Learn about hiring paid in-home help

Having paid in-home help can make it easier for people to stay in their home as they age.

The in-home help might be:

  • Skilled care, such as health assessments, wound care, physical therapy, or medication or treatment management

  • Personal care, such as help with eating, bathing, dressing or walking

  • Help with tasks, such as housekeeping, preparing meals or driving

Different staff and organizations offer different kinds of in-home help:

  • Nurses, therapists and social workers provide skilled care, usually through home health agencies.

  • Geriatric care managers are usually nurses or social workers who assess needs, coordinate services, develop plans and advocate for older adults. They may work with public programs or agencies or as consultants.

  • Aides, assistants and attendants provide personal, companion or household care. They may work with home health agencies, home care agencies, non-medical or companion agencies, or on their own.

Writing a job description can make the search for in-home help easier by spelling out:

  • All care and tasks needed and how often staff will help with each

  • Important skills, such as dementia care training or languages spoken

  • Important qualities, such as familiarity with or respect for certain communities or cultures

  • Work hours and schedule

  • Wages

  • How to document work activities and share information

  • Whose car staff will use, if driving is part of the job

  • Expectations around schedule changes, meals, work-related expenses, phone use, visitors, smoking and other issues

People can either get in-home help through agencies or hire staff directly.

Agencies hire, screen, schedule and manage staff, as well as handle payroll, taxes, insurance and benefits. Some agencies provide training for staff. Insurance may be more likely to cover in-home help through agencies, than with staff who are hired directly. However, using agencies may be more expensive, and scheduling or services may be less flexible than with directly hired staff.

With direct hires, the person doing the hiring has all employer responsibilities, including recruiting, interviewing, screening and managing staff, plus handling contracts, payroll, taxes, insurance and benefits. That includes finding other help if staff miss or change work hours. Insurance may not cover in-home help from staff who are hired directly. However, directly hired staff may be less expensive, more flexible and mean fewer staff changes than using agencies.

Whether using agencies or hiring staff directly, searches for in-home help include:

  • Getting recommendations from professionals, colleagues, friends or family

  • Checking references from past employers or clients

  • Checking with state agencies for licenses, insurance and complaints

  • Interviewing staff to find a good fit

  • Doing criminal background checks or making sure agencies run background checks on staff

  • Confirming costs, including for initial visits, per-hour charges and additional services

The costs of hiring in-home help may be covered or reduced by:

  • Medicare, Medicaid or private insurance, if it's skilled care ordered by a healthcare professional

  • Medicaid, depending on state programs and eligibility rules

  • Long-term care insurance, depending on policy

  • Veterans' benefits

  • Local programs through Area Agencies on Aging, Aging and Disability Resource Centers or community organizations

Some state Medicaid programs, Veterans' programs and long-term care insurance policies may pay family members to provide some in-home help to older adults. The local Medicaid or Area Agency on Aging office, Veterans' Administration or insurance company can provide details.