In-home care provides medical and non-medical assistance to individuals who want to remain in their homes rather than move to a facility. Services range from companionship and light housekeeping to skilled nursing and physical therapy.
40 steps across 8 sections
1. Assess Care Needs
- Identify which activities of daily living (ADLs) require help: bathing, dressing, eating, toileting, transferring
- Determine if skilled medical care is needed (wound care, injections, PT/OT, medication management)
- Evaluate how many hours per day/week of care are needed
- Consider cognitive needs (dementia supervision, medication reminders)
- Assess the home environment for safety and accessibility
2. Consult with Healthcare Providers
- Talk to the primary care physician about home health needs
- A doctor's order is required for Medicare-covered home health services
- Ask for referrals to Medicare-certified home health agencies
- Get recommendations from hospital discharge planners if leaving a hospital
- Consider a home care assessment from a geriatric care manager
3. Choose Between Agency and Private Hire
- Home care agency Handles hiring, background checks, training, payroll, insurance, and backup coverage; more expensive but less management burden
- Private hire (independent caregiver) Typically cheaper ($15-25/hour vs. $25-40/hour through agency); you handle hiring, payroll taxes, insurance, and finding replacements
- Registry/referral service Middle ground; matches you with vetted caregivers but you are the employer
4. Find and Evaluate Providers
- Search for Medicare-certified agencies at medicare.gov/care-compare
- Contact your local Area Agency on Aging (1-800-677-1116)
- Ask friends, family, and medical professionals for recommendations
- For private hire: use referral services, caregiver platforms, or community resources
- Request and verify references, background checks, and certifications
5. Interview Caregivers
- Discuss experience with specific conditions (dementia, mobility issues, etc.)
- Ask about certifications, training, and continuing education
- Verify reliability, transportation, and schedule flexibility
- Assess personality fit and communication style
- For agencies: ask about backup caregiver procedures
6. Create a Care Plan
- Work with the home health agency or caregiver to develop a written care plan
- Include: medical needs, medication schedule, dietary requirements, activity goals
- Specify emergency procedures and who to contact
- Set up a medication management system (pill organizers, reminder alarms)
- Post emergency contacts and medical information in visible areas
7. Prepare the Home
- Remove tripping hazards (loose rugs, cords, clutter)
- Install grab bars in bathrooms and handrails on stairs
- Improve lighting throughout the home
- Create wide pathways for mobility aids
- Ensure smoke detectors and emergency systems are working
- Designate storage for medical supplies
8. Monitor Care Quality
- Check in regularly (in person and by phone)
- Install monitoring cameras if appropriate (with consent and legal compliance)
- Maintain open communication with caregivers
- Track medications, appointments, and changes in condition
- Attend care plan review meetings
- Address concerns promptly with the agency or caregiver
Common Mistakes
- Not getting a doctor's order for Medicare-covered services
- Hiring without background checks
- Not creating a written care plan
- Ignoring employer obligations for private hire
- Not having backup caregiver arrangements
Pro Tips
- Start with a trial period (1-2 weeks) before committing to a long-term arrang...
- Use a home care agency initially for reliability, then consider transitioning...
- Ask agencies about their caregiver matching process — personality and cultura...
- Set up a communication log (notebook or app) that caregivers update each visi...
- Medicare home health has no copay and no deductible — use it fully when eligible