functioning at survival themselves. Many years ago when my mother was going through her slow dying process from an inoperable brain tumor, and wanted to stay at home, we got two caregivers per week on 24 hour shifts. Mom played one against the other, favoring the weekday nurse.... who ended up robbing her blind, making charges on her credit card, manipulating her into signing personal checks for her, and Mom's treasures began to disappear. The premise that an agency is protection is a fallacy to try to give us some reassurance. Stay aware.

Taking care of a elderly loved one is a big challenge for many of us. For such people have one option i.e caretakers. They will take care of our loved ones.

This not true for many of us. We want the best for our parents and do not want them to outlive their savings. Many cannot afford to pay for their parent's care when that happens. There's a balance and we do very much love and care for our parents. It's sad that you've experience this from family members.

Please look up your local Area Agency On Aging . State Home Care available on sliding scale payment. Check with local Senior Center for contact.

Mom had home health care for limited periods after falls/breaks until she finally needed daily care after a fall three years ago. At that point, she started out with 3-4 hours in the morning to help her get up and showered, dressed, fix meals, do laundry and light housekeeping. As her physical mobility has decreased and risk/incidence of falls has increased, she now has CNAs 24/7. Sometimes and aide's personality/style of care differs with Mom's, and we've asked to have the aide taken her off the schedule. Fortunately, Mom has regular (5 days) CNAs who really are dedicated to her care. It's not cheap (average $24/hour), but Mom is determined to stay at home as long as possible. She was in a NH for a month after a major fall and hated it. She's too frail for even the highest leval of AL. With private caregivers in the home, she doesn't have to wait for more than a minute or two for someone to help her to the bathroom, get a drink of water, or get her something to eat. We've engaged through a home health agency, and all the aides are, at the minimum, CNAs (some higher level), bonded, etc. As I live 400 miles away, I visit Mom for a week or so every month, cutting the CNA hours back to 3 hours in the am for help in bathing and dressing (also so I can get out for a walk or jog). I cook and bake a lot to fill up the freezer so she' not eating institutional or microwave meals. Even if you can only afford the minimum of 2 hour shifts a few times a week, it's well worth it, especially if you are a full-time homegiver, so you can get some "me" time. BTW, the agency insists Mom not keep a lot of cash in the house and the CNAs are to use store gift cards to buy groceries, both for Mom's safety and to avoid the CNAs of being accused of stealing (we all know older people with some level of declining mental ability can forget where they put things or make false accusations).

I take issue with this. As the full-time caregiver of my elderly mother, I spend hundreds of dollars every month bringing in a caregiver from a so-called "reputable" agency to provide me with respite and my mother with some new/different people in her life. The agency is only interested in getting their money. The only attempt they make is to find someone who can do the schedule I need. I pay a high dollar for what should be quality care but is just low-end help w/people who don't like what they're doing & don't give a whit about my Mom.

[cont.]
2. Theft from recipients: Absolutely this is an issue, even with "reputable" companies employees. It's a problem in facilities, and it's a problem with home care employees.
3.& 4.&7&8: Hiring only for those very sick, or very old? Maybe they do offer up to 24/7 home care...but try to get it!?? And extremely costly--it should be the other way around: It SHOULD be cheaper to have home care, than facility care. Simple care is available, but, it is often not covered, unless a patient reaches a certain level of needs, THEN they can start getting help. At the other end of the spectrum, getting 24/7 home care is generally disallowed, because when someone nears need for 24/7, they get told to move the person to a facility for that level of care....unless the person or family can afford to pay out-of-pocket--then, sky's the limit!
5. "No say in who comes..." This is rather more true than false. Usually, because most areas outside larger Urban areas, lack staffing, and/or, the staffing they have, most appear as though they should be in the bed, not the patient! Not much choice.
6. "Quality of home care vs. Facility care..."? Home care is too often done by poorly educated impoverished workers desperate for a job, or being rehabbed, etc. They don't listen well in class, or if they learn proper techniques, they fail to keep doing them with patients in home-care settings. Care quality at Home, can suffer, because workers are not closely supervised, so feel they can get away with cutting corners, or perusing the house to see what looks likely.
9. It IS Costly!!!!
One lady I know, lives in Assisted Living [in CA], but assigned to an Independent care room [to help her feel like she still has a smidge of autonomy left]. It costs her over $7000 / month, paid for by various funds and insurance. And, she's running out of funds to cover it.
EVERY facility the family checked [including 4 facilities the woman has been successively moved to in the last 2 years], have similar costs.
Even a board/care home in a more rural city, with only a handful of boarders, would have cost around $6K monthly, and no safety net in case she needed a higher level of care.
10. If a family member is sole caregiver...they absolutely need help!

One thing to remember if you hire a caregiver who isn't from a licensed Agency, you need to add a "workman's comp" rider to your homeowner's insurance.... in case that caregiver gets hurt on the job. Your regular homeowner's coverage might not cover for an "employee".

1. "They don't care..." Maybe they do care; however, it appears they don't, because those sent to do evaluations, usually miss things that would qualify the recipient for more care-hours, and/or, more care helpers. This results in recipients NOT getting the appropriate care they need, to help them age-in-place. This recently happened to one of my clients, who had her hours cut to about 44 hours per month, but she really needed nearly double that or more. Trouble was, the evaluator came on a day when the lady, at cursory view, APPEARED to only need that few; the evaluator failed to LISTEN to the recipient describing her usual situations.

If the family is on a limited income, they have no option but to get the least expensive care available.

24 hour a day coverage at $20 hour comes to $14640/month vs $3600-5000/month in assisted living community. Even care provided by a non-agency person would be about half of what agency charges but it would still be more than what ALF charges. Many families do not qualify for any of the programs shown nor do they have long term care insurance.

I've been using in-home care for years and here's my experiences.

#2 My mother's wedding rings were stolen when we first began using a "reputable agency". She had other valuable jewelry in the house as well, but the thief chose to take her wedding rings. Since Mom was beginning to have memory loss I thought she'd just misplaced them. For me it's heartbreaking every day, at least for her she doesn't always remember.
#5 When using an agency we've always met the care giver first BUT never received the care giver we met. Something always came up that made the one we met not show up and a replacement be sent. No way to refuse/change services at that point. You basically take who you get and are happy someone shows up.
#8 & 9 The info is somewhat correct. Some agencies do provide 24 hour care - their hard to find and even more difficult to keep the same consistent workers. If 24 hour accompaniment is required, but not 24 hours hands on care, some agencies provide a lower cost (less than $20 an hour) for live-in services as long as the caregiver is able to sleep 8 hours and have time throughout the day for themselves. But no matter what it still costs way more than assisted living for 24/7 in-home care.
I've found a reliable independent person to provide care so I can have weekends with my husband. She accepts $10 an hour. That means Mom's paying $720 for a usual weekend (10a Friday to 10a Monday) - or about $3000 a month and that just covers weekends. Assuming the author's suggested price of $3600 a month is correct, that's a big savings when you consider it's full time (not just weekends as my $3000 example is) and includes food and all the costs of home ownership.
I do completely agree if you're providing care to a loved one, you need time off to recharge. Although finding and keeping reliable, trustworthy in-home help it's a tough job it's worth it.

The cost for at home care in the large metro areas will be much higher than smaller towns.

And for Assisted Living and Nursing Homes, some areas use those terms to mean the same thing. In my area each one is different with a much different cost.

When my Dad [94 at the time] needed caregivers due to him being a fall risk, I hired from a national chain since they are licensed, bonded, insured, and had workman's comp in case a caregiver got injured on the job.

I had excellent luck in finding caregivers that were a good fit for my Dad. The cost was expensive at $30/hour [$720/per day] but Dad had saved for such a rainy day.

Dad's caregivers made the meals, did the laundry, light housekeeping, took Dad for walks, took Dad to his doctor appointments, etc. They even made sure when Dad was on the telephone that he wasn't talking to someone who might scam him... and they wouldn't let anyone in the house unless Dad said it was ok.

The day caregiver would take Dad to visit my Mom who was in long-term-care and the caregiver scheduled it to be there when lunch was being served so that she [the caregiver] could help feed Mom. This was going up and beyond her scope of employment :)

Not one thing was ever missing, and my Dad had a habit of leaving his wallet sitting out [I always checked and the same dollar amount was always in there] and leaving out his check book [no checks were ever missing]. Eventually I took over the finances because Dad wasn't paying his bills, so I dragged all the paperwork and checks home.

Maybe for thoughts who have the money to pay for top professionals you'll get great help, but low income families do not get what has been written.They get the concerns.

Just for sitter services (no hands on care) is $20 an hour. I had to almost quit my job to care for my mom because I would lose money going to work. There is no way I can live with myself putting her in a nursing home. I'm still glad I have my mom though. Everyday I am thankful she is still with me. She's 87 with advanced Alzheimer's.

A sitter is about $20 an hour--they do nothing but sit. No hands on care. A CNA is about $40 an hour. If your loved one is on medications, that's a home-health nurse visit because a CNA is not legally allowed to administer any kind of medications (that's practicing nursing without a license). Home health is very very expensive, even just for a sitter. While there are volunteers, that increases the likelihood of abuse or theft.

Have You checked Hospices. Alzheimer's qualifies as a terminal Diagnosis & funds exist. She could have home care or go into a decent Alzheimer's assisted living. Good luck
Case Mgr for Hospice

My mom lives with me in Northwest Ohio. i am her 65 year old son and Legal Guardian .She is 90 years old with Alzheimer's. I have not been able to work for the last year because of agencies under the Area Office of Aging and Ohio Department of Agings Passport Program cannot or will not staff the rural area we live in. I have dealt with four different agencies. Out of nearly 30 aides maybe 3 or 4 aides were trained properly to be with an Alzheimer's patient and they where only one day temp help. Now I'm being forced into the Consumer Directed Program wear it takes a minimum of 3 months for an aide to be qualified to work in the home. And there's no guarantee that person is any good. So as far as the article #1 I have had aides who have just sat and ignored my mom even with me in the same room with them. #2 aides fix food my mom can't eat. So they eat it.Is that stealing? I don't know. #5 agencies send anybody they can find or nobody at all. #6 In my case the agencies did not come up with properly trained aides. The good aides went to the families who paid out of pocket. #8 In our case the day care did not have enough " experienced professionals" on hand and passport does not pay for 24 hour care. #9 I cannot afford to pay $20.00 dollars an hour 5 days a week. And finally every aide I had come into my home,as soon as they saw that I didn't have to work they wanted half the day off. It didn't matter what I needed to do they had some kind of excuse to go home early. So in my case this past year has proved to me that most of the concerns still do live on in reality. RTB

I won't get into the details of Medicaid eligibility because they are very complicated, but the idea that an elderly person has to be "destitute" in order to be eligible for Medicaid is false. As one example of the applicable rules, a person can have up to over $500,000 in equity in their home and still be eligible to receive Medicaid for long-term care. Sure, the program is complicated to sign up for and there are, indeed, waiting periods in many instances. But the waiting periods are largely due to demand. Meaning, other then wealthy folks who pay out-of-pocket and those who had the foresight (and the money) to get long-term care insurance, Medicaid is the way that the rest of the elderly in America pay for professional long term care services whether in a nursing home or at home. I just don't want anyone reading this to be dissuaded from seeking Medicaid benefits if they need it as a means to pay for services.

Good article, but that national median number of $3,600 is misleading. How about a range instead, like $3600 up to $? I found that 24/7 minimal skill home care cost twice as much as a rehab or assisted living. Here in Southern California, that room, excluding board and care, can run from $6000 to $15000, for a rated facility. As to Medicare or Medicaid, find this out first. Big difference. Do your research.

I have extensive experience with homecare vs assisted living and these are all good points. When mom moved to assisted living,24 hour care and meals and snacks were included . 35 hrs/wk of homecare was 2700 dollars/month plus groceries. Assisted living was 3300/month for day/night care and then minus groceries , easily making assisted living the better deal. The choice is not as black and white as it might look

I have had to hire privately, 24 hr caregivers and it IS expensive unless you settle for just your neighbor down the street to sit with your elder person. That MAY work fine, but usually doesn't because they are NOT skilled in what to observe and could potentially be a problem for your elder. You HAVE TO TAKE AN ACTIVE role in the overseeing of anyone coming in to the home, ALL the time. Therapists are a HUGE benefit, but the every day living requirements and attention does NOT fall into that category and IS VERY EXPENSIVE. If you choose to follow state LAWS on hiring you almost have to become a business and match taxes, provide Work Comp, etc and THAT ALONE is time consuming as well as expensive at the end of the year. ANYONE demanding 'cash' isn't there FOR your elders benefit but more for their OWN financial gain and I suggest you be VERY WARY of them. Also, making SURE the vaulables are NOT present helps a lot. Eliminate the hazards of too much furniture, too many knick knacks and things that could prevent easy movement in the home FOR THE ELDER and take out all the heirlooms that have value (whether its monetary value or emotional to the family) and you are ahead of potential issues of theft or damage. It can be overwhelming to prepare but well worth it for the elder persons SAFETY and protection. Also, pop in OFTEN and unnounced. Go at all hours and days and do not stick to a 'schedule' so you get a realistic picture of what REALLY GOES ON. Talk often to the elder, in PRIVATE and really listen to what they TELL you they 'see happening' and then talk privately with the caregiver too. See THEIR take on what is going on. You can tell more from a casual conversation than if you 'grill them' about the misplaced statue or expensive earrings that Aunt Tilly hid in the hankerchief drawer.

Interesting, the $3,600 a month figure. This is about the lowest available in my area, but additional services add up quickly. Extra for laundry, extra for holiday meals (even father's day) just for starters and this is for the smallest unit available. And that is assisted living. Now, if you want to talk memory care. This same facility charges $6,500.00 a month and includes standard items like laundry. But, imagine, if your mom with dementia is moved into a memory care facility, naturally she is going to be extremely disoriented, so becomes combative. The facility is certain they can provide the level of care needed. So, they request an outside caregiver as a 24/7 companion for a period of time. In our case it was nearly six weeks. At $20.00 an hour, a whopping $13,000.00 a month in addition! And the reason mom was moved? Facility is cheaper that remaining in her home! And through the POA determination that a facility is cheaper she failed to take into account that there were two elders being cared for, and they would have to be in different rooms at the facility. So, the monthly cost for the two of them 24/7 at home at the $20.00 rate would have been the $13,000.00, which would actually be less since a discount is applied for 24/7 care. Facility cost for one assisted unit and one memory care unit, about $11,000.00 a month, that is before any additional for outside caregivers. And where is the cost benefit analysis? What is the value of having one on two care vs one on six or seven or nine or even more that is found in most facilities?

That's fine and dandy but what if you have a parent who is in denial and refuses home care. I tried respite relief and the agency was great, the worker was well suited to her personality and needs, but mom's obnoxious and antisocial behaviour became far more stressful for everyone concerned, so we had to cancel the services. The agency even adapted to having no housekeeping assistance, which mom refused, and reducing the mandatory hours from 3 to 2, twice instead of three times a week. Home care only works if the person is willing to allow it - client self determination - and many are in complete denial of their illness and how it incapacitates them.

I don't care for statements in this article regarding statements of 24 hour availability and the cost of home health care solutions. In our case it would have been more expensive to have 24 hour availability. Not that many places offer. And why would you direct someone to reverse mortgages. This option should not be just thrown out there as a solution when it needs so much research to see if it was a good fit for seniors. In addition, Medicaid is not easily available and there are so many conditions that very few qualify for it. Ones who do also live with the fear that their houses will be taken away in order to recoup the cost of providing care.

Just to add on: I personally know a family whose mother died at 105 years.
She had a million plus dollar home on a lake. She had a professional caregiver to drive, cook and clean that lived with her. (Yep, the caregiver stole). She died nearly 3 years ago. The family has been embroiled in lawsuits which continue. The will was very specific as to what the 5 family members would get, but wills are easily contestable and so one sibling decided to contest. The other four were happy with the distribution. So the battle goes on as of this writing with no end in sight.

Well, let's do some math!
Home care: $20/hr X 24hr/day = $480/day. $480/day X 30 day/month = $14,400/month
Assisted Living: $3,600/month
24 hrs/day X 30 days = 720 hrs/month $3,600/720 = $5/hr
$14,400-S3,600=$10,800
Then take out home maintenance; heat; light; water; property taxes, etc and you have a huge difference in costs.
Of course you only have one bedroom, but most assisted living facilities have swimming pools; exercise rooms; dining rooms; social activities, ect.
It may be more desirable for many people to remain in their home of so many memories and keep the many artifacts they have collected over the years, but it is a far more expensive decision.
Then again, it is much easier on the children. The estate is divided up with no contest, and the house is sold. The person only has a bank account to be split according to a simple will. Assisted living facilities usually require funeral arrangements to be made, so if someone dies they can remove the person immediately.
I have seen children take months to clean out a parents house and put it up for sale.
So, assisted living vs home care? No contest.

It's nonsense, even in lower COL states you're looking at about $5K a month.

Wonder where Genworth gets their numbers. certainly not in major metropolitan areas where assisted living homes charge predatory pricing of 6-7 thousand per month. As for round the clock in home care here in Chicago agencies are getting as much as $375 a day.

Agencies charge $25-45 for a worker who is getting paid $8-$11.50/ hr (real numbers, BTW). So -- who exactly do you think is willing to work for minimum wage? The best & the brightest? The highly trained?
Or the is it those who have fallen on hard times or don't have other marketable skills? This isn't to belittle those who have caring as a calling, or find themselves working for an agency, but probably better if at all possible to hire better caregivers directly and pay them a reasonable wage.