A Guide to Caregiving in Senior Care

What Is a Caregiver?

Caregivers help older adults with personal care, companionship and activities of daily living (ADLs). Some, such as home health aides, assist with basic health- and medical-related care. A senior may need short-term care or long-term care due to an injury, illness or disability.

Sometimes older adults need care simply as a result of natural aging. If you’re not familiar with caregiving, just know that older adults typically receive care in their home, but a caregiver can also come into a long-term care facility to deliver care.

Unpaid loved ones, paid loved ones, home aides, companions, home health aides, nurses and other professionals serve as caregivers. A caregiver can also be someone who attends your religious institution or a trusted neighbor who volunteers to help you.

Types of Caregivers

Unpaid Family Caregivers

Family members are the first people older adults turn to. They usually work well for older adults who don’t require major medical assistance. A staggering 53 million family caregivers in the U.S. now help a loved one without getting paid for their services.

Most commonly, a spouse or daughter offers to step in. But a family caregiver could also be a son, sister-in-law or grandchild. You could be a family caregiver without realizing it. Family caregivers help older adults by prepping meals, providing transportation and helping with housekeeping or their daily activities.

Professional Caregivers

Caregivers who are paid for their services are professional caregivers. Who makes up the professional caregiver network? They include homemakers, personal care attendants, companions, home aides, home health aides and nurses. The caregivers will come to your home, adult day care facility or a long-term care facility.

We recommend considering formal caregivers for older adults:

• Whose loved ones live far away or cannot manage their needs.
• Who want to safely age in place, but now require formal help.
• Who need a hand, but don’t require major medical assistance (or have complex medical conditions).
• Who are not comfortable with a relative handling personal hygiene tasks, such as toileting or showering.
• Whose unpaid family caregivers have stepped up to the plate, but have burned out after extensive caregiving.

Professional Caregiver vs. Nurse: What’s the Difference?

A family caregiver isn’t supposed to provide medical assistance. A professional caregiver — a companion, homemaker or home aide — cannot legally provide medical assistance either. A home health aide (HHA) is trained to provide limited medical-related care.

HHAs can give medication reminders and do basic health monitoring under the supervision of a nurse. HHAs can’t administer medications, give injections, or insert or remove tubes.

Older adults who need a higher level of care can hire private duty registered nurses. Registered nurses (RNs) monitor vital signs, change dressings, insert and maintain catheters, administer medications, and provide end-of-life care. RNs have at least an associate degree and pass a certification exam. They’ve completed clinical hours, which involves working directly with patients and learning from practicing nurses.

How to Decide If You Need a Caregiver

Let’s say your mother needs help managing on a day-to-day basis. You help out twice a week after work and her neighbor stops by. Your aging mother has people checking on her, but you wonder if it’s time to create a formal arrangement with a regular caregiver.

There are many advantages to having paid professionals in the home. They can help prevent falls, which are common in seniors, and help protect your family member’s safety. You’ll also gain peace of mind knowing your loved one is eating regularly, able to chat with someone and can get rides to medical appointments.

Signs Your Loved One Needs a Regular Caregiver

These could be indications that you need more help. Relying primarily on informal help — such as a family caregiver or a neighbor popping by once in a while — may have worked originally, but it may not be enough now. It may be time to hire a professional caregiver.

Our senior parents may feel that they’re fine on their own. Some dislike the idea of strangers coming into their home and resist the idea of hiring caregivers. Change is hard, especially as we get older. Check out our guide on how to talk to your loved one about caregivers for valuable tips about starting the conversation.

What Are a Caregiver’s Typical Duties?

Some common duties of professionals who offer home care include:

• Personal care, such as bathing, dressing and other everyday activities
• Meal preparation and nutrition monitoring to adhere to dietary needs
• Mobility assistance with walkers and transfers from wheelchairs
• Transportation to medical appointments, grocery shopping and errands
• Reminders about taking medication and medication management
• Supervision for seniors with dementia or Alzheimer’s disease
• Light housekeeping, laundry, and tidying the kitchen and other rooms
• Companionship and emotional support

What Qualities Should You Look for in a Caregiver?

A caregiver will spend a lot of time with the older adult receiving care. Be sure their personalities mesh well — but that doesn’t mean they have to match exactly. Sometimes a reserved parent will get along well with an outgoing and talkative caregiver. The important thing is that your loved one feels comfortable and likes their caregiver.

Other factors you should consider when hiring or choosing a caregiver include:

• Experience: Look for someone with experience caring for people with similar needs to your loved one.
• Training: Training can enhance a quality caregiver. Certified home health aides undergo formal training and also assist with activities of daily living. Other training to look for includes CPR and basic first aid.
• Trustworthiness and reliability: Caregivers take on a good deal of responsibility, so you need someone you can trust. You’ll want someone to take proper care of your loved one, show up on time, respect the home they’re in, admit if they make a mistake and log only hours worked. Before hiring, check references and run a formal background check.
• Vaccinations: For the safety of the senior and the caregiver, you may insist on hiring a person who’s immunized against influenza, shingles, pneumonia, tuberculosis or other transferable diseases. Learn more about vaccination laws for health-care workers in your state through the Centers for Disease Control and Prevention.
• Choose a bonded and insured caregiver: Licensed home care agencies that are bonded and insured pay for protection in case employees are responsible for damage, theft or other financial losses to their clients.

How Do You Pay for Caregivers?

Medicare may pay for a caregiver, but not always. Original Medicare (Parts A and B) requires that your loved one is under a doctor’s care with a regularly reviewed care plan, needs skilled nursing care or therapy services on a part-time or intermittent basis, is certified as homebound by a doctor, and receives services from a Medicare-certified home health agency.

Covered services include:

• Skilled nursing care on a part-time or intermittent basis
• Physical therapy, occupational therapy and speech-language pathology services
• Medical social services
• Part-time home health aide services (only when also receiving skilled care)
• Durable medical equipment and medical supplies

You will likely have to pay out of pocket to cover 24-hour care and meal delivery services.

Medicare Advantage plans typically don’t cover caregiving expenses such as long-term personal care or homemaking. Some top Medicare Advantage plans, however, are starting to incorporate supplemental benefits such as limited, short-term coverage for home-delivered meals post-hospitalization, nonemergency medical transportation, and a few days of adult day care per month.

Many families use private pay, private medical insurance, long-term health insurance, Medicaid, or veteran’s benefits to afford a caregiver.

How to Get Paid to Be a Caregiver for Parents

Family caregivers can be compensated for caring for senior or disabled family members. Eligibility requirements and application processes, however, vary significantly across the country.

• Medicaid pays family caregivers through consumer-directed care programs if your loved one meets strict income requirements. The name for the care varies, depending on where you’re from. Some states, such as Virginia and Texas, use “consumer-directed care,” while others call it “in-home support services” or “cash and counseling.” Contact your state’s Medicaid office directly or visit Medicaid.gov to check eligibility and find the state waivers list.
• Veterans Affairs programs offer four payment options: aid and attendance, housebound pension, program of comprehensive assistance for family caregivers, and veteran-directed care. If it’s too complicated, the Elizabeth Dole Foundation or American Legion can help you navigate the benefits.
• Paid family leave is available in California, New York, Washington, D.C., Rhode Island, and nine other states. Four more states plan to add programs by 2026. You’ll need to notify your employer to get health-care provider certification of your loved one's condition.
• Long-term care insurance policies may cover family caregivers if your loved one needs help with activities of daily living. (Note that a mere 3 percent of adults over 50 have policies that allow that type of coverage.)
• Personal care agreements can be created to outline caregiving duties and compensation based on local care rates. It’s probably best to get some legal guidance about creating these documents.

Caregiver Resources and Support Groups Near Me

Finding support — especially when it’s nearby — can make life easier for caregivers who are already faced with so much. The following resources provide a variety of offerings, from online communities to local support groups to information on respite care, elder abuse and financial aid. We hope they help you navigate the challenges of caregiving.

• The Caregiver’s Corner from SeniorLiving.org: This Facebook group offers family caregivers a safe space to connect, ask questions, seek advice, share experiences and access trusted information and resources from experts in the field.
• AARP’s Family Caregiver Resource Guides: You’ll find state-specific information on local programs and services for caregivers on the AARP site, including respite care, financial assistance and support groups.
• National Family Caregiver Support Program (NFCSP): Find support programs in your state. Funded by the federal government, NFCSP provides counseling and training and offers information on elder abuse prevention.
• Family Caregiver Alliance: They offer educational webinars, fact sheets on various caregiving topics, and online support groups. The Family Caregiver Alliance also advocates for policies supporting family caregivers.
• Caregiver Action Network (CAN): CAN provides educational materials, a helpline to connect caregivers with information and assistance, and online and in-person support groups. They also have an active Facebook community.
• VA Caregiver Support Program: People caring for veterans can join peer support groups, learn about the local caregiver support coordinator and access training and education.
• National Alliance for Caregiving: The organization focuses on research and caregiver advocacy. Find resources on caregiving challenges, tips for managing stress and information on locating support.
• U.S. Administration on Aging’s Caregiver Corner: Learn about federal and state programs that support caregivers, including information on respite care, home care services, and legal and financial assistance.