What Are the Home Caregiving Options?
Family caregivers cannot do all things all the time. Recognizing when you need outside help is good for you, and also for your loved one.
At least 2.4 million U.S. workers provide home caregiving services, both in-home personal and health care for older adults and people with disabilities. That number has more than doubled since 2010, according to PHI, a New York-based nonprofit advocacy group that works to improve the quality of direct-care services and jobs.
A recent shift in long-term care has moved away from institutional settings like nursing facilities toward aging in place within one’s own home and community, which has fueled this growth. This trend is expected to continue as the population ages. The U.S. Census Bureau projects that the 65-and-older population, which was just over 54 million in 2019, will grow to 94.7 million by 2060.
There are several types of paid home caregivers that provide a range of services.
Personal Care Aides
PCAs are not licensed and have varying levels of experience and training. They serve as helpers and companions, providing assistance with bathing, dressing, housekeeping, transportation to shopping and appointments. Training requirements vary by state, and some states have no formal standards. This is typically an out-of-pocket expense since Medicare or private health insurance usually does not cover these services.
Home Health Aides
HHAs monitor the patient’s condition, check vitals and assist with activities of daily living such as bathing, dressing and using the bathroom. They also provide companionship, light housekeeping and meal preparation. This group must meet a federal standard of 75 hours of training, though training and certification vary by state.
Licensed Nursing Assistants and Certified Nursing Assistants
LNAs and CNAs observe and report changes in the patient, take vital signs, set up medical equipment, change dressings, clean catheters, monitor infections, conduct range-of-motion exercises, offer walking assistance and administer some treatments under direction of a registered nurse or nurse practitioner. They also help with personal care including bathing, bathroom assistance, dental tasks and feeding, plus changing linens and serving meals. Federal law requires at least 75 hours of training, though some states have additional requirements.
Licensed Practical Nurses
LPNs are skilled nursing providers who meet federal standards for health and safety and are licensed by states. They evaluate, manage and observe a senior’s care and provide direct care that nonmedical and home health aides cannot. Tasks include administering IV drugs, tube feedings and inoculations, changing wound dressings, and educating caregivers and patients. Some LPNs have training in occupational therapy, physical therapy and speech therapy. Medicare covers home health skilled nursing care that is part-time or intermittent, doctor-prescribed and arranged by a Medicare-certified home health agency.
Registered Nurses
RNs hold a nursing diploma or an associate degree in nursing, have passed the National Council Licensure Examination and satisfied state nursing board licensing requirements. RNs provide direct care, administer medications, advise family members, operate medical monitoring equipment and assist doctors in medical procedures.
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