Setting up home health care for an elderly family member starts with understanding what level of care they need, then finding the right provider and making sure the logistics (payment, legal documents, home safety) are in place. The process can feel overwhelming, but it breaks down into a series of manageable steps that most families can work through in a few weeks.
Figure Out What Level of Care Is Needed
The single most important first step is honestly assessing what your loved one can and can’t do on their own. Care professionals typically evaluate two categories of daily function. The first covers basic self-care: bathing, dressing, using the toilet, eating, getting in and out of bed, and maintaining continence. The second covers what’s sometimes called “instrumental” activities: managing medications, preparing meals, handling finances, doing laundry, using transportation, and keeping up with housework.
Walk through each of these tasks and note where your family member struggles, needs reminders, or simply can’t manage safely. This assessment shapes everything that follows, because the type of help falls into two very different categories:
- Home health care is medical care delivered at home by licensed professionals like nurses and physical therapists. It covers skilled nursing, wound care, pain management, physical and occupational therapy, and mobility training.
- Non-medical in-home care focuses on daily living support: bathing, grooming, meal prep, medication reminders, light housekeeping, companionship, and transportation. These caregivers don’t need a medical license, and these are the same tasks family members often handle themselves until the workload becomes unsustainable.
Many families need some combination of both. Someone recovering from a hip replacement might need a physical therapist twice a week and a personal caregiver every morning to help with bathing and dressing. Someone with advancing dementia might primarily need non-medical support but also benefit from periodic skilled nursing visits to manage other chronic conditions.
Get the Legal Paperwork in Order
Before you start contacting agencies or hiring anyone, make sure the essential legal documents are in place. These become critical the moment a care provider needs to share medical information with you or follow your family member’s wishes during a health crisis.
- Healthcare Power of Attorney: This legally authorizes a designated person to make medical treatment decisions if your loved one becomes unable to communicate or make decisions independently.
- Financial Power of Attorney: This covers monetary and property decisions, including paying for care services, managing insurance claims, and handling bills.
- Living Will: This documents your loved one’s specific medical preferences, such as wishes about life-sustaining treatment, so healthcare providers and family members have clear guidance.
If your family member is still mentally competent, now is the time to complete these documents. An elder law attorney can draft all three, often in a single appointment. Waiting until a crisis hits makes the process far more complicated and sometimes impossible without court involvement.
Understand How to Pay for It
Cost is usually the biggest concern, and what’s covered depends heavily on whether the care is medical or non-medical.
Medicare Coverage
Medicare covers home health care (the medical kind) but only when specific conditions are met. Your family member must be considered homebound, meaning they either need assistive devices like a walker or wheelchair to leave home, need another person’s help to get out, or have a medical condition that makes leaving home inadvisable. Leaving home must require considerable and taxing effort. They must also be under a physician’s care, have a doctor-established plan of care, and need skilled nursing on an intermittent basis, physical therapy, speech therapy, or ongoing occupational therapy.
If those criteria are met, Medicare pays for the skilled services at no cost to the patient. What Medicare does not cover is non-medical personal care on its own. You can’t get Medicare to pay for someone to help with bathing and meal prep unless skilled medical services are also part of the plan.
Medicaid and HCBS Waivers
Medicaid is the primary payer for long-term home care in the United States, covering over half of the roughly $286.5 billion spent on home and community-based services nationally. While federal law requires states to cover nursing home care through Medicaid, home-based services are offered through waiver programs that vary significantly by state. These waivers, often called 1915(c) waivers, let states expand services and set their own financial eligibility and needs criteria. Contact your state’s Medicaid office or Area Agency on Aging to find out what’s available where you live, because the services offered, income limits, and waiting lists differ from one state to the next.
Paying Out of Pocket
If your family member doesn’t qualify for public programs, or the programs don’t cover enough hours, you’ll be paying privately. Long-term care insurance (if your loved one purchased a policy years ago) may cover a portion. Veterans’ benefits through the VA’s Aid and Attendance program are another possibility for those who served. Otherwise, the cost comes from savings, retirement income, or family contributions.
Choose Between an Agency and Hiring Independently
You have two basic options for finding caregivers: going through a home care agency or hiring someone directly.
Using an Agency
Agencies handle recruiting, background checks, training, scheduling, and payroll. They also carry liability insurance and manage substitute coverage when a caregiver calls in sick. When interviewing agencies, ask these questions drawn from the National Institute on Aging’s screening guidelines:
- How do you check the background and experience of your care providers? Can you provide references?
- How do you train your care providers?
- Is your service licensed and accredited by the state or local government and a professional association?
Ask how they handle caregiver turnover, what happens if your family member and the assigned caregiver aren’t a good fit, and how quickly they can arrange coverage gaps. Agencies cost more per hour than independent caregivers, but they remove the administrative burden entirely.
Hiring Independently
Hiring a caregiver directly is less expensive per hour, but it makes you a household employer with real tax obligations. If you pay a caregiver $3,000 or more in cash wages in a calendar year, you owe Social Security tax (6.2%) and Medicare tax (1.45%) on those wages, and the caregiver owes the same percentages from their pay. If total household employee wages reach $1,000 or more in any calendar quarter, you also owe federal unemployment (FUTA) tax, which works out to 0.6% on the first $7,000 of wages after credits. You’re not required to withhold federal income tax unless the caregiver requests it and you agree.
Beyond taxes, you’re responsible for verifying the caregiver’s eligibility to work, running your own background check, arranging backup coverage, and carrying workers’ compensation insurance if your state requires it. A payroll service that specializes in household employees can handle the tax filings for a modest monthly fee and is well worth considering.
Consider a Geriatric Care Manager
If the process feels like too much to navigate on your own, a geriatric care manager (sometimes called an aging life care professional) can coordinate the entire setup. These specialists work with older adults and their families to assess needs, create a care plan, and connect you with services in your community. They can make home visits, evaluate what level of in-home care is appropriate, coordinate medical services across multiple providers, suggest potential living arrangements if home care isn’t enough, and address the emotional dynamics that often come with these transitions.
Geriatric care managers are especially useful when family members live far from the person who needs care, when there’s disagreement among siblings about the right approach, or when the situation is medically complex. They typically charge by the hour, and their fees are not covered by Medicare, though some long-term care insurance policies include care coordination benefits.
Prepare the Home
A few targeted modifications can dramatically reduce fall risk and make the home workable for both your family member and their caregivers. The Mayo Clinic Health System recommends these priorities:
- Lighting: Ensure good lighting throughout the home, particularly on stairways, in hallways, and in bathrooms. Use night lights along walking paths. Outside, place solar lights along sidewalks and exterior paths.
- Bathroom safety: Install grab bars near the toilet and in the shower or tub. Use a non-slip bath mat. Set the hot water heater to no more than 120 degrees to prevent burns.
- Clear pathways: Remove loose rugs, electrical cords across walkways, and clutter that could cause tripping.
- Emergency planning: Have an emergency escape plan that both your family member and caregivers know.
If your loved one uses a wheelchair or walker, doorways may need widening, and thresholds between rooms should be flush with the floor. A hospital bed, shower chair, or bedside commode may be necessary depending on their mobility level. Medicare often covers durable medical equipment like these when a doctor prescribes them.
Build and Adjust the Care Plan
Once you’ve assessed needs, chosen a provider, and prepared the home, the final step is creating a written care plan. This document should spell out what tasks the caregiver handles, what schedule they follow, what medications your family member takes and when, any dietary restrictions, emergency contacts, and the physician overseeing medical care. If you’re using a home health agency for skilled services, they’ll create a formal care plan with input from the prescribing doctor.
The plan will need updating. What works in month one often changes by month three as your family member’s condition evolves. Schedule regular check-ins, whether with the agency, the caregiver directly, or a geriatric care manager, to reassess whether the current level of support still fits. A common pattern is starting with a few hours of non-medical help per day and gradually increasing coverage as needs grow.