We do not provide care. We install the equipment that frequently reduces how much of it is needed, which means we are in a lot of houses at the moment this question arises.
The vocabulary is confusing and the distinctions have real cost consequences, so here they are.
The four types
Companion care
Company, conversation, light housekeeping, meal preparation, errands, transport, reminders. No hands-on personal care.
The cheapest tier and the most underrated. For somebody who is physically managing but isolated, this addresses the thing most likely to affect their health.
Personal care, or home care aide
Everything above plus hands-on help: bathing, dressing, toileting, transfers, mobility assistance.
This is what most families mean by home care, and the transfer element is where equipment and care meet. A gait belt and proper technique protect the aide as much as the person.
Home health
Clinical care at home, delivered by licensed staff: nursing, wound care, medication management, physical or occupational therapy.
Frequently time-limited and ordered by a physician, typically after a hospital stay. It is not the same as ongoing personal care and it does not replace it.
Skilled nursing at home
Continuous or near-continuous licensed nursing. The most expensive option and the one where a facility frequently becomes cheaper.
The signs it is time
Rarely one event. Usually an accumulation somebody has been quietly managing.
- Weight loss, or a fridge with food nobody has cooked.
- The same clothes on every visit or video call.
- Medication that is not being taken, or taken twice.
- Mail unopened, bills unpaid.
- Bruises they cannot explain, or a fall they did not mention.
- Rooms no longer being used.
- A spouse or adult child who is exhausted.
That last one is the signal families discount hardest. The CDC reports falls as the leading cause of injury death for adults 65 and over, and a caregiver too tired to assist safely is part of that risk rather than separate from it.
Start smaller than you think
Most families jump from nothing to several days a week, which is expensive and frequently resisted.
Four hours once a week, framed as help with the housework rather than care, is accepted far more often. It also gets a second pair of eyes into the house regularly, which is worth more than the hours themselves.
Build from there. Our guide to that conversation covers why framing decides the answer.
Agency or private hire
An agency handles screening, insurance, payroll, training and cover when somebody is sick. Costs more per hour and removes most of the risk.
Private hire costs less per hour and makes you an employer, with the tax, insurance and cover obligations that implies. It also means no replacement when they are unwell.
Either can work. The mistake is choosing private hire for the rate without understanding the obligations.
What it costs and who pays
Charged hourly, with minimum visit lengths and higher overnight rates. Call two agencies locally and ask for the rate, the minimum, and the overnight figure.
Medicare covers short-term skilled care after a qualifying hospital stay and does not fund ongoing custodial care. Medicaid waivers frequently do, and Medicaid.gov is the place to start. Long-term care insurance may. Our funding guide covers all five routes.
Where equipment changes the arithmetic
The point we can speak to directly.
Care is charged by the hour, so anything that reduces the hours reduces the cost permanently. A stairlift removes the trips where somebody was being helped on the stairs. A ceiling track turns a two-person transfer into one. A properly fitted rollator and a bathroom that works can be the difference between needing help twice a day and needing it twice a week.
That is a one-off cost against a recurring one, and it almost never appears in the family spreadsheet.
Questions for an agency
- Are caregivers employees or contractors, and are they insured and background checked?
- What training do they have in safe transfers specifically?
- What happens when our regular person is unwell?
- Will we see the same person, or a rota?
- What is the minimum visit, and the overnight rate?
- What equipment do you require in the house before staff will perform transfers?
That last one is important and rarely asked. Many agencies have manual handling policies and will decline a transfer without the right equipment present. Ask early, because a gait belt and a slide sheet are frequently what lets a visiting carer do their job.
Our transfer aids guide covers what belongs in the house, and all of it ships free from our online shop.
Respite care
The category families discover last and need earliest.
Respite is short-term cover so a family caregiver can rest, work, travel or recover from illness. A few hours a week, a weekend, or a fortnight in a facility.
It exists precisely because the commonest reason home care arrangements collapse is caregiver exhaustion rather than a change in the person being cared for. Booking it before it is desperately needed is the difference between a plan and a crisis.
Adult day programs
Somewhere to go during the day: activities, meals, supervision, sometimes health services. Considerably cheaper than in-home hours and it addresses isolation, which in-home care frequently does not.
For a working family caring for somebody who should not be alone all day, this is often the answer nobody suggested.
Hospice and palliative care
Worth distinguishing because the words get used interchangeably. Palliative care focuses on comfort and symptom management and can run alongside treatment. Hospice is care at end of life, typically when treatment has stopped.
Hospice organizations frequently provide equipment and are experienced at arranging a house quickly and gently. If that is the situation, ask them what they supply before buying anything.
Making the first arrangement work
Be present for the first visit, write down what the person likes and how they prefer things done, and be specific about tasks rather than leaving it to interpretation.
Then ask the person afterward, privately, how it went. Arrangements fail quietly when nobody asks. Our conversation guide covers the resistance side, and smaller equipment ships free from our online shop.
What Medicare does and does not fund here
Worth stating plainly because it is the most misunderstood part of this subject.
Medicare covers short-term skilled care after a qualifying hospital stay: nursing, therapy, time-limited and physician-ordered. It does not fund ongoing custodial care, which is the help with washing, dressing and moving that most families actually need.
It also generally does not cover home modifications, because Part B covers durable medical equipment rather than construction. Our coverage guide explains the rule and why it produces such odd results.
Watch for the caregiver, not just the person
The signal that gets missed. Somebody caring for a spouse or parent full time is the person most likely to be hurt and least likely to say so.
If transfers now need two people, if they are bracing rather than guiding, or if either of them has been hurt doing it, the equipment or the care arrangement needs to change rather than the technique. Our transfer aids guide covers the ladder from a gait belt to a full lift.