How are others managing when paying for privately for assistance at home?

40 is more than most agencies charge even in the Bay Area. Interview other agencies .

Judycares, it is expensive to hire Agency caregivers. And yes, it is common for a caregiving Agency to have a minimum number of hours that one of their caregivers can work. Otherwise the caregiver would find it nearly impossible to arrange his/her schedule to work other clients to work a 40 hour week. Agency caregivers are licensed, bonded, and insured.

It can be hard to budget the cost especially if one wasn't able to do the old fashion "rainy day fund" which was popular back in the 1940's and 1950's.

Thank goodness we have Medicaid [which is different from Medicare]. Call your State Medicare office to see what is available for your State.

I have seen ads for Care.com that offer caregivers. You need to check to see if they are licensed, bonded, and insured.

Is your husband a Veteran? If so the VA has programs that can provide caregivers for some hours.
Have you checked with your local area Agency on Aging to see if there are any services that he or you may qualify for.
Have you looked into Adult Day Care programs. Some will pick up in the am and drop off in the pm giving you a good portion of a day to get things done for yourself. Some, depending on the program will shower the participant.
Check with the local Senior Center they may also be aware of programs or Volunteer services that might help.
Hiring privately will always be less expensive than going through an agency. There are advantages and disadvantages to both.
(The 2 best caregivers I ever hired were from the local Community College and had just completed the CNA certification and were waiting to begin the Nursing program that would start the next semester.)
there are services like Care.com that act as a "go-between" (for a fee) for people looking for services like caregiving, baby sitting, pet sitting.
The only caution that I have is that you make sure that background checks are done but even that does not guarantee that you will not have problems.
I also urge you not to "pay under the table" make sure that the costs involved with caring for your husband are documented and this also means that the person that is hired will pay taxes on the income.

I have looked into agency care but so far have managed with private pay. You have to keep looking until you find the right person.
Sometimes a housekeeper can be a more affordable source of help, freeing you up to do more of the personal care.
Also when your DH becomes difficult to take out, check into Home Health if you have original Medicare. They have a home bound benefit which will provide a weekly nurse, baths and therapy. Plus blood draws, urine tests. X-rays. Several things that are easier done at home. Your DH sounds like he could benefit from therapy now. Ask his primary to order an evaluation.
Also check with your County Area Agency on Aging. Look on their website for services they offer to both caregiver and the patient.

FYI, we're paying $36/hr for agency home health aides. Although they have a 4 hour minimum per shift, there is no weekly minimum number of hours. When we first started with them back about 4 years ago, they offered 2 and 3 hour shifts, but the cost per hour was greater. Now, they only have 4 hour minimum shifts. Right now we're having 3 shifts per week, MWF. We're very fortunate to have LTC insurance, however.

$40 an hour seems rather high, especially if you need to lock in for 12 hours a week.

In my state (with the highest cost of living), the place that we used was under $30/hour and it depended upon how many hours per shift and what was expected during the shift. There were 3 cost tiers: up to 4 hours per shift, 5-11 hours per shift, 12 hours or more per shift. The cost per hour decreased as the number of hours per shift increased. Minimum number of hours per shift was 3 hours with a commitment of 12 hours per week. The cost increased based upon the level of care that was expected. Nurses Aide cost less per hour than registered nurses (prescription meds). Bathing, cooking meals, driving to appointments were an add-on cost. (Housekeepers in my state make more than this per hour.) More commitment of hours per week lowered the cost per hour. Whether you are on a bus route or if they have to have a car to get to your place, made a difference too. Caregivers were not assigned to clients.

Licensed and bonded care givers cost more than unlicensed care givers. I recently looked at 2 other agencies and the cost was $34/hour (12 hours per shift 7 days a week and 2 assigned caregivers) and $35/hour.

For us, 9 hours per night, 7 days a week, plus a daytime adult care, plus food, property taxes, utilities, gas, and HOA fee (notice no mortgage), was more out-of-pocket than to put my Mom in MC. The plan is to rent her condo, which will allow us to make her money last a bit longer.

Look around. The prices vary a lot and the amenities differ considerably. Some automatically include a 21 meal plan and some had a 7 meal plan. Some included excursions, others didn't.

There are people in my Mom's MC ward, where 1/2 of the couple lives in assisted living and the other half lives in MC, in the same facility. The more able bodied of the couple visits the other, takes them out, etc.

While you are not strapped for cash, take a hard look at the out-of-pocket costs. That might help you come up with a plan for the future. If you are thinking that Medicaid will "save" you, don't count on having the same options, as many of the "desireable" places give preference to non-Medicaid, and have long waiting lists. Prior to COVID, waiting lists of 1.5-3 years was common.

Good luck to you. Its a tough, eye opening and exhausting experience.

P.S. Because caregivers cost less than housekeepers per hour, I was told of several instances where the caregivers were expected to clean the bedroom and bathrooms, do laundry, etc. as a caregiver. Those caregivers in the know, told the agency that they would rather not work, than be assigned to those places. Get a housekeeper to do dishes, clean bedrooms and bathrooms and closets, and rearrange the office and furniture. Some of them will even do your laundry. A caregiver entering the field, wants to care for people. If they really wanted to clean bathroom, bedrooms, etc, they would have gone into the housekeeping career which pays better.

The caregiver isn’t seeing 40. It’s more like 20. This may be uncool…but realistically, people get by on paying indy caregivers under the table all the time.

You're wise to think of this now because you will reach a point when you no longer can care for him, and for me, home health care was a godsend.

I first contracted for 3 hrs. a day, 2x a week because I didn't really knw what I needed. I think that was the agency's minimum. ($29.50 an hour now). That lasted a month because he became profoundly weak quickly, & I got live-in care - $375. a day. He also slipped into dementia quickly (or it was pain, I never found out) & began having psychotic episodes at night. I had an overnight aide 2 nights - $29.50 /hr for 12 hrs. The live-in care lasted 2 weeks, and then he went into the hospital.

We were lucky because my LO could draw from his investments to pay for home health care. We had a limit, but we didn't come close to reaching. He was in the hospital for a week, went to hospice, & died in 4 days.

I went with an agency because I didn't have to worry about coverage or background checks. (Not that that background checks protect you 100%, but it's a layer of protection to fall back on.)

There's always the fear that you'll outlive your money, so people are reluctant to use what they've saved, but that's what it's for.
We had a limit, but we didn't reach it because his illness took him so quickly. There are people on this forum who aren't as fortunate as we were, and they struggle to get reliable help, or their LO or family members resist it, or they think they can do it on their own. My LO was mildly resistant, but our families were happy, & he quickly accepted it. We have 2 floors, so I also got a refurbished stair lift. I kept it because I have a knee problem & I may need it in the future.

It would have been impossible fore me to care for him on my own. The live-in was a kind, loving, caring woman, and she freed up my time so i could spend some quality time with him.
Good luck.

Visiting Angels is a franchise operation so you may be able to work out an arrangement with the owners. You have to factor in the lost time the workers have when traveling between jobs.

We used them for my dad and agreed on 2 morning hours and 2 evening hours 7 days a week. We had a lot of different workers because of this schedule but most of them worked out.

I’m not sure where you live but in Ohio the cost was $27 an hour. The fees cover insurance, bonding, and background check costs as well as the company management.

I went thru care.com to find a private caregiver. I put in an ad, and stated what I needed, the hours, and what I could pay. Right now I am paying $17.50 an hour for four hours a day Mon-Fri.

Also, I am not sure, but I believe you can talk to your family doctor to have an aid come in to give him a weekly shower. My Mom did that for my Grandmother.

Good Morning,

Have you thought about one 1/2 day per week of a "Day" dementia program. Some offer p/t, ot/ and speech therapy, paid for by your health insurance. There is usually a co-pay of some sought for these programs with continental breakfast and lunch included. There is supervision, some have RN's on duty and also transportation.

You could start out small--again the more the days the more $$$. Everyone is in the same boat. CNA aren't not paid enough and it's backbreaking work. I recommend review your health insurance policy, speak with a hospital social worker and possibly a Nurse at the Primary Care Doctor's Office. I find the Nurse Practitioner's are thorough and seem to have more resources and better versed on these things compared to the doctors.

These things are tricky because people need to be paid what they're worth but also you have to keep a roof over your head and food on the table and make sure your loved one's in not in harm's way and that they are kept on track.

Check out the Department of Elderly Affairs. They can come to your home and provide information and let you know what is available. Usually the needs change along with the person's health.

I hope this is of some help to you.

See an elder law attorney. With your age difference I would especially recommend getting him on Medicaid. Assets especially the house will be taken out of his name and put into yours. This will qualify him for the care he needs and protect you from half the home going to a facility down the road.
I know Medicaid varies from state to state and that’s another good reason for an elder law attorney. Good luck and don’t wait long.

Hi my Mother wants to stay in her own home. She has elderly dementia. She doesn’t have that much money, but she qualifies for nothing. We found private help that is much cheaper. With this we will be able to keep her home a lot longer. We were able to find 2 different girls with experience for $10.00 hr. They fix meals , light cleaning and give her companionship. My mother doesn’t have any other health issues except memory. She’s 88 1/2

We used both agencies and individual caregivers for our mom. We got the individuals by talking to the local public health nurse, who gave us names and we interviewed them and they did a good job. The only reason we kept the agency was that the person they provided was excellent. We wanted the agency to provide a backup when this person was unable to come, but they didn't. In my opinion, if you contract with an agency and they cannot provide more reliable service than individuals, then they are not worth the extra cost.

If he is a veteran he does qualify for some type of assistance

Check out Medicaid waiver option. Once the person qualifies for needing assistance with ADL’s determined by an inhome assessment you apply for Medicaid. According to the finances, the person may even qualify for a partial reimbursement. My mom was just a bit over but was able to get a small amount.

I don’t know what CO offers but in my moms state they have programs that assist for patient's who don’t qualify for Medicaid, don’t need a NH yet but need more assistance that they can afford. Your local Agency on Aging should be able to help guide you to those programs. While there were programs through the local senior center and guidance on some of that they weren’t versed in all of the actual state programs so absolutely go talk to them but go to the state web site or call the local state agency on aging or equivalent and do some poking around. In our case a case worker came out interviewed us and made a suggest care plan, then she filled out the apropreate application, in Moms case Medicaid and once approved her original Care Plan kicked in. She has PCA and homemaker services which include meal prep and picking up groceries I ordered on line, it’s so helpful!

You can also have his doctor order an evaluation, again what and by who may depend on the state but they should be well versed in it.

Good luck.

Does husband happen to be a veteran? If so, take him to nearest VA hospital/clinic. They run tests. Diagnosis comes back disabled and in need. They have a program named Silver Angels. However many hours the VA approves that will bring a Silver Angel to your home helping with light housekeeping etc.. they also allow you to leave to catch your breath going to the grocery store or beauty salon. They are wonderful. THE BEST NEWS IS THIS IS A FREE SERVICE TO VETERANS WHO QUALITY.

I so understand how you feel. Our Insurance provider will cover the home care but at a much lower contracted rate than self care rates. We had used a company named Care Advantage for many years. Recently my wife spent 2 months in the hospital and on discharge Care Advantage promised they had an aide ready on the day before discharge but on the day after my wife came home they told us they were not going to send anyone. The reason, not the one they gave but the real reason, is they were having trouble finding aides( I should say bodies because the help they had sent for the previous year could not rise to the level of a home care aide), was they wanted to only send the bodies they had to the self pays they were gouging.
There are independent home health carers that you can negotiate prices with.

We just went up to $20 an hour because of the raise in the minimum wage to $15 an hour. We hire the people and do not use an agancy. My wife needs a lot of care due to progressive dementia. We use the help 77 hours a week so we are spending roughly $80,000 a year. We use to travel and cruise at least 4X a year and our travel budget was $100,000 a year. We have one gal M-Th and the other F-Su. They cover each other when one goes on vacation or a family affair.

Good luck.

W

I have two private sitters for my mother to give me a few hours to get out of the house. I found one by calling my mother's church and asking if there were any ladies who were interested. In addition, my mother's physical therapist recommended a retired physical therapist she use to work with. Both of them have no minimum number of hours and their rates are $17.00 and $20.00 per hour. Not cheap but better than an agency.

My mother lives with me, so I pay for these sitters with her social security. I don't ask them to do any housekeeping chores, but could probably negotiate that with them if needed.

There are also house cleaning services that you could hire to come every two weeks to relieve you of heavy house cleaning.

Also because of my mother's dementia diagnosis, medicare pays for weekly physical therapy for her.

Blessings.

Look into a nursing home deferral program in your state. My mother had dementia and qualified for a nursing home which we didn’t want to do. The program supported us at home instead. It took a long time to qualify but ultimately it helped.

3) Medicaid HCBS Waivers – for Medicaid beneficiaries, HCBS (Home and Community Based Services) Waivers provide a variety of care services and non-medical support for the elderly and their caregivers. These services are specifically intended to prevent nursing home placement and allow seniors to live at home or in the homes of their caregivers.

Privately hired help might be cheaper, but you are responsible for checking backgrounds, filing and paying taxes, and finding a substitute if the expected aide cannot come. Just keep that in mind when deciding between an agency or a private hire. A four hour minimum shift is quite common.

I found this with Bayada but $30 and $31 an hr. Based on regular v. Weekend/overnight rate (for father); for mom, they come 2 days per week for 4 hours each day—more flexible I guess due to 24/7 care for father. They initially wanted 3 days per week for her. These are home health aides.

Rates are location-dependent. For example, an hourly rate in Washington DC area is probably higher than in Idaho or New Mexico. It is driven by economy and demand (which is driven by density of population). But the 4-hr minimum requirement seems to be industry standard.

Some mentioned about Medicaid. It is different from state to state, but if you can be qualified for Medicaid, power to you. It really helps defray the cost!! Keep in mind though that not all care agencies accept Medicaid. This is why so many caregivers are bankrupt to finance the caring of their loved ones at home. Or quit their jobs to do so themselves.

Something is wrong for a super wealthy country in the world with a crappy health system.

I live in southern Oregon and I am having problems finding in home care there is a tremendous shortage of workers. I have been promised by major health care providers to give me referrals with no success. Searching for providers most of what I find is referral services that do not actually employ people. I even tried visiting angels with no success next I tried the internet and got 1 response from someone 40 miles away. I am very frustrated
where do you look next.

This is somewhat standard and must be changed: it’s outrageous. I suspect if you keep looking. you’ll find help from someone who isn’t being exploited by an agency like this!

My experience is the 4 hour increments are designed for company's to assign 1 person, the same person. The same person, for most, is very important.
They say hours less than 4 require multi different folks to help those in need. And, again most, prefer the same person...hope that helps
I've been able to get help for my mother from a few individuals who help already (within a small condo community).

Private in home help is pricey. Those who don't blink at $480 per week (or much, much more than that) have savings that will probably see them into the future for many months or years. The rest of us don't even put it on the wish list.

So short answer to how people manage to pay for home health - they don't.

It's possible a cleaning person to help you out one day a week with heavier chores might be financially doable for you. Do you know anyone who has a cleaning person? If so, ask if you could be added to that person's cleaning schedule. If you have children, talk to them about you needing a little help and see what they have to offer. Start there.