In-Home Care




There are a variety of services available. Some are in-home and some are offered in other locations such as Senior Centers or churches.

Some services are available for free to anyone who is a senior (typically 60+) and/or their caregiver, some ask for voluntary contributions, some are sliding-fee, and some are fee based.

It is important as you coordinate services that you find out the eligibility requirements of the service and the cost.

Information and Referral Specialists at your local Council or Department on Aging (find them through your Area Agency on Aging) can help you determine what services are available in your county and whether you will be able to access them.


To find out what services are available, try the following:


For-profit in-home services agencies usually advertise in the Yellow Pages. That is another option in looking at what is needed and what is available locally.

Every county will be different. And, there are a lot of groups that offer volunteer assistance to help fulfill needs such as friendly visiting, building wheelchair ramps, yard work, and household repairs and home modification.

There are also services available to help those who are hearing disabled, have vision loss, or have other disabilities.

It is always a good idea to check with your local aging agency. It is their job to know what is available locally to help you. And, they are glad to help. Remember, local aging agencies are designed to work with older adults and their caregivers. They can help with finding services, even those not offered by their agency, and with accessing the services. If you like, they will also follow-up with you to ensure that you got the services you needed and that you were satisfied with the assistance.


In North Carolina, the Division of Health Services Regulation - the agency that licenses home care agencies - has developed an online guide to home care.


In North Carolina, most of the services offered through Councils or Departments on Aging (find them through your Area Agency on Aging) are paid for with Home and Community Care Block Grant funds that come from the federally funded Older American's Act. These services are offered to seniors (60+) and their caregivers on a cost-sharing (voluntary contribution) basis. Since funds for the services are limited, it is asked that you contribute as much as you are able so that more people can make use of the service.





Hiring Help

To help a family member remain safely at home, a caregiver may need additional help. This help may come from family and friends, an individual you employ, or an agency.

Should you need to hire someone to provide in-home care, there are two choices - hiring a person through an agency or hiring a person directly. Each offers benefits and caveats.




Paying for Care

Part of your consideration in arranging for in-home care for your family member will be the cost of the care. There are various ways to finance care which may be used individually or in conjunction with other sources.




Providing In-Home Care Yourself

In order to keep your family member living at home you, as the caregiver, may find that you need to assist your family member with certain tasks such as getting up from a chair or getting out of bed. You may also find that the emotional toll of the daily realities is wearing you down. There is help available. Learning the proper way to perform the skills needed to help your family member will help you. And, learning how to recognize the effects of stress and understand why it is important for you to take care of yourself will also help.

Daily tasks are usually called Activities of Daily Living by the health care community. These activities are not always defined the same but usually include:

  • bathing
  • dressing
  • feeding
  • moving from a bed to a chair (also called transferring)
  • toileting
  • walking


At first glance, it may seem easy to assist with these activities. However, some of the activities have the potential to harm you, the caregiver, and your family member if not performed correctly.

So, how do you learn to perform activities such as transferring a person from a bed to a chair or assisting them with bathing? The first place to start is to check with your local caregiver specialist or Area Agency on Aging to see if they provide hands-on training or know of any other local agencies that provide that type of training such as local hospitals, hospice agencies, or aging services providers.

If no local training is available, consider paying for a consultation and training session with an occupational therapist or physical therapist. Physical therapists are experts in movement. Occupational therapists are experts in helping people manage daily tasks as easily as possible. Or, ask your friends if they know anyone who is a nurse. A nurse would know the proper way to perform these tasks and he or she might be willing to teach you.

Nationally, training has been developed by both for-profit and non-profit agencies to help provide caregivers with the skills that they need to both care for a family member successfully at home and to deal with the emotional realities of caregiving responsibilities. Some of the larger programs are identified below. If you are interested in any type of caregiver training, contact your local Area Agency on Aging or caregiver specialist to find out what is available in your area. If cost is an issue, be sure to ask if "scholarships" or sliding fee scales are available to help. And remember, some training sessions are offered for free.



In North Carolina, the Red Cross sometimes offers hands-on caregiver training. Many of the regional caregiver specialists have been trained for the "Powerful Tools for Caregivers" program and may offer the resource locally. Other training may be available as well.



Outside North Carolina, many of the same training opportunities are available. Contact your Area Agency on Aging to check for availability in your area.


There are other programs available, as well as video tapes and books. Many for-profit companies offer these products.

If none of the above work for you, there are a few online options.

Resources Supporting Family and Community Legacies Inc. is a non-profit Canadian corporation founded in 1999. Harry van Bommel is both a founder and a co-executive director. He is an adult educator with interests in the fields of home and hospice care (nearly 25 years); adult education (over 25 years); and management and staff development in health care (nearly 15 years). He has written many books and now offers some of them online, for a fee. One selection deals with Activities of Daily Living, complete with diagrams to help you visualize the task. Some of the topics discussed are:

  • adaptive clothing
  • bed care
  • dealing with incontinence
  • general care of hair
  • getting from a chair to bed
  • getting someone out of bed
  • giving a bed bath
  • helping someone onto a bedpan
  • helping someone turn in bed
  • helping with a bath or shower
  • moving someone in bed
  • other areas needing care
  • personal care
  • using a bedpan or urinal
  • walking







Please remember that having personalized hands-on training is the best way to learn in-home care skills. Some of the transfer skills are dangerous if performed incorrectly and could result in you, the caregiver, becoming injured. Your older family member could also be injured if improper techniques are used. Please keep this in mind when you read about the skills online.




House Calls by Physicians

Home visits by doctors used to be common place. Those needing care could be seen in the comfort and privacy of their own home. They seem to be making a comeback again with Medicare reimbursement for home visits for reasons other than being homebound.

Medicare will pay for physician home visits to patients who are covered even if the patient is not homebound. Justification for a home visit must be documented, but the patient being homebound is only one of many reasons a home visit may be appropriate. Patient convenience and patient request are not the types of justifications Medicare is looking for, however.

Older Woman at Home

Covered reasons might include:

  • immobility
  • need to assess the home situation
  • need to involve home based caregivers
  • cognitive, psychiatric, or emotional inability to go to the office

Medicare also covers selected home health agency services for patients who are not homebound. These include physical, occupational, and speech therapy. Coverage is by Medicare Part B (which also covers physician services). Coinsurance and deductibles may apply if the patient lacks supplemental insurance.

The American Academy of Home Care Physicians provides a list of its members and medical groups providing home care physician services. There may be other physicians in your area that provide home visits. Contact your state's medical association for assistance in locating local resources. Please note that there may be an additional charge, not covered by Medicare, for travel by the physician. However, the expense - if you can afford it - may be worthwhile.

*courtesy of the American Academy of Home Care Physicians




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