Why Lower Cost Home Care is Not a Bargain

I do a fair amount of public speaking on elder care issues in front of a variety of audiences, most of them professionals in various segments of the rapidly expanding elder care industry. On occasion though, I do speak to groups of elders on consumer awareness in the selection of care.

When speaking to this type of audience I always ask the rhetorical question, "If you need assistance with things like bathing, dressing, mobility, etc, and you have the choice of getting that care at home or in a nursing home what would be your preference?"

Not surprisingly, the preference for care at home is nearly unanimous. One of the greatest fears of older Americans is to be placed in a nursing home. They have visions of dreary environments and sub-standard care which is an issue we'll be discussing in future posts.

But there are misconceptions about care at home that should be closely examined. One is that "home care is cheaper than nursing home care", that is sometimes true and sometimes not true. If you were to need only a few hours each day to get you started and could then safely go about your day at home without supervision or support, a few hours of home care will be less expensive than 24 hours of care in a nursing home. But if you are severely disabled due to a stroke, or suffer from dementia and can't be left alone, 24 hours of home care is likely to be considerably more expensive than the daily cost of a nursing home.

Another misconception about home care is that "you don't have to pay the going rate for a licensed home care agency, there are independent caregivers that will charge you a much lower hourly rate." This is also true, sometimes these independent providers work through something called a "registry". Registry services are usually run by people who maintain a rolodex or data base of home care aides that would rather be employed directly by the familiy or the person neding care, than work for a licensed home care provider.


Preferable though it can be,the home care setting can be an undesirable place to be cared for if the elder needing care is left alone with an aide who is not well supervised or held accountable. Patients and families should be aware of their "Patients Rights" and ask for a written copy of these rights before services begin.

There have been numerous cases of both physical and financial abuse of frail elders at home just as there have been such reports in a nursing home.

The homebound elder should never be left without care when care is supposed to be provided. If the paid caregiver is unavailable due to illness or due to their own family problems, the elder or a member of the family should be assured that substitute caregivers are available on short notice.

While using home care personnel from an agency that acts as the responsible employer of the aides may be more expensive, using this alternative is safer and much less risky for the elder and their family.

Fortunately there is a national organization, known as the National Private Duty Association (NPDA) that works to set standards and to educate the public about both the risks and benefits of getting care at home.

Last year NPDA proposed model legislation that raises standards in the home based caregiving industry. The model bill and regulation represent the first comprehensive licensure framework produced for private duty home care and led by private duty providers.

Before you seek out the services of a home care provider I urge you to visit the web site of NPDA at http://www.privatedutyhomecare.org/displaycommon.cfm?an=1

At their site you can obtain a copy of the "Model Legislation Document" and the "In-Home Personal Care Services Code".

NPDA has targeted the widespread practice of registries placing workers in the home environment to provide home care services without clearly explaining (or sometimes even misleading) consumers and referral sources regarding the risks and responsibilities that consumers and workers have in these situations (i.e. making the consumer the employer of that worker without his/her knowledge).

Some of the other valuable consumer information available from the National Private Duty Association includes the following

Independent Contractors v. Employees: A Legal Challenge

Model Legislation (Act 999): Home Care Consumer and Worker Protection Act

Position Statement on Registries & Independent Contractors

The Accidental Employer

Elder Abuse Guidelines

NPDA Member Ethical Guidelines