Before we go into the most popular questions we are regularly asked, we should address how the private home care industry works.  This will benefit you immensely so that you will understand some of the reasons why this industry operates the way that it does.

The private home care industry is essentially a staffing industry.  Most agencies hire all their caregivers, they have W-2, insurance, and are bonded.  What many customers don’t know is that all of our caregivers are considered “per diem” employees.  They are not guaranteed work, whether it is full-time or part-time.

The reason for this is because both caregivers’ personal and professional schedules change frequently, as do our customers.  We often get last-minute calls for hospice patients who need 24/7 care, for the five days before they pass away.  In our industry, it is not uncommon to receive a number of these types of cases within the same day.  When it rains it can pour, but there are also times where it is slow; because of this, caregivers are classified as per diem rather than salaried or guaranteed a certain amount of hours.

When these events occur it is our job to have ample caregivers hired with Minute Women to call, matching their availability and caregiving abilities to the case.  Because clients call us requesting all types of different schedules, we need to have hundreds of caregivers available to meet the needs of our customers.

So back to how home care agencies operate…

If you imagine a circular lake and houses all around the waterfront.  Now instead of there being water in the lake, it is filled with caregivers; and the houses represent home care agencies.  The different home care agencies advertise for caregivers and hire the ones that meet their standards and decline caregivers who do not.  This likely means the top caregivers are hired as per diem employees at multiple agencies.

This means they are being offered multiple jobs and shifts per day from multiple agencies.   So the caregivers are in a position of accepting or declining shifts or resigning from one case to get more hours at a new case.   Most customers I explain this to have no idea how our industry works (I didn’t when I went through home care for my mom so don’t feel bad) but it is important to know so you can make an informed decision on what you think is best for your family.

This leads to why having minimum hours is important and how the more hours you schedule the more consistency you will have.

Let’s start with the most asked question first, because it’s on the top of everyone’s mind when they start exploring senior care options.  How much is this going to cost me?

Unfortunately, home care isn’t cheap.  Having a dedicated personal caregiver is expensive and in the Massachusetts area, the rates are between $33-$38 per hour.   I believe once minimum wages have been raised to $15 per hour (which caregivers command more than that, but incoming tides raise all boats) home care services will plateau around $40 – $42 per hour.

If you are interested in comparing costs, you should take a look at the Genworth Cost of Care tool on their website.  This allows you to look up the average cost of care, not only for home care services but assisted living communities as well as skilled nursing facilities.  You will see that in many cases home care is far less expensive than the cost of assisted living and nursing homes.

Of course, this depends on the number of hours per week of home care you are purchasing.  24/7 care is going to be more expensive than an assisted living community because you are getting around-the-clock 1:1 care.  Additionally, you should be hesitant to compare assisted living and home care services because they offer two different services.  Assisted living communities to offer a social model of care including room and board with only a few hours of 1:1 time.   If your loved one declines and needs more assistance, the assisted living community will either increase the care they are providing which means a higher monthly cost, or recommend you hire a private home care agency to provide the care.

Most home care companies charge by the hour, but in some cases, they charge a flat rate, especially with live-in services.  The caregivers are paid a flat rate and customers are charged a flat rate.  This is because there are fewer shift changes if any at all.  The caregiver isn’t clocking in and out as they normally would with an hourly case, because as the name suggests, live-in life in the home.

You can expect to pay anywhere from $400 – $600 per day depending on the agency and if you want one caregiver or two caregivers to handle a week of care.  If you want just one caregiver, that will cost more money as the caregiver is still paid hourly and overtime laws are applicable to this type of service.

As home care rates continue to rise it is understandable that prospective clients might consider hiring a caregiver privately and even under the table.  The benefit of this is you save money, you cut out the costs of insurance and the agency staff who handle the day-to-day operations of management of the caregiving staff.

While there are success stories when it comes to hiring a “private private” as we call it in the industry, there are many downsides.  Good caregivers with no supervision or accountability can easily turn into bad caregivers.  There are horror stories of caregivers taking advantage of the seniors they care for, moving their own family members in, and stealing money as well as items from the home.   It happens far more often than you can imagine, and there is little recourse if your parents have memory issues and there is no other proof that police can go on to make arrests, and even if there were, it is unlikely there will be any restitution.

Another downside is what happens when the privately hired caregiver gets sick or needs time off, who covers for them? Or what if they have a schedule change and can no longer work the hours you need? That likely means you are back to the drawing board of recruiting, interviewing, and hiring another caregiver.

Before going down that road to save money, consider the downside of those choices and the risks associated with it.

Yes, it does.  Long-term care insurance is optional insurance you can purchase that will pay for senior care services once they are needed.  Most insurance professionals suggest you start purchasing long-term care insurance once you are in your early 60’s, but you can purchase policies into your 70’s and possibly later.  Long-term care policies pay for home care, assisted living, and nursing homes services.

Long-term care insurance has changed over the years.  In the early ’90s, there were many issues where policyholders complained about their insurance holders.  The insurance companies underestimated how long people would live and how expensive senior care services would become.  This led to a perfect storm where insurance companies were losing millions on these policies.  Many made their policyholders jump through many hoops to get their benefits, hoping they would pass away before paying out.  Some companies just refused to pay outright because they were losing so much money.

Now things have changed.  The premiums on the insurance policies have become much more expensive to reflect the cost of care and how long people live, but hybrid models have become popular where if you do not use your benefit you get a chunk of the premium returned to you.   Most benefits have a 90-day elimination period, meaning you must pay out of pocket for services for that period of time, then you can start getting reimbursed.

The policyholder needs to require assistance with multiple activities of daily living needs.  You must speak with your home care company about ensuring the proper paperwork is handled so that your claims are paid.  Without the proper paperwork, you might not get your insurance money, so remember to mention it to your agency the moment you start services.  The standard procedure is that the home care company gets paid by the family, then the family is reimbursed by the insurance company.

An option some families love, while others are not fond of, is the assignment of benefits.  This is where the family provides paperwork to their insurance company that allows their home care company to directly bill their insurance.  With the assignment of benefits, you do not need to pay anything out of pocket or wait to be reimbursed.  The insurance company will pay the home care agency directly.   Please note, that if you require more services than the insurance company will reimburse for, you will be left paying the difference.  Also, the home care agency is not responsible for what happens with your insurance agency and policy.  If for some reason the insurance agency stops paying the assignment of benefits, the home care agency will still need to be paid.

Since you are reading this, you are likely an adult-child considering care for your parent(s). The question you should ask yourself is, is now the right time for you to plan for your future, how you plan to age, and how you will pay for it?  If so, I would recommend you speak with Mike Harrington, who is a local broker for long-term care insurance out of Woburn, MA.  Minute Women has no financial relationship with Mike, just our recommendation of someone good that you can count on.

The short answer is, no it does not.

The longer answer is it isn’t likely, but there are a lot of different medical insurances out there and maybe yours does, so it is worth checking.

The reason why most insurances do not cover home care is that the services we provide are not considered medical services.  In the senior care industry, we are often called “non-medical home care services.”   We are providing assistance with activities of daily living and instrumental activities of daily living.

ADLs include:

• Feeding
• Bathing/showering
• Selecting Attire
• Dressing
• Grooming
• Toileting
• Maintaining Continence
• Walking and Transferring (ie moving from bed to wheelchair)

IADLs include:

• Managing Finances
• Handling Transportation (driving or navigating public transit)
• Shopping
• Preparing Meals
• Telephone Use
• Managing Medications
• Housework & Basic Home Maintenance

As you can see, none of the listed tasks relate to medical care which is a primary reason why medical insurance usually does not pay for home care and other similar senior care services.

As mentioned earlier, activities of daily living are important to know for not just long-term care reimbursement, but for conversations with senior care professionals, doctors, and nurses that will come and visit your parents.

Knowing what your parents are struggling with and what they are able to handle on their own is an important indicator of where they are in the aging process.  Over time you can cross off the tasks that they are unable to accomplish on their own and use that as a guide on where your parents are going to need more support.

This will allow you to have some objective information to make the best decision possible for your parents.  Does it make sense to have them move in with you?  An assisted living?  Age-in-place with home care?  Or move into a nursing home setting.  Without knowing what their baseline is, it will be difficult to make a confident decision.

Though most medical insurances do not cover senior care services, they are usually tax-deductible (talk with your accountant).  If you are like the other 90% of families who pay for services out-of-pocket, you can usually deduct the cost of home care from your parents’ income.   While not ideal, it is better than nothing.

Regardless of the industry, staffing costs are directly influenced by insurance and staff.  It does not matter if this is a nursing home, assisted living, home care, or a white-collar staffing company; what you pay the workers will directly influence the cost of care.

The senior care industry’s costs are rising.  Nurses (LPNs and RNs) and home health aides (HHAs) , and certified nursing assistants (CNAs) are always at the top of the list of shortages in the healthcare industry.  There are just not enough nurses and aides to accommodate the demand.  Because of this, wages have been increasing dramatically to keep current caregivers paid well, in addition to attracting new caregivers to the industry.

What is also causing the cost to increase is that more families are reluctant to let their parents move into a nursing home.  This leads to seniors living at home with more complex and challenging care needs that are now in the hands of home care companies.  Clients that are more appropriate for a nursing facility will need far more care in their home, leading to increased burnout of caregivers, leading to more caregiver turnover.  To get caregivers to accept these shifts, means they need to be compensated more.

For example, we recently had two different cases where the clients we were caring for both had a form of dementia that caused them to be combative, angry, and violent.

We knew their actions were caused by their dementia, but it was still difficult for our caregivers to care for them day in and day out.  In some cases, it may make more sense for seniors with dementia that results in these types of behaviors to be placed in a memory care unit, but often their families are resistant to placement.

On top of this, we are seeing more seniors with colostomy bags, g-tubes, and catheter bags attempting to age in place.  These needs were usually met at a nursing home, but now we are being asked how much assistance we can provide with these types of tasks.

Because of the shortage, caregivers have the option to decline a case or resign from a case, knowing that soon enough a different case will become available.  Again, this leads to the wages of caregivers increasing to entice them to take more complex cases, rather than wait for less strenuous assignments.

Insurance is a big cost for home care agencies, more specifically workers’ compensation insurance.  Caregivers are considered at high risk to injure themselves just by the nature of the work they do. Transferring a client from bed to wheelchair, changing or positioning them in a bed that is too low/too high/does not have rails (ie not a hospital bed) are all opportunities for injury to the caregiver’s back.

Imagine entering a stranger’s home and being asked to provide care for someone.  There might be clutter, animals, slippery surfaces, and stairwells you are not accustomed to; this all leads to increased risks of injury, which is why insurance is so costly.

Have you ever heard the saying “it takes a village”? Well, that describes the culture at Minute Women Home Care. There is so much that goes on behind the scene to ensure that we provide the best care possible to our clients.

I have promoted multiple caregivers to become schedulers or care coordinators and their primary job is filling all the shifts of our clients.  There are a lot of moving parts and it is far more complicated than they ever imagined.  Things change quickly in our world.  Seniors decline, they get better, immediate services are needed then not needed.  Long cases, short-term cases, and everything in between.

Every single scheduler who was once a caregiver has been shocked at the amount of work, organization, and skill it takes to handle the ever-changing schedules of our clients and also our caregivers.

In order to provide the best possible care to our clients and families, there needs to be ongoing supervision, customer support, and caregiver support which is provided by our client care staff. Once the client care needs are identified through our assessment process, our care coordinator schedules the shift with caregivers whose skills and personalities match the case.

It is essential to have an active recruiter working to find, interview, hire, and onboard caregivers that meet our standard to be part of the Minute Women team.  The expectation from our clients is that when there is a call out or an emergency, we will handle it.  That means having enough staff in the bullpen to provide care when a last-minute shift or emergency occurs.

We will often talk with new clients who are frustrated with a previous home care agency.  They will explain how they asked multiple times for a new caregiver as they were not happy with their current caregiver, but the same caregiver kept showing up over and over.  This is because the agency has not invested the time in recruitment and they have no one else who is able to show up and replace the current caregiver.

Finally, we need to provide 24/7 care as well as 24/7 customer and caregiver support.  This means a Minute Women employee is on-call at all times for emergencies that occur when the office is closed.  If you have a problem you can reach someone every day of the year including major holidays.

The cost of providing care will continue to rise over the next few years.  These are the reasons why customers who use senior care services are seeing their bills increase.

Minute Women offers three different services for prospective customers to consider.

The first, and most popular, is hourly caregiving services.  This can be from a few hours of transportation to 24/7.  Hourly cases allow families to pick times that work best for their needs and we find caregivers who are available for those shifts and who also have the abilities and skills needed to be successful.

As mentioned before, the more hours a family is willing to schedule will provide more consistency in having the same caregiver(s).  Anything over 35-40 hours per week, and you are likely to have a consistent caregiver once you find someone who works well with your situation.

Live-in care is the next most popular service.  This is when a caregiver moves into the home and lives with your parent(s).  This can be for a few days, for the whole week, or ongoing.  Most families looking for live-in services are expecting the services to last an indefinite period of time which is why this is the most cost-effective service we offer.  It provides the most care for the least amount of money.

The caregiver is expected to be available to work for up to sixteen hours per day, and then has eight hours of sleep.   While that sounds like a lot of work, most seniors have downtime while they are reading, watching tv, or taking naps throughout the day.  This allows the caregiver to take a break if all the tasks around the house are completed.

You can choose to have one caregiver for seven days a week, or you can choose to have it split throughout the week.  There are pros and cons to each situation.  With a split-shift week, you have two caregivers who know the case.  In theory, if one has an emergency or vacation, the other can fill in; though this is not guaranteed.  With a seven-day-per-week caregiver, your eggs are all in one basket, but the benefit is no shift changes or major moving parts.    The caregivers who are looking for full week live-in jobs have chosen that profession for their own reasons and they are willing to make that commitment.

While not a totally different service, one specific type of care we provide is hospice care. This is noteworthy because, unlike many other agencies, we have caregivers who can administer hospice medications from a pre-drawn syringe, on a scheduled basis with the hospice agency’s oversight. Our caregivers are trained to observe for signs of pain and/or discomfort, reach out to the hospice nurse to report their observations, and provide medications for breakthrough symptoms as directed by hospice.  This allows the family the peace of mind that as their loved one’s condition changes, they will not need to be in pain.  We are the eyes and ears for the hospice team when they are not present.

When my mother was on hospice, it was a time filled with stressful days, and at night you sometimes just crashed.  It was a blessing to have overnight caregiving staff not only be there for my mother but to have the ability to provide comfort medications to her so that we could get some sleep. Otherwise, we would have to get up every 2-4 hours to administer the medications. Those who have been in that situation, know how important even a little sleep can be, so you can get ready for the next day to provide care, try to be upbeat and spend time with your loved one.

Minimum hours are the fewest hours you can request from a home care agency to staff.  This can vary quite a bit from agency to agency.  Many agencies have a minimum of a total of fifteen-hour per week, meaning you need to schedule at least fifteen hours per week for them to consider accepting you as a client.

Once you fall below the minimum hours one of two events will trigger:

1. You will be declined services and will need to continue your search for a home care company
2. You will pay a higher hourly rate if the hours are below the agency’s minimum 

The first is easy.  Some home care agencies will terminate services or decline to work with you if you are requesting less than their minimum hours.  Other agencies may accept the offered schedule but charge you more for the services because they fall below the minimum hours.

In the latter case, the “minimum hours” refers to the minimum amount of hours to receive their standard price, going below those hours triggers a cost increase.

The reason for minimum hours is not to be greedy or to make more money.  It is because staffing low hour cases are difficult, the fewer hours in the shift the more likely there will not be continuity of caregivers and/or difficulty filling the shift. 

As mentioned in previous questions, caregivers know they are in demand, and will often decline short-hour cases and wait for longer shifts.  For those caregivers that do accept short-hour cases, they likely are accepting the shifts until they are offered long shifts by another agency.

What is unique about home care staffing is the understandable method of starting small and growing over time makes sense in theory but is inverse.

By starting small you are going to have caregivers who resign regularly to accept bigger cases that pay more money.  This leaves families feeling like the agency can’t keep their staff and understandably leaves a sour taste in their mouths.  “Why should we get more hours when these folks can’t handle what we already give them?”   Then they leave for another agency.

The problem is this agency and the one after that is going to have the same issues.  Caregivers will resign or decline to accept the shifts because they are all looking for 8-16 hour shifts.  This leaves families who only need a few hours of care accepting new people into their homes regularly, and this is especially difficult when personal care is provided or the senior has memory care issues.  Even outside those circumstances, families want consistency. 

As we have discussed in some previous questions, there is nothing about healthcare that is inexpensive.  We hear from countless families that they had no idea their loved one was falling or declining…until that last fall which resulted in a fractured hip.  After many months of brainstorming ideas and researching options, we are pleased to introduce Minute Women’s fall and emergency detection system powered by WellAware Care.

One of the biggest issues facing our industry is the cost of care.  Simply put, not everyone can afford 1:1, assisted living, or a well-kept nursing home.  While our fall detection system is not for prevention, this smart system alerts unlimited family members, friends, and neighbors if a fall has occurred.  The fall doesn’t need to be from tripping, this can occur from a heart attack, stroke, epilepsy, or any other reason someone could end up on the ground.

The beauty of this system is that the senior does not need to wear anything, press anything or interact in any way with the system.  Once installed, it just works.  When a fall is detected, an SMS text message is sent to family members alerting them of the emergency.   This is just the tip of the iceberg on what this system can do.  Our smart sleep pad allows you to monitor your parent’s heart rate, sleep patterns and automatically turns on lights when they get up in the middle of the night.  This enables you to have useful and objective data on what is happening in your parent’s home without the need for invasive cameras (which are available if you want them) that many seniors refuse to have.

All of this for a fraction of the cost of what home care, assisted living or a nursing home would cost.

Minute Women has partnered with WellAware Care in hopes of putting our fall and emergency detection devices in the homes of all seniors, regardless if they can pay for the services.   Not everyone has a family who can help or can afford expensive staffing care.   While we can’t prevent falls, we can prevent seniors from being on the ground unable to call for help for hours until someone checks on them.  With our system, a senior’s family and friends (as many people as you add to the system)  can be notified within one minute of a fall occurring.

Pretty impressive!

This all depends on the company.  Some agencies do not bother with transportation unless you are an existing customer who is currently receiving home care services, and there are other companies who are happy to provide transportation as their only service.  There are also agencies that provide both home care and transportation as separate services, meaning you do not need to be an existing client – you can call up, schedule a ride and that is all.

One big question is, who’s car is being driven.  Families commonly use the caregiver’s car to drive their parents as the caregiver is most comfortable in their own vehicle, but you do have the option of letting the caregiver drive your car too.  Many caregivers may have their licenses but do not have their own car.  It is becoming commonplace that caregivers use Uber or Lyft for their transportation needs.  This means it is harder to find caregivers who are able to provide transportation because they either don’t have their own care or don’t have a driver’s license.

Not every home care agency does a driving history check, it isn’t something that is commonly done in the “background check” for employment.  The background check is more for criminal history rather than unsafe driving.  Because of this, many agencies limit the driving jobs to the local area only.  Grocery stores, pharmacies, and doctor’s appointments are the most common reasons for transportation needs.  The changing landscape with the delivery of goods and telemedicine may soon reduce the need for transportation services except for medical procedures and mandatory in-person doctor visits and appointments.

At Minute Women we are happy to provide you transportation services.  We schedule them regularly.  The way we work is we charge per hour from the time we leave the office to the time we return to the office. If we need to wait, we charge for that time as well.  Please note, this isn’t a taxi service, we are providing assistance getting to the car, out of the car, and to their appointment and back safely.  We will walk with your parents or wheel them (if in a wheelchair) to their appointment, ensuring they arrive on time and safely.

You should expect to be charged more for transportation-only services.  The higher hourly rate is because usually people only need 2-3 hours worth of time for transportation, and as we talked about in previous questions, the short hour cases require paying the caregiver a higher rate than the longer hour cases. This rate is usually all-inclusive, meaning there is not a per-mile charge as well. .  The pickup, the drive, and drop off, then the ride back home takes a few hours of time.  If you are an ongoing client, then your hourly fee would cover the transportation time. But if the caregiver is driving their own vehicle, you will likely be charged a nominal per-mile fee (ours is $.55/mile) to reimburse the caregiver for gas, wear and tear, and depreciation on the vehicle.

In all honesty, Uber and Lyft are cheaper alternatives to what we charge for transport-only services, but they only pick up and drop off.  While you may have a driver willing to go above and beyond, escorting a senior to their appointment is not expected from ride-sharing services.  Also, seniors are not as comfortable with using the app, setting up the payment (some seniors don’t have debit or credit cards) and then a “stranger” picks them up.  With Minute Women, there is the chance the same person will be their driver each time, and seniors like that consistency.

Minute Women’s service area is broad. As an independently owned agency, we can service anyone in any town. Compared to franchises, who can only provide care in a certain geographical area (usually 6-7 towns), they are limited to where they can go.

One benefit is when someone calls for services, it is far more likely we can assist them with care, while a franchise may turn away clients or referral sources (hospital, rehabs, etc) because they legally can’t service that town.

Minute Women’s service area is roughly 15 miles around Lexington, MA but that’s a general guide. We have provided services in Gloucester, in Dracut, in Quincy, and in Stoughton. In the end, it all depends on the hours a client is looking for and if a caregiver is willing to drive to accept the shift. The more hours, the more likely someone is willing to drive there. If we get a call for someone in Quincy for four hours per day, it is highly unlikely we can fill it; but a live-in, I bet we could!

In general, the more hours you are looking to have scheduled (there are 168 hours in a week) the more caregivers are going to be interested in the shift. Like anyone else, caregivers are doing this to put food on the table, and longer, consistent hours are something they are all interested in.

One area of concern is that as it gets more expensive to live (rent and homeownership), towns outside of I-95 are going to have more difficulty finding caregivers, especially for lower-hour needs. Towns like Acton, Carlisle, Lincoln, and Sudbury are so expensive caregivers do not live anywhere remotely near them. This leaves the residents there who require just a few hours of care per day in a difficult position. Caregivers are unwilling to drive from where they live in Watertown or Waltham to Acton for a four-hour case, especially when they know if they wait a bit longer an eight or twelve hours shift will become available elsewhere.

This isn’t unique for Massachusetts. It’s happening in suburbs across America. Caregivers often live in the lower-cost cities and towns and feel that driving or taking an Uber 30-45 minutes with traffic to get to a client’s home is not worth the cost. If your parents need just a few hours a day of care for showering and they live in the suburbs or outside of I-495, you can expect to be asked to increase your hours to have the consistency of caregivers; otherwise, you will likely be disappointed in the services you are getting.

So we don’t end on a negative note, this does not mean you can’t find someone, it’s just more difficult. There is likely someone reading this who has had great success finding a caregiver that has provided a small number of care hours for a reasonable cost and consistency, and if that is you, congratulations – you’ve hit a home run!  This is not the rule, it’s the exception to the rule.