How are others managing when paying for privately for assistance at home?

Since covid hit over the last 3 years we have had very, very poor experiences with agencies being able to provide coverage if their worker called out day of or even day before service. I have accounts with 3 different agencies and it is pretty common to get a call "Susie called out today and we don't have anyone we can send you."

Secondly, most of the agencies do not require prepayment. I'd try to avoid agencies that require a down payment with the contract. One of the national agencies we use required that
and I was a novice and desperate when we signed up. The other two agencies I work with don't require a down payment when starting the contract.

Thirdly, Read every line of agency contract. One of the national agencies has a clause in the contract that their workers can not lift more than 10 pounds. This was not on the radar when Mom was walking a mile a day with her caregiver. Not that she is late stage alzheimers this clause is problematic and means a caregiver can't even carry groceries from the car.

Our best direct pay caregivers have been through personal referrals.

We did not have good luck with care.com. I could never get anyone to send over a resume so we never met anyone from there. It seemed somewhat scary.

Over the past 10 years our best workers have been CNA's. They have been far superior to
the unskilled workers working in care. When I have to use a care agency I specify CNA's.

Unskilled women working in care have been very poor particularly early on in Mom's disease (years ago.)

You need to shop around.

We pay for most of our caregivers directly but I have accounts with three agencies.

I've never encountered the 12 hour minimum per week from an agency.

We've had around the clock care for years.

We live in a very low income poor county in Maryland. I've just raised our start pay to $25 per hour. (It was $18 per hour.) We have some who have been with us 10 years making $31 per hour. We pay legal through our accountant so workers get social security, workers comp and unemployment. Agencies in my area are all charging around $29 per hour.

We have one agency worker who has been with us about 3 years and around 30 hours per week. The biggest problem with agency workers is the constant turnover.

You also need to remember with this 4 hour minimum, the driving distances and gas cost. Our county is a very large area-wise county. People don't want to have to drive long distances from home to client and client to client. If someone wants to work and be paid for an 8-hour day, they don't want to drive another couple of hours to get back and forth. It would be much easier for them to have 2 clients with 4 hours each in a day, then 4 clients with 2 hours each. It doesn't help us the clients needing to provide care for their loved ones at a decent, good out of pocket cost, but it makes sense for the aides.

Hello! We are paying for private duty care for my parents. I'm not sure what area of the country you are living in but there is a great variation in rates. We live in the Northeast. After much research we found that it was much better to hire caregivers directly, for 2 reasons. 1.You are able to interview them yourself and get a feel for whether they are the person you would like to have in your home. 2. It is much less expensive than going through an agency. You don't have to do it completely on your own. We joined a service ($140/year) where we have access to RN, CNA, HHA and Companions. All the resources you need to do background checks, registry checks, etc. are available through the agency. Once you have vetted the applicants and you have chosen the people that you want, you can also have a payroll company handle payments, although you are not required to do so. All that being said these are the differences in pricing that we found: The initial agency, that we had called when first starting, charged us $35/hr. That was just for a Home Health Aide, not a nurse. I learned that of that $35/hr, the HHA was paid $15/hr.
When we switched to a self managed agency we were able to have Certified Nursing Assistants with Medication certifications and experience with Dementia. We have 3 people. 1 only works 5 hours a week. We pay all of them $23/hr. The agency that we went through is Care.com. I am not sure if they are nationwide or just in New England. Best of luck with everything!

Most home healthcare agencies require at least 12 hours per week and at least 4 hours per visit. It needs to be worth the caregiver's time to add you as a client. What you may not know is that the caregiver only gets paid minimum wage.

If you need somebody less expensive, consider hiring 2 caregivers privately. Let them take care of all morning needs for your husband - bathing, dressing, cooking his breakfast, tidying up after breakfast, light housekeeping... for about 4 hours (more or less) per day. You can negotiate wages, services, and times. When you hire, get a lawyer to make up contracts as well as help you cover the intricacies of being an employer.

I'm in the Los Angeles area, and I posted a notice to my neighbors on "Next Door".
I got lots of people applying, and most are happy with $20 an hour. Of course you have to do the interviewing and checking them out. You could also ask the various nurses or church members or other neighbors. Word of mouth and personal recommendations are best.

I've hired from the hospital registry for my dialysis assistance. I have 5 days a week and have my tech with me for 4 hours on those days. I'm wheelchair bound, but I can transfer to the toilet or bed without assistance. I have two aids who help me showering and dressing daily. One works M-Thurs and the other one F-S. I also pay my two granddaughters who come at other times for four hours at a time as needed for other help. I pay all help$15.00 per hour and withhold taxes and Social Security. I pay approximately $900.00 a week. Starting next week my long term care insurance will kick in and pay 700.00 a week. I like being at home and that's what I saved and worked for and paid long term insurance premiums for years. But when it becomes undoable at home I'll go into the nursing home.

I will try to be brief in my answer. I spent hours and hours of time over months and months looking into possible options for the care of my 97 yr old mother who was living in her own home. I provided the majority of her care over a period of 10 yrs. Her needs increased over that time as her COPD and mobility issues worsened, she lost most of her vision due to macular degeneration and started demonstrating the early signs of dementia. I believe I contacted every agency both local and national supposedly serving the needs of the elderly and disabled. I talked to care managers and social workers. Many agencies that reportedly offer assessment and assistance in finding care solutions had waiting times years out. Otherwise the "resources" just circled back to lists of agencies that provide a variety of caregiving or medical services for private pay at an hourly rate. These agencies all had minimum hours per day and per week. The very least expensive I found was Seniors Helping Seniors at $30/hr for no-skills caregiving like companionship or (very) light housekeeping or simple meal prep. Their per day and per week minimums were more manageable. I did use this service for a few months which mostly gave me a break from going to my mother's house and cooking dinner 3 days a week. Using this service did require a lot of initial time orienting 2 caregivers to my mother's home and sharing my lists of simple things I was hoping they might do during a 2 hour stay. This level of help was really inadequate however as it was becoming apparent that my mother needed care available 24/7. At some point you reach capacity on what you are able to do yourself, even living in the same home.

Simple math tells you that even those untrained caregivers full time would cost $720 a day and $21,600/month as compared to the $4,600 a month assisted living facility that we moved her into. I did not feel competent to advertise and hire a private full-time caregiver that I could trust with the care of my mother. I didn't find a nursing registry or anyone who knew of a person interested in doing in-home care. Obviously you would need more than 1 person for full-time care and even for part-time care it is best if there are at least 2 people who can come regularly. People don't show up, cancel, don't do what you expect and it all requires a tremendous amount of your personal time and energy even with caregivers coming into the home.

I don't like to be so negative but there doesn't seem to be any solution aside from spending lots of money for private care. You might qualify to receive payment for the caregiving you provide though it doesn't seem to be much money. I did not do that but there are other posts that address that process. I believe it is paid through Medicaid. Perhaps it would at least pay for some of the expense of caregiving help. I hope you find some help that you can afford.

Check out care.com instead of the agencies. We had much better luck with them. The agencies charge more, but the workers only get half of that fee, at the most. If you hire off of care,com, you stipulate the hours and and agree on the price. Plus, you get personal accountability because its the same person every time. Just make sure to check them,out before hiring them.

Shop around. The well-known companies such as Visiting Angels are often much higher than little-known agencies. Some agencies will work with you on a lower rate if you commit to a certain number of hours. Be hesitant if they require a down payment (for “last payment”). They don’t like returning that money.

I would like to add a word of caution here that if you want the VA's help, you must apply, or your LO must have already applied and been accepted. My journey with the VA has been so bumpy and awkward and still not qualified. They knew my husband well for many year's service, in and out of war, but now they don't know him!
You must do paperwork and wait for an answer.....govenment grinds exceeding slow! Be patient and careful with your paperwork and it might happen. Just don't go there thinking you can say he/she is a vet and it will happen.

Hi Judycares, I’m a vet with the American Legion and if your husband is a wartime vet (he’s at the age of Korean or Vietnam era), he may qualify for the improved pension with Aid & Attendance, which can help pay for home health aide expenses, and if he’s registered at his local VA clinic/hospital, his doctor there can also order additional hours of home care in addition to the Aid & Attendance. Feel free to reach out for additional info.

I was right where you are and this is my experience.
I shopped. You gotta shop.
I shopped businesses like Visiting Angels, turns out there's a gazillion of them. Some have commercials, most don't cause it's too expensive.
I discovered the caretaker, for a fee, can solicit business thru these "middle man" orgs that give you their contact information readily on the website. Other media offers hired help and it's just shopping. SHOP
Also, if you are paying you never have to combine "companion with help bathing" or "folding with toilets?" You may go directly to "help with bathing and toilets". I was a much better companion when I didn't have to clean the bathroom. I had more mental and physical energy for the good stuff. Always hire for the tasks that you don't want to do. Be certain and be specific.
Thru my shopping I hired exactly what I wanted and it worked very, very well for me for 3 years. I started with 1 hr/week and ended with 30 hrs/week at 25.00/hr. over the 3 years. The sum cost for 3 years was about $22,000.00....with the same caretaker.
Most of these folks are professional. They work with everyone's needs and schedule.
I shopped. You gotta shop.

My mom's agency is ~$35/hr with a 2-hr minimum; seems like a small difference but over time it adds up. If the $480/wk is just *somewhat* out of your budget, you might shop around to get slightly better rates. Otherwise, you could try a nursing registry -- these are non-profit registries that maintain rosters of nurses, CNAs and companions that are available for private hire. They don't provide anything else that an agency would provide, like bonding/insurance, ready replacements if an aide calls out sick, etc. -- they're basically just a referral agency -- but they usually do some vetting (reference checks, etc.) up front, so it feels a little more comfortable/safer than just hiring someone out of the personal ads. Your local agency on aging or senior center should be able to tell you if there's a registry in your area. Best of luck to you!

My first thing for help with my mom was to hire a cleaning service. They come every other week for 3 hours and it's wonderful.

I asked around and get references for some private caregivers. We've used 3 and they've been awesome. Start asking friends and if no one. knows of someone, try a facebook page for your area to find someone. Ours charge $25/hr. Different aides prefer different time frames - I have some that don't mind coming for 2 hours but someone that lives further, wants 3+. Makes sense.

You said hubby didn't want another round of PT. Very unfortunate. I would ask doc for a new referral and don't allow him to cancel again. Regaining some strength and endurance would be great for him. I use mom's home aides to do the exercises with her that the PT has prescribed. If you can do them with him too, that's great, but my mom won't listen much to me and I'm too tired to argue and cajole, etc. She's pretty happy to do it with the aides though.

Judycares: Perhaps you can shop around for in home care.

won't medicare pay for anything?? there are aides that medicare would pay for and some nursing you just have to call and write info down. then compare and see what info is good for you and husband.. don't know what your financial situation is like but keep checking everywhere you may come across places that help those without the financial means. you have to do your home work - it will be worth it for both of you. gives you a reprieve

dear judycares:
My husband is now in a local memory care facility and had been there for 2 years.
I researched @ home care and found that I couldn't afford it and I could no longer care for him myself. This really nice lady @ the adult day care where he was going for 2 days a week told me about several memory care facilities and I called each one and found out they were very expensive, with the exception of the one he is now living in. The first one was $10,000 a month ( almost fell off the couch!) the second one was the one he is now living @ $2,500 a month and includes everything. The facility is very old and not @ all updated but has everything he needs. He receives 3 meals a day, laundry taken care of, sheets, towels, depends and staff to take care of his meds, etc. I can't ask for more. I'm very happy that I can pay for his care. We both worked very hard all our lives and this money we saved is for his care, I'm glad I can pay it. Medicaid strips you of practically all you have. I also checked that out. I know that in home care thru an agency is very expensive. I wish you the best because I know how hard it is to try and figure out the budget. You also have to think about your living expenses too. It is very hard to place a loved one in a facility this I know first hand but for me it was the best and I know he is being cared for. I visit him every other day and sometimes every day. I know what you're going thru and I'm sending lots of prayers & hugs, Roofie

I totally understand where you are coming from. It was going to cost us $20,000 a month to keep my dad at home but that was 24/7 care. Yes they all have a minimum of how many hours a person has to stay and a minimum of how many hours a week. If you’re husband is a va he can get the assistance you are talking about and it could possibly be free. It is based on if he was in a war active duty how long he served and his rank. My dad qualified for 8 hours a week which was 4 hours twice a week. They would take him downstairs to the basement and help him shower or give him a sponge bath in bed. Change his sheets do the laundry clean the bathrooms vacuum and whatever else needed to be done. They even took him to the dr a couple of times (va doesn’t pay for that type of transportation) they even did some grocery shopping. He also got a hospital bed, wheelchair, handicapped rails, a stool lift, shower chair at no cost. He even got a scooter and the thing to haul it with put on the back of his car. The scooter took like 2 or 3 years to get approved there’s a lot to go through to get one and this was definitely before he started declining after a fall he had in March 2021 where he got 2 brain bleeds and cataracts and retina tares. He also could have gotten more hours as he progressed unfortunately we did not make it that far however; I believe the maximum is 16 hours a week. He may also qualify for aid in attendance. Which is extra money a month I believe it is 2,400 a month but I’m not sure, this benefit is based on the earlier information I gave you and income, as far as income I do not know how that works except some stuff doesn’t have to be used to qualify. It takes about 6 months to get approved but it is retro backed to when he applied. In addition; you can qualify for some and I think that is $1,200 a month and you can still receive your portion after he passes (but I’m thinking you have to have a medical condition to receive it). If you’re husband applies and it is not approved before something happens to him, then you would have to reapply. I believe for sure then there has to be something medically wrong with you. This money is to help with his in home care or upgrades that need to be done. It can also be used if he would have to go to a nursing home. You can also look into Medicaid and Medicare. I would caution against Medicaid because they have a five year look back rule in which they can make you spend your assets down to 3,000 before you get assistance (at least that’s how it works in a nursing home) I know though they can make you pay back everything they pay for you or if you have no assets they can put a lien against your house in which if it is sold they get there money first. I would suggest getting an elderly law attorney especially if you have any assets even if it’s just your house. My sister took my mom to one (because when you go on Medicaid) you have to do a division of assets. They have to leave you a place to live and an automobile and you get half of any money you have. The lawyer my sister went to was experienced in Medicaid and va. The only other thing I know is there was going to have to be a trust created for my mom and they had to figure out how much money she needed every month. I hope you find this information helpful

From what I know minimum 12 hours a week, at 4 hour increments is pretty normal, but $40 an hour seems pretty high! I believe Medicare will pay for bathing assistance 2x a week. If husband is a vet, VA would be a good resource. A cleaning service every 2 weeks could help you. Ask friends, family, church for recommendations to pay independent care givers ($20 -$25 an hour). Lastly, ask your husband's doctor to recommend a physical therapy referral). If he receives PT, it will help him be stronger to transfer independently.
Best wishes to you and your husband.

Is your husband a veteran? If yes he might qualify for a VA pension in the Aide and Assistance program. It provides monthly money to help with expenses needed for his care. It’s been a lifesaver for me caring for my dad.
And I tried using an agency and didn’t like the care given. I friend recommended her friend who has become my dads companion. She is absolutely wonderful with him. She makes her own hours so she is not considered an employee of mine. Her being here allows me to run errands or make appts, knowing he is well cared for. She asked $20/hr and I am in NY.

Home Instead is a national franchise that offers care flexible hours and days and rates that vary depending on total weekly hours. I contracted with them for four hours two days a week at $35 hourly rate. Many in-home care-giving organizations require a minimum hour requirement. Assisted Living and Memory Care facilities require minimum stays for Respite Care ranging from seven days to thirty days at $250--$300 per day. Good luck.

Gosh where are you located? I interviewed Visiting Angels for my mom and they were $24 an hr. That rate is pretty much the standard rate in my area. South FL. I ended up using a local private care company thru a referral. Same rate but just amazing personal care with so much interaction between me and the owners.

Unfortunately the rates have gone up signficantly. When I first needed an aide the going rate was around $15. The aides are asking for more because there is or was a shortage in aides. So their demand went up. This is what someone who owns an agency told me a year or so ago. The best route is private care. Some charge outrageous rates but you can find good genuine ones for much cheaper. It also depends on how much care your loved one needs. Negotiate. You need them as much as they might need you. Don't let them charge you so much you can't survive. Judge your payment on how much work is needed and their references and experience. Medicare or caid might provide aides but they might only be for a few days or hours a week or month. I can't remember exactly which one but I tried to go that route but I needed Mon-Fri care and they did not provide that whether the days or hours and I believe it wasn't that much a month. I would still have to find someone else but if it can save you and you get decent care look into it. Maybe you can find a good person who will do it for cheap even if it's only for half the hours you need and hire the agency for the rest. Split the time. It's something I'm finding I have to do now because my caregiver only works 5.5hrs but can't do the physical stuff. Right now I am not working but when I go back I will have to find care from an agency or privately and split the time. The one I have now I trust. Which is most important! But I know I will need someone when I go back to work and you need 2 caregivers at the least.
Hope it works out for you.

Private in home help is pricey. Those who don't blink at $480 per week (or much, much more than that) have savings that will probably see them into the future for many months or years. The rest of us don't even put it on the wish list.

So short answer to how people manage to pay for home health - they don't.

It's possible a cleaning person to help you out one day a week with heavier chores might be financially doable for you. Do you know anyone who has a cleaning person? If so, ask if you could be added to that person's cleaning schedule. If you have children, talk to them about you needing a little help and see what they have to offer. Start there.

My experience is the 4 hour increments are designed for company's to assign 1 person, the same person. The same person, for most, is very important.
They say hours less than 4 require multi different folks to help those in need. And, again most, prefer the same person...hope that helps
I've been able to get help for my mother from a few individuals who help already (within a small condo community).

This is somewhat standard and must be changed: it’s outrageous. I suspect if you keep looking. you’ll find help from someone who isn’t being exploited by an agency like this!

I live in southern Oregon and I am having problems finding in home care there is a tremendous shortage of workers. I have been promised by major health care providers to give me referrals with no success. Searching for providers most of what I find is referral services that do not actually employ people. I even tried visiting angels with no success next I tried the internet and got 1 response from someone 40 miles away. I am very frustrated
where do you look next.

Rates are location-dependent. For example, an hourly rate in Washington DC area is probably higher than in Idaho or New Mexico. It is driven by economy and demand (which is driven by density of population). But the 4-hr minimum requirement seems to be industry standard.

Some mentioned about Medicaid. It is different from state to state, but if you can be qualified for Medicaid, power to you. It really helps defray the cost!! Keep in mind though that not all care agencies accept Medicaid. This is why so many caregivers are bankrupt to finance the caring of their loved ones at home. Or quit their jobs to do so themselves.

Something is wrong for a super wealthy country in the world with a crappy health system.

I found this with Bayada but $30 and $31 an hr. Based on regular v. Weekend/overnight rate (for father); for mom, they come 2 days per week for 4 hours each day—more flexible I guess due to 24/7 care for father. They initially wanted 3 days per week for her. These are home health aides.