ColumnistsLong-term Care

There’s No Place Like Home

By Susan Suben

Two of my clients are experiencing dramatic changes in their health. Tom, who just turned 86 and has been dealing with arthritis, can no longer walk up the stairs to his bedroom. He finds it difficult to prepare his meals, clean his house and take a shower by himself. Carol, who is 82, has COPD and relies on the use of oxygen, needs help with her household chores as well as assistance dressing, bathing and transferring due to shortness of breath.

Both have children who live in other states and both are adamant about wanting to stay at home for as long as possible.

As we age, the likelihood that we will need help with our activities of daily living (ADLs) and instrumental activities of daily living (IADLs) increases.

ADLs include bathing, dressing, toileting, continence, transferring and mobility. IADLs include cleaning, shopping, driving and medication management. Losing the ability to perform ADLs and IADLs means you are losing the ability to remain independent and safe at home. It also means having to transfer these responsibilities to others.

There are many resources in the community that can help postpone the need to give up independence and quality of life as one ages and experiences a decline in health. These resources can be companion care, licensed/certified home health care or adult day care. They can help supplement care provided by family members or friends and provide peace of mind to loved ones who live far away. The amount of services received is dependent on the assistance that is needed as well as what is financially affordable.

Companion care is non-medical, non-licensed care. A companion is not permitted to provide hands-on assistance. The goal is to increase quality of life and limit depression and cognitive decline through conversation and companionship as stated by Comfort Keepers, a nationally recognized companion care agency. Companion care services include but are not limited to meal preparation, laundry, light housekeeping, grocery shopping/errands, incidental transportation, medication reminders and grooming guidance. Companion care is meant to keep you socially, mentally and emotionally engaged, thereby helping to promote a positive attitude, sense of well-being and security.

Companion care has been shown to be a valuable service when transitioning from a hospital stay to home. Studies have shown that proper support can hasten recovery and prevent readmission.

The average cost for companion care is $22/hour with generally a minimum of four hours per visit. Agencies accept clients who are private-pay or have private insurance.

A licensed home care service agency (LHCSA)) is not certified under Medicare. These agencies can provide skilled nursing care, home health aides, personal care aides and homemakers. The care can be hands-on for ADLs and medication management. Nurses can perform medical procedures as well as provide various therapies.

A certified home health agency (CHHA) is Medicare approved to provide part-time, intermittent health care services to individuals who need skilled nursing care/therapies and are homebound. Medicare certification means that the agency has met certain federal guidelines regarding patient care. Medicare will only pay for skilled care for a limited number of days and hours per week. Once you no longer need skilled care, Medicare will discontinue services.

Both LHCSAs and CHHAs charge approximately $25-30/hour.

Adult day care helps individuals stay at home by providing up to eight hours care per day. This is especially valuable for spouses or family members who are primary caregivers and perhaps still working or need respite from caregiving responsibilities. There are centers that specialize in Alzheimer’s/dementia care. Meals are provided and participants can engage in activities meant to promote socialization and mental stimulation. The cost averages $80+ per day.

Tom and Carol, along with their children, coordinated care plans that utilize some of the services described above.

Tom has a companion twice a week to make sure the house is clean and safe. She takes him to the supermarket and helps prepare meals. A home health aide comes in three times per week to help him bathe and manage his medications. Two days per week he goes to an adult day care center. A bed has been setup for him in his living room and the bathroom has been modified to help him shower more easily. His children stay in touch with each service to make sure their dad’s needs are being met.

Carol has a home health aide come in every day to help with her ADLs. A companion comes in twice a week to do grocery shopping, prepare meals and do household chores. To supplement this care, her family was fortunate to find a neighbor who spends time with Carol each day.

Staying home is everyone’s desire when dealing with an illness or the effects of aging.

Know that there are services available so that you can remain safe, comfortable and most importantly happier in your own home.

Susan Suben, MS, CSA, is President of Long Term Care Associates, Inc. and Elder Care Planning. She is a consultant for Canandaigua National Bank & Trust Company. She can be reached at 800-422-2655 or by email at

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