In-Home Care Cost

[Isabel81]

My father, a long-time paraplegic with diabetes, just learned that he will have to be bed-bound for the rest of his life on account of skin ulcers that will not heal.  He is torn between resigning himself to a nursing home for the rest of his life (which could be another year or another 40 -- he's in his 50s now) and just going back home, where he lives alone, and doing whatever he wants until an infection kills him.  This would probably happen in 1-2 years at the latest, based on his medical history.  I've been trying to convince him to give the nursing home a shot for a year or two so my husband and I can buy a house near our family and move him in with us (living in his house is not an option, nor would it save money -- he owes more on it than it's worth).  We're both 27, and we currently live in a small apartment 1500 miles away from him.  What I'd like to know is how much in-home caregivers tend to cost, per hour, or what the range is.  My husband and I both work full-time, and my father has a set amount of money for aid and attendance from the government.  I had assumed his income would be enough for someone to come in a few hours a day, change the dressing on his wounds, and make him lunch, but the more I learn, the more expensive and impossible everything sounds.  Has anyone else been in a similar situation?  What did you do?  

[swampcritter]

The costs vary quite a bit depending on location.

There are two levels of people hired to be a caregiver. There are "home aides" which perform mostly non-medical work such as cleaning and meal preparation, and there are CNAs (certified nurses assistants). CNAs have some medical training, they can take vitals and they usually have an investment in their job as a career, so they are a little more stable.

The caregiver will be someone's employee, yours or an agency's. Agencies are more expensive but allow you to easily swap out caregivers that aren't working out. In addition, every agency worth its salt has an RN on staff who will visit every 4 weeks to make certain the job is being done correctly. As oversight of caregivers is a big, this is invaluable.

Be sure to background check anyone you hire. You can ask them to produce a good conduct certificate in some areas, and if they are a CNA many states have a method for you to check that their license is current.

I've got 4 caregivers, and 3 others, hired for two people. The caregivers range in price from just over minimum wage to $20 / hour (this is an agency caregiver).

Taxes -- you should carefully talk to your tax person about this. The basic information is that you might be able to deduct from taxes the caregiver's wages that correspond to medical procedures (such as changing the dressing). However, you cannot deduct non-medical expenses (like preparing a meal). There is a tax credit for home care, and if you hire someone legally by the book, you can deduct payroll taxes.

In general -- and I am being very general here -- it sounds like what you want should be doable for $2000 - $3000 / month in a inexpensive area.

There is another option, which is to find someone to live with him. Sometimes you can find a student or someone just starting out who is willing to do it. Free room and board means much in this age of expensive housing.

Good luck to you, this sounds like a sad situation.

[Isabel81]

Thanks.  Do you happen to know any websites where I can find agencies in different areas?  I'm not sure where to begin looking to find one, and I know that some must be better than others.

[swampcritter]

No, not really. Sorry. You might ever start with the yellow pages, or talk to a social worker at the local hospital.

[JennyO63]

You could try contacting your local MS Society and see if there are any patient advocates available. I am one from Pennsylvania. I have been caregiving since a child. My grandmother had MS, five of seven of my mom's siblings have had me as their homecare aide. I have a very hard time asking for money for this service! It seems so natural to get up, get dressed, and go dress,feed,encourage,etc... the patients in my care. I have lifelong experience, never finished college. I have my AS in Biological science, but stopped there to hospice my aunt with emphysema. I strive to keep the sick and disabled live in their own homes until death. I see what happens in "assisted living facilities" and nursing homes. Truthfully, there's not much difference between the two places! The minute your loved one dies in a nursing home/assisted living~ their belongings DISAPPEAR in minutes!!! Staff and other residents see to the thefts! Enjoy going to funerals for your fellow facility resident patients almost weekly. You don't go there to get better, that's for sure! I walked into a facility with "24/7" security at 3am after my shift and NOBODY stopped me, nor were the doors locked! I could have been anyone!!! I called the police. The nursing staff~ all out on a smoke break all together, leaving the patients all unattended~ didn't quite like me taking pictures of the negligence I have seen, even as a church volunteer at several facilities in three states.
My SPMS patient is cruel to me only, not his family who can't bear to see him"wither away". He paid my rent twice in the year I cared for him, which is $575/monthly. I am/was there with him 3-5 hours everyday,morning and evening. Divide $575 by 30 days= $19.16 per day. I feel bad taking ANY money at all, but I am spending all my savings quickly!!!!! Anyone needing nursing care at home in Las Vegas area~ email me.

[swampcritter]

It seems that there really is no good place to connect caregivers with clients (a "virtual agency").

Swampy's mom has MS, although, at this stage in her life, the MS is well managed and her primary problems are just related to normal care.

[Heiferly]

There are many agencies that can help connect you with a list of agencies or independent providers.  Many areas have an Area Agency on Aging; check with the National Association of Area Agencies on Aging.  They can be great resources for referrals.  

http://www.n4a.org/

Your local Medicaid/Job and Family Services Office may be able to provide you with a list of agencies, as Medicaid waivers are sometimes used to pay for home health aides through nursing agencies.  

Here is another website that may help:

http://www.eldercare.gov/Eldercare.NET/Public/Home.aspx

If your father has Medicare or Medicaid, some home health care may be covered.  If you have more questions about this, feel free to send me a message.  Good luck!

[jo929]

In okla , if you draw soc security, you can get an aide and it does not cost anything they will do a little cleaning and bathe the pt the agency pays them  $8 an hr. also here in okla they work for less you can get a list of agencies at the local hospital, they stay about 3 hr in okla the wages are a lot lower than anywhere else  I am sorry that you and your family have these problems, but remember most agencies are out to make the dollar, you get the good with the bad  luck  jo  My husband has a caregiver that bathes him he does not walk and is on oxygen luck  jo  these free places are set up so that people can stay in their own home as long as they can, but if you get completley helpless it will have to be a nursing home unlessa a family member can live with him

[vision271]

It has been almost impossible for me to find one of these "home health care workers" in my city. Either they do not show at all, they want a job where they can watch television, or they try to take advantage of the patient in any way they can. The agencies do not care. The workers are totally untrained--all that is required for the job is a criminal background check.They are often illiterate which can pose dangers. They otherwise pose dangers to the patient. Workers at McDonald's have more requirements, and make the same wage. I am afraid that word gets around that it is a job you can manipulate.

Maybe your city has better agencies/workers. I certainly hope so. You could use this help. I am telling you this so that you will be careful, not to be negative.