A Guide to In-Home Care for Alzheimer’s and Other Dementias

It’s only natural for seniors to crave remaining in their homes as they age. Home is familiar and filled with memories and precious belongings. People with Alzheimer’s or other forms of dementia may cling to the familiar in the face of cognitive decline, but they often need more support than seniors without these conditions. 

If you have loved ones with these conditions, you may worry about being able to care for their increasing needs. While some families may turn to memory care or nursing homes, aging in place is becoming increasingly popular and can be done safely with home support and training for family caregivers, even for elder adults in the later stages of their diagnoses.

This guide offers a deep dive into understanding home care, how to choose and find the right kind of care and tips for family caregivers. It also offers insight into how much this type of care can cost when outsourced and how to pay for the expenses.

Not all home care is made equal. While you should be able to expect a high quality of care no matter the kind you choose, the various types offer different services. Your loved ones may be fine with just one or two types of home care provisions or several, depending on their needs.

Companion care providers are social lifelines for seniors. This care is particularly suitable for seniors with early-stage Alzheimer’s who don’t yet require extensive assistance or supervision and would otherwise be home alone during the day. Common services provided by companion care providers include:

• Keeping an eye on their clients
• Driving to appointments
• Spending time doing things the senior likes to do, such as reading out loud or playing board games
• Preparing light meals or snacks

Often referred to as home care, these services offer nonmedical assistance with daily living tasks and may include respite care for families as needed. Aides can also meet needs that family caregivers can’t, such as lifting someone to assist with bathing. This is often a suitable option for seniors with early-stage Alzheimer’s without complex medical needs. Common services include:

• Assistance with activities of daily living such as dressing, grooming, eating and bathing
• Shopping for groceries and meal prep
• Transportation to medical appointments

Homemaker services provide assistance with chores and daily tasks that a senior may not be able to tend to anymore. This is a useful option, especially in tandem with other types of care, for seniors who can’t manage their home’s upkeep anymore and still want to remain at home. Services can include:

• Meal preparation
• Light housework
• Laundry
• Transportation to appointments
• Running errands
• Assistance with eating

• Wound care, first aid and skilled nursing
• Physical, occupational or speech therapies
• Assistance with maintaining medical devices
• Medication administrations
• Management and monitoring of chronic conditions

With 24-hour or live-in home care, seniors always have an attendant present with them. An agency providing shift coverage may be able to offer 24-hour care, meaning there is always a caregiver awake and on shift to attend to the senior’s needs. 

Live-in caregivers are present constantly unless otherwise arranged. However, live-in caregivers still need to sleep, so while someone is always in the home, the caregiver may not be awake.

Seniors who sleep overnight without needing much assistance can often benefit from live-in care, whereas as cognitive decline becomes severe, 24-hour care is often better.

The right kind of home care depends greatly on what kind of assistance your senior loved ones need and the stage of Alzheimer’s they’re in. Below are some guidelines to get an idea about which type of care would be the right fit for your loved one.

In the earliest stages, it’s common for the affected individual to still function independently. Some of the common symptoms at this stage include:

• Struggling to come up with the right name or word, or not remembering new people’s names
• Struggling with work or social tasks
• Forgetting something that was just read
• Misplacing or losing things
• Struggling with organization and planning

Depending on their health, seniors with early-stage Alzheimer’s or other dementias can likely live with familial support or with a few hours of in-home care as needed.

As cognitive decline progresses, so does the need for additional support. At this stage, symptoms have become more noticeable and include:

• Forgetting personal events
• Moodiness
• Struggling to recall basic information about themselves
• Being confused about where they are or what day it is
• Choosing clothing that doesn’t match the weather or occasion
• Incontinence (bowels and bladder)
• Disrupted sleep patterns
• Increased wandering behaviors
• Personality changes, delusions and repetitive behavior

Seniors can still engage socially and participate in their daily schedule with assistance. At this stage, regular home care is likely to be required to keep them safe. 

The final stage of this disease causes severe changes to a person’s cognitive abilities. Symptoms at this stage are completely disruptive of seniors’ lives and include:

• Losing awareness of their surroundings and recent experiences
• Losing the ability to walk, sit and swallow
• Struggling to communicate
• Becoming more susceptible to infections 

At this stage, it’s no longer safe for seniors to be alone at all. Live-in or 24-hour care is most likely to best suit their needs, or loved ones can consider hospice care.

The cost of in-home care for seniors with Alzheimer’s or dementia can vary greatly across the country based on location, the number of hours needed and services provided. The table below displays the national average cost of in-home and home health care based on 44 hours of care per week as calculated by the 2021 Genworth Cost of Care Survey.

Seniors with dementia who require home care of any kind may be able to receive financial assistance through Medicare, Medicaid or the VA. 

To be eligible, a senior must be deemed homebound and require part-time or intermittent skilled services. However, Medicare won’t cover custodial care, homemaker services, meal delivery or 24-hour care.

Veterans may qualify for the Aid and Attendance (A&A) benefit that can be used to pay for long-term care, including in-home care. To qualify, veteran seniors must meet eligibility requirements, including requiring assistance with activities of daily living, being bed-bound, being in a nursing home or having limited eyesight.

Finding in-home caregivers for your loved one with Alzheimer’s or dementia can be stressful. Thankfully, there are steps you can take and resources you can use to protect your seniors and ensure they are well cared for. To get started, consider these points:

• Speak with Your Loved One’s Doctor: Your senior’s primary physician can provide information about the kinds of care your loved one needs and what types of care are best suited to the senior’s unique situation. A primary physician may also recommend local home health providers for people with Alzheimer’s.
• Ask Around for Recommendations and Experience: People who have loved ones with cognitive decline may be able to provide you with their experiences and recommendations for home care providers in your area.
• Search Online: Caring.com offers an in-home care search tool that you can use to start compiling lists of agencies in your area. With this tool, you can enter your city, state or ZIP and browse options and their reviews.

Once you’ve got a list of potential options, you can begin weighing which one will be right for you and your senior loved one. These tips may help you make the best pick for your unique situation.

• Know your needs before you begin. Make a list of what types of care you need.
• Always review references, and conduct background checks when choosing a caregiver. This can give you peace of mind that you’re choosing someone trustworthy.
• During the process, have multiple interviews with potential hires to really get to know them.
• Research any agencies you’re considering. What are their policies? Do they have backup caregivers if the primary caregiver is unavailable for any reason? What kinds of care do they provide?
• How familiar are agencies or caregivers with cognitive disorders? Do they have any specialized training that will help?

Interviewing a home care provider can be stressful. After all, how can you assess from a short meeting whether someone is suitable to care for your loved one? That’s what these questions are for.

• How much experience do you have with dementia care? 
• How do you approach dementia care?
• Do you have any references from cases similar to my senior loved one’s?
• What sort of training do you have? 
• How will you communicate with me?
• What happens if you get sick or have to miss a shift?
• How do you build relationships with your clients?

Nearly 1 in 3 adults provides care to other adults. For these people, caregiver burnout is a real concern, resulting from caregivers not practicing self-care. However, caring for yourself is just as important as providing care. These tips and tricks can help caregivers streamline their days, meet their own needs and keep their senior loved ones safe.

• Practice Self-Care: Self-care is one of the simplest ways caregivers can avoid burnout. Set aside some time each day for yourself. 
• Use Respite Care: When you need a break or if you are unavailable for any reason, seeking respite care can help meet your senior loved one’s needs. There are options for both in-home and facility-based respite care.
• Ask and Accept Help When You Need It: You don’t have to do this alone. Reach out to family members or outsource care and tasks as needed.
• Use Visual and Verbal Cues: Visual and verbal cues for daily activities can help jog seniors’ memories without you having to tell them anything. For example, you can place signs on doors so they can easily navigate their home.
• Break Tasks Down: Instead of giving your loved one a multistep task such as, “Go make food,” you can break it down into smaller steps, such as, “Peel this orange,” or “Get your dishes.”
• Dementia-Proof the Home: Consider adding locks to medicine cabinets and stove knobs. You can also install alarms and locks on windows and doors, and remove rugs and runners that seniors may trip on. Also, consider removing potentially dangerous appliances, kitchen utensils and anything else that could be harmful.
• Set Up a Schedule: For seniors with dementia or Alzheimer’s, a daily routine is one of the biggest tools to keep their lives stable. Of course, there should be some flexibility, but try to follow a predictable schedule.
• Use Technology to Your Advantage: Tools such as Amazon Alexa can be highly advantageous when used correctly. An Echo Show can be used to drop in on your loved one, provide regular reminders for tasks and foster a sense of connection to the rest of the family through the Alexa Together program.
• Offer Simple Choices: Give your senior loved ones some sense of control over their lives by offering simple choices. For example, let them choose between two outfits or two meal offerings.

Caregivers and seniors with Alzheimer’s considering in-home care may not know where to start or how to locate resources. These programs can help prevent caregiver burnout, locate in-home care resources and determine senior needs.