By Carol Levine, AARP

Creating a safe and comfortable environment is only one factor in staying in your home. Many older adults need at least some help at home. Some people need just a little assistance with transportation and shopping, for example, while others need a lot of help with personal care such as bathing and dressing. People with complex chronic conditions usually need help with managing medications, operating medical equipment, monitoring symptoms, and similar tasks. In the following sections, I help you consider whether family members can provide those important services or whether you need to consider hiring trained professionals.

Allocating tasks to family

At least 80 percent of assistance at home is provided by unpaid family members. A first step for providing help at home is to allocate tasks to family members and/or friends. Talk to them to find out who’s available and willing to help and what limitations they have. If several cooperative family members are involved, the tasks can be divided. One person may be able to spend several afternoons a week shopping and preparing meals, while another can manage medications and doctor visits. A friend may be able to pick up prescriptions from the pharmacy or drive to religious services.

Drawing a CareMap will give you a snapshot of all the people in your life who can help and the services they can provide. Don’t forget to add the friends who say, “Just call me if you need help.” When given a specific task, they may be quite happy to help.

When you arrange a plan for allocated tasks, make (or have someone help you make) a master list of family helpers, their phone numbers, their tasks, and the schedule. Put the list in an easy-to-find place, such as on the refrigerator, to help the person being assisted remember who is coming when. Also be sure to distribute the list to family and helpers so everyone knows what tasks are being taken care of.

Community-based agencies such as volunteer groups, social-service agencies, and faith-based groups have services that are often helpful. These arrangements can be complicated, but if everyone is willing to be flexible, the necessary tasks can be accomplished.

Searching for services

When family members and friends can’t provide all the help that is needed, paid home health or companion services provided by agencies or hired privately can fill the gaps. One factor in your decision to stay in your home may be the availability — and affordability — of these services. Home care comes in many varieties and from many different sources.

Medicare (Original Medicare and Medicare Advantage plans), Medicaid, private health insurance, and long-term care insurance have their own rules and criteria for providing services. Some people are covered by more than one policy. Here are a few key points to remember:

  • Medicare home healthcare is intended to be part-time or intermittent (not constant). The goal, according to Medicare, “is to provide treatment for an illness or injury.” The Medicare home health benefit “pays for you to get certain healthcare services in your home if you meet certain eligibility criteria and if the services are considered reasonable and necessary for the treatment of your illness or injury.”

To be eligible for this benefit, you must have a need for skilled nursing — that is, the kind of care provided by a nurse or physical therapist. Personal care provided by an aide is included only when this need exists.

  • Medicaid for low-income people provides long-term home healthcare, including aide services, but eligibility and availability vary by state. Many states have created Medicaid Managed Long-Term Care plans (MMLTC), which are implemented by private companies.
  • Private employer-based insurance generally follows Medicare rules.
  • Home care services are generally available through long-term care insurance but vary by policy, and there may be waiting periods and other limitations.
  • Hiring workers privately is also an option that gives you more flexibility but also more responsibility.

Having reliable, competent, and friendly home care workers can make a big difference in someone’s ability to age in place, but working out a suitable arrangement takes time and effort — and often money.

Finding help for other chores

In addition to family, friends, and paid home care workers, you may need additional help in taking care of pets, maintaining the yard, cleaning the gutters, and all the other chores that become difficult to do. If these regular maintenance tasks aren’t taken care of regularly, the home can quickly deteriorate, leading to safety problems as well as expensive repairs. Serious problems, such as a leaking roof or frozen water pipes, can create havoc. Chores that involve climbing, shoveling, heavy lifting, and other strenuous activities are best done by someone younger and stronger.

Some community agencies and religious organizations have volunteers who will help with these chores. Ask the organizations you belong to or senior centers for suggestions. Local schools or universities may also have community service programs for students. Some heavy or risky chores should be performed only by trained workers. If you hire people to help, make sure that they give references and do the job competently.

Putting technology to use

Technology is all around us, and assistive technology — devices and adaptations that are designed to help people who are aging or have disabilities function independently — can make a big difference in a person’s ability to stay at home safely. Assistive devices come in all sizes and shapes and can be cheap or very costly. Common assistive devices — grab bars, handrails, and raised toilet seats — are pretty well-known. Other common devices, however, are hand-friendly tools for opening jars or gardening, TV remote controls with big numbers, and Personal Emergency Response Systems (PERS), the kind immortalized and satirized in the TV commercial, “I’ve fallen, and I can’t get up!” In the healthcare world, telehealth — distance monitoring of chronic conditions like daily weight checks on a person with heart failure — is growing, especially in rural areas.

How far you’re willing to go to bring assistive devices into your life is a personal choice. Inventors and investors have identified people staying at home (and their adult children) as a huge market for these products. The products include mattresses that sense every movement and can relay information about how many times the person gets up to go to the bathroom or the kitchen, monitors that track a person’s movements in the home, and GPS devices that can locate a person with dementia if she wanders. A robot that can make a bed, cook a meal, and even carry on a conversation is not yet on the market, but if there is a demand, it will certainly be produced. The movie Robot & Frank, which described an aging man’s reluctant adaptation to a robot, is a fantasy, but fantasies are sometimes early glimpses of reality.

Buying an assistive device is only the first step. You have to learn how to use it and perhaps teach an older adult or an aide how to use it. Some devices that seem simple are not. For example, a cane is probably the most common assistive device. Yet it should be the right length and used on the correct side of the body. (Hint: It’s not the side where the pain or injury is.) And as you move up the scale toward devices with moving parts and controls to set, the need increases for adequate instruction and someone to call when there are problems. Constant monitoring means constant responses, most of which will turn out to be false alarms. If you’re the responder, it can become all too easy to ignore that flashing red light or annoying beep.

Looking for technological solutions to the problems of aging overlooks a basic human need for contact with other people. And while technological devices offer to provide peace of mind, the devices themselves can fail and at best require someone to respond whether there is a real emergency or just a faulty sensor. That in itself can be a major responsibility.

Consider assistive devices, but focus on the ones that will make a difference and that don’t add burdens to your life. AbleData.com, a project of the National Institute for Disability and Rehabilitation Research, has information about products and resources.