Cost of in-home care is getting more expensive

By Michelle Singletary

When my father-in-law came to live with my family, we hired home health aides to help with his care.

He couldn’t cook or feed himself and needed help with bathing and getting dressed. He required assistance taking his medication and even rising from a bed or chair.

My father-in-law had a decent amount of savings, but to try and make the money last longer to cover the long-term care he needed, we hired someone for just four hours in the morning and then another aide came for two hours in the evening to help my father-in-law get ready for bed. The rest of the time my husband and I were his caregivers.

It cost about $20 an hour for the in-home care services. And when my father-in-law was diagnosed with stage 4 lung cancer and placed under hospice care, we kept the one aide he liked and significantly increased her hours because he was in so much pain and needed extra attention.

When people ask for advice about helping their elderly parents age in place — in their own homes — I suggest they look into in-home care.

The cost of long-term care will make you choke, which is why many families turn to the less expensive option of in-home care.

But a new survey by Genworth Financial found that the fastest-rising long-term care cost is not for the most skilled care at a nursing home or assisted-living facility, but the cost for in-home services.

Genworth reported that the cost of homemaker services — in which an aide may help with tasks such as cooking, cleaning and running errands — has increased 7.14% in the last 12 months. That’s four times the increase in the median cost of a private room in a nursing home, which rose 1.82%. The cost of a home health aide — who assists someone in eating, getting dressed or taking medication — increased 4.55%.

On an annual basis, the median cost for homemaker services is $51,480 based on 44 hours per week ($22.50 an hour). The yearly cost of home health-aide services is $52,624 ($23 an hour).

Looking at state-by-state data, the median monthly costs for home health-aide services is lowest in Louisiana at $3,241, compared with a high of $5,815 in Minnesota and Washington.

In its 2019 Annual Cost of Care survey, Genworth added a new category for in-home services — skilled nursing care. The median cost is $87.50 per visit.

The annual median cost of care in a nursing home is $90,155 for a semi-private room and $102,200 for a private room. The daily rate for a semi-private nursing home care ranges from a low of $160 in Texas and Oklahoma to a high of $994 in Alaska.

The median yearly cost of care in an assisted-living facility is $48,612. The lowest monthly rate for assisted-living facility care was $2,881 in Missouri. The highest was $11,288 in the District of Columbia.

“The findings underscore the need for individuals and families to plan ahead for who will care for them and how they will pay for it,” said Gordon Saunders, a Genworth senior manager who manages the Cost of Care Survey.

At some point in their senior years, most Americans will need long-term care. The problem is many people don’t realize that Medicare does not cover long-term care except in very limited situations. Medicaid does provide coverage, but to qualify for the benefit you have to be low-income.

The cost of care for in-home services is rising for a number of reasons, according to Genworth.

“Home care providers we consulted say the tight labor market has intensified the competition for care professionals,” Saunders said. “They must offer higher pay and more benefits to compete against other higher-paying and less demanding service jobs.”

There’s also a relatively high turnover of workers in this field. Managing patients with developing cognitive impairments or mental health issues can take a supreme physical and emotional toll.

Employment of home health aides and personal care aides is projected to grow 36% from 2018 to 2028, much faster than the average for all occupations, according to the Labor Department. The median annual wage for home health aides was $24,200 in May 2018.

I understand that the cost of in-home care — even compared to the price of a nursing home or assisted living facility — may still give you pause.

But when my father-in-law closed his eyes for the last time and took his last breath, standing at his bedside with me and my husband was his home-care aide. By the time of his death, Ronda was practically living with us. She was a saint and well worth the cost of her services.

— Washington Post Writers Group