Long-term care is commonly defined as a collection of supportive services required to meet a person’s personal care needs over an extended period of time. Long-term care is generally not medical therapy; rather, it is assistance with daily personal chores, commonly known as ADLs and IADLs, however it may involve skilled nursing care.
ADLs include bathing, using the toilet, dressing, eating, and transporting a person to and from a bed or chair. Others may require long-term support with activities of daily living (ADLs) such as housework, medication administration, bill payment, grocery shopping, and food preparation.
According to the US Department of Health and Human Services and the Administration on Aging, 7 out of every 10 persons over the age of 65 will require long-term care at some time in their lives, with 1 in every 5 requiring it for more than 5 years.
This statistic is one of the key reasons why some people prefer to migrate to a continuing care retirement community (CCRC, also known as a life plan community) while they are still physically and mentally capable.
Confronting care decisions
The majority of seniors, however, do not live in a senior living facility that provides care services, such as a CCRC, whether by choice or necessity. As a result, when an elderly loved one requires ADL or IADL support, families must sometimes make difficult decisions about how and where the person will receive the necessary assistance.
Some families prefer to take on these carer responsibilities themselves, either at the senior’s home or in their own, because paying for supportive services is excessively expensive for them, or because they believe it is their responsibility to care for a family member. While this may appear to be the most cost-effective alternative, as I’ve previously discussed, the cost to the carer is frequently significantly greater.
Other families prefer to move their loved one into an assisted living facility, where the senior may receive the specific types of support they need, when they need it. At first glance, this may appear to be a costly option, with Genworth’s 2018 data showing that the national average for a private one-bedroom flat costs almost $4,000 per month (which covers lodging, food, and care services). The average cost of nursing home care is around double this amount.
Others prefer to hire a caretaker to provide long-term care services at their loved one’s home. According to Genworth, the average monthly cost for 44 hours per week (about 6 hours per day) of home care services is $4,004 — roughly the same as the national average.
Those who opt for home care must decide whether to engage an independent carer on their own or work with a home care agency to find a carer. But what is the distinction between these two types of long-term care? Is one better than the other?
Independent caregivers
Independent or private carers are individuals who are directly hired and employed by the senior or their loved ones. In addition to ADL or IADL assistance, some independent carers are trained to provide medical care such as wound care, injections, and vital sign monitoring; however, this is less common and would come at a higher hourly charge.
The most significant advantage of hiring an independent carer is the cost, which averages around $15 per hour and can be 20 to 30 percent less than carers hired through an intermediary home care organization. The disadvantage of hiring an independent carer is that the senior’s family must manage the duties of an employer, such as background checks and any relevant licensing verification, liability insurance, payroll, and related taxes. However, there are third-party payroll providers that may manage your paychecks and taxes for you at a reasonable fee. It’s also worth considering how difficult it can be to find a high-quality carer and then replace the carer if he or she moves or changes employment, which happens frequently.
Home care agency caregivers
Home care agencies are legally permitted enterprises that employ a team of carers. The agency then enters into contracts with families to deploy carers to the homes of their loved ones to offer the essential long-term care services. Some agency carers may be licensed nurses or nursing assistants who may provide medical care. Others offer conventional help with ADLS or IADLs.
While costs can vary significantly from place to place, home care agencies are more expensive than independent caregivers across the board. Nationally, the average hourly rate for home care through a home care agency is $20+ per hour — again, approximately 20 to 30 percent more than an independent caregiver.
Other factors to consider
For example, if your loved one primarily requires in-home medical care, it may be in your best interest to hire a carer through an agency, which will verify the individual is adequately qualified and licensed to conduct the necessary healthcare activities.
If your loved one only requires companionship and/or a little assistance with ADLs or IADLs, an independent carer may be the best option. Perhaps the senior no longer has the ability to drive and just requires assistance getting to doctor’s appointments, the library, or the grocery store. Some agencies will not allow their carers to transport seniors due to liability concerns. An independent carer would be the superior alternative in this case.
One thing you probably do not need to consider in your decision between an independent and agency-based caregiver is Medicare. Medicare will not cover any non-medical home care services, regardless of who provides those services. (Note: If home healthcare services, such as skilled nursing care or therapy, are deemed medically necessary, Medicare will cover a portion of the cost for a period of time.
