Long-term care refers to a range of supportive services needed to meet a person’s daily care needs over an extended period. Often these services are non-medical and focus on helping with everyday tasks—commonly called activities of daily living (ADLs) and instrumental activities of daily living (IADLs)—though long-term care can also include skilled nursing when required.
ADLs typically include bathing, using the toilet, dressing, eating, and transferring between bed and chair. IADLs cover tasks that support independent living, such as housework, medication management, paying bills, shopping, and meal preparation.
Estimates from the U.S. Department of Health and Human Services and the Administration on Aging indicate that seven out of ten people over 65 will need long-term care at some point, and about one in five will require that care for more than five years.
Because of these odds, some people choose to move into a continuing care retirement community (CCRC), also known as a life plan community, while they are still healthy. Living in a CCRC provides peace of mind: residents have access to a full continuum of services—from assistance with ADLs to full-time skilled nursing—if their needs change.
Confronting care decisions
Most seniors, however, do not live in a community that provides a full continuum of care. When an older loved one begins to need help with ADLs or IADLs, families often face difficult choices about where and how the care will be provided.
Some families take on caregiving themselves, either in the senior’s home or in their own, because professional services feel unaffordable or because family members prefer to provide care personally. While this can seem like a cost-saving solution, caregiving carries hidden costs: reduced work hours or lost wages, diminished benefits, and physical and emotional strain on the caregiver.
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Other families move their loved one into an assisted living community, where staff provide help as needed. Although assisted living can appear expensive—the national average for a private one-bedroom was around $4,000 per month (including room, food, and care services) according to Genworth’s research—nursing home care often costs significantly more.
Many families instead hire in-home caregivers to provide support where the senior lives. Genworth reports that 44 hours per week of home care (about six hours per day) averages roughly the same monthly cost as assisted living—around $4,000—but that cost is in addition to housing and food, and the senior may still be alone for parts of the day.
If you decide on home care, you must choose between hiring an independent caregiver directly or working with a home care agency. Each option has advantages and trade-offs.
Independent caregivers
Independent caregivers are hired and employed directly by the senior or their family. Some have training to provide basic medical tasks such as wound care, injections, or monitoring vitals, though clinical care is less common and typically commands a higher hourly rate.
Cost is the primary benefit of independent caregivers: hourly rates often average around $15, which can be 20–30% lower than agency rates.
The trade-off is that hiring a private caregiver makes the family the employer. Responsibilities include conducting background checks, verifying licenses if needed, arranging liability insurance, handling payroll and taxes, and complying with employment regulations. Third-party payroll services can simplify the pay and tax tasks for a fee. Finding a reliable caregiver and replacing them if they leave can also be time-consuming, and because most elder abuse occurs in private homes, thorough vetting and background checks are essential.
Home care agency caregivers
Home care agencies are licensed businesses that employ caregivers and contract with families to provide in-home services. Agencies may offer credentialed nurses or nursing assistants who can deliver medical care, in addition to caregivers who assist with ADLs and IADLs.
Agency care tends to cost more: average hourly rates commonly exceed $20, typically about 20–30% higher than independent caregiver rates. The higher price reflects agency overhead, licensing, insurance, and administrative support.
>> Related: Crunch the Numbers: Staying in Your Home vs. Moving to a CCRC
Other factors to consider
Beyond cost differences, other considerations can influence whether an independent caregiver or an agency is right for your situation.
If the primary need is in-home medical care, an agency may be preferable because it can supply properly trained and licensed professionals. If the senior mainly needs companionship or help with errands, chores, and light personal care, an independent caregiver might be a better fit. Some agencies limit caregiver driving due to liability concerns, so if transportation is essential, a private caregiver could be more flexible.
Medicare generally does not cover non-medical home care, regardless of who provides it. When skilled nursing or therapy is medically necessary, Medicare may cover some home health services for a limited time.
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Accounting for care quality
Care quality depends largely on the individual caregiver. Whether independent or agency-based, caregivers vary in skill, reliability, and rapport with the senior. An advantage of working with an agency is the ability to request a replacement caregiver if the match isn’t working. With an independent hire, finding a replacement requires repeating the search, hiring, and onboarding process.
Making the right choice
Choosing the best care option involves weighing many factors. Consider costs, the level of medical need, the senior’s preferences, family bandwidth, and long-term plans. A few practical steps can help:
- Make a pros and cons list for each option, including direct costs, potential lost wages if family members provide care, expected quality of care, and the effect on the senior’s well-being.
- Visit nearby assisted living communities to see if any are a good fit. Talk to residents, read reviews, and consult local long-term care ombudsman resources for any concerns.
- Talk with friends or neighbors who have cared for an aging relative to learn from their experiences and ask for referrals.
- Research home care agencies in your area. Request references or speak with recent clients to learn about their experiences.
- Search for independent caregivers locally and ask for recommendations and references from past clients before hiring.
Ultimately, the right path depends on the senior’s needs, the family’s resources and preferences, and the available local services. Careful research and thoughtful planning will help you find a solution that balances safety, comfort, and cost.