In-home care includes a wide range of services provided in the home, rather than in a hospital or care facility. It can allow a person living with Alzheimer's or dementia to stay in his or her own home and can be of great assistance to caregivers. Not all in-home services are the same. Some provide companion services such as help with supervision, recreational activities or visiting. Others provide non-medical help, such as assistance with bathing, dressing, toileting, eating, exercising and other personal care. In-home medical care provided by a licensed health professional, such as a nurse or physical therapist, is also an option.  Common types of in-home services include: 

  • Companion services: Help with supervision, recreational activities and visiting. 
  • Personal care services: Help with bathing, dressing, toileting, eating, exercising and other personal care.
  • Homemaker services: Help with housekeeping, shopping and meal preparation. 
  • Skilled care: Help with wound care, injections, physical therapy and other medical needs provided by a licensed health professional. A home health care agency often coordinates these types of skilled care services when ordered by a physician. 

Getting started. Deciding who will provide in-home care is an important step. For some, using an agency is the best choice; for others, an individual care provider is a better fit. The following steps can be helpful when trying to find the right care: 

  • Create a list of care needs. Before contacting prospective providers, create a list of care needs (e.g., friendly visiting, meal preparation, toileting) as well as your expectations on how these needs will be met. 
  • Ask for recommendations. There are likely many people in your community who have gone down this path before. Starting with family and friends, ask for recommendations. You may also want to ask health care providers, including doctors, nurses and social workers. Reach out to your local Aging & Disability Resource Center, check with colleagues, ask fellow support group or church members, and peruse local newspapers. 
  • Call first. When you call to screen in-home care providers, find out what kind of help they offer and if it meets your specific needs.
  • Interview at home. Meet with a prospective home care agency and/or provider in your home. Prepare questions beforehand. It's a good idea to have a third person present so that afterward you can discuss your impressions. 
  • Check references. Some agencies will perform criminal background checks. Ask if these have been conducted. It is also a good idea to talk to others who have worked with the provider. 
  • Share information. The more care providers know about the person they are caring for, the better care they can give. Familiarize the care provider with  past accomplishments, fond memories and other guideposts that are still strong in the person’s current memory. It will help them form a greater bond. 

Questions to ask an agency. When choosing a home care agency, there are a number of factors to consider. Use this checklist of questions when considering an agency:

  •  Operations 
    • How long has the agency been in business? 
    • Is the agency licensed or accredited? 
    • Are the employees bonded and insured? 
    • Does the agency offer a visit from a registered nurse prior to start of service? 
    • What kind of quality control checks are made by supervisory personnel and how frequently are they made? Who is available if problems arise? Is 24-hour call-in to a registered nurse available? 
    • What happens if an aide doesn’t show up? 
    • Are there a minimum number of hours or days per week required by the agency? 
    • Is there 24-hour care in case of an emergency? 
  • Staff 
    • What kind of criminal background checks are performed for prospective employees? 
    • Are references checked? How many? 
    • Does the agency provide employee job descriptions? 
    • Are personnel files updated annually? 
    • What kind of experience/certification do the aides have before they are hired? 
    • What type of training does the company provide to employees? Does training cover Alzheimer's and dementia care? 
    • Who pays the worker's social security or other insurance? 
    • Is there a care plan in writing for each client? 
    • Will the same person be providing care on a regular basis? 
    • Is a list of agency references available to check the level of client satisfaction?
    • Can I interview the employee? Is there a fee for this? 
    • Does the aide have reliable transportation? 
    • If specialized medical care is needed, are employees licensed to perform? 
  • Costs 
    • What is the cost of the service? 
    • Are there additional costs for weekends, holidays or other times? 
    • What is the billing procedure? Do you pay the agency or the aide directly? 
    • Does the agency bill Medicare or other insurance directly for covered services?*

*Costs for home care services vary depending on many factors, including what services are being provided, where you live and whether the expenses qualify for Medicare or private insurance coverage. After talking with the agency, you will also want to meet and talk directly with the care provider.

Questions to ask the individual care provider. When hiring an individual home care provider, either through an agency or independently, there are a number of factors to consider. Use the following questions as a guide:

  • How long have you been working in the field? 
  • Do you have experience working with someone with dementia? 
  • Are you specifically trained in dementia care? 
  • What is your approach/philosophy to caring for someone living with dementia? 
  • Are you trained in first aid and CPR? 
  • Are you with an agency? 
  • Are you bonded (protects clients from potential losses caused by the employee)? 
  • Can you provide references? 
  • Have you undergone background checks? 
  • Are you available at the times needed? 
  • Are there a minimum number of hours you require? 
  • Are you able to provide backup care if you should be sick? 
  • What type of help or care do you provide? 
  • Are you able to manage our specific health and behavioral care needs? 
  • Is there anything you are unfamiliar or uncomfortable with? 
  • What are your costs (if independent)? 
  • Do you have your own transportation? 

In addition, consider describing a typical day and some challenges that may arise. Have a conversation with the care provider about how they would go about the day and brainstorm ideas. Introduce them to the person with dementia and see how they interact. Be sure to have ongoing discussions and maintain a good relationship with the care provider as you partner to provide good care.

Reprinted from the Alzheimer’s Association

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