Senior Living: Knowing your long term care options is crucial

 PUBLISHED in the DAILY BREEZE: October 15, 2018 at 6:00 am

By David W. Hart, Ph.D.

Contributing writer

We’re an aging population and the statistics are eye-opening to say the least:

  • 77 million Baby Boomers;
  • 10,000 are reaching retirement age each day;
  • And about 45% of them have zero retirement savings to support them in older age.

This may be the primary reason that nearly 82% of them support increased taxes to shore up social security benefits.

Americans are living longer and this is no exception for Baby Boomers.  Epidemiological evidence suggests that this generation will have a life expectancy of 82 years.  But longevity does not necessarily correlate with well-being as a significant number of older adults find that age brings physical, emotional, and cognitive impairments that interrupt their ability to live independently.

David Hart, Ph.D.

Planning for future health challenges is understandably depressing because many of us are in denial that we’re aging at all.

Planning for your long-term care now or sometime in the future requires knowledge.  I could write several columns on the subject of senior care options and will discuss assisted living options in two weeks but for now the focus is on remaining in the comfort of your own home.

Non-medical home care is basically hiring a personal aide to assist you with performing activities of daily living.  What does that look like in the real world? Anything from medication reminders, transportation and meal preparation to toileting, bathing, dressing, and grooming.

Choosing a home care organization can be overwhelming.  You’ll have dozens of companies to choose from (Disclaimer: my family owns Always Best Care South Bay/West LA) and knowing what to look for can be confusing.  So what criteria can you use to help you make your decision?

The single most important criteria when choosing a home care organization is determining whether or not the company is licensed.  In 2016, California lawmakers passed the Home 

Care Consumer Protection Act, which effectively regulated home care in the state. New regulations require licensed Home Care Organizations (HCOs) to:

  • Hire caregivers registered as Home Care Aides with the Department of Social Services.
  • Aides must pass an FBI fingerprint background check, be free from tuberculosis, and receive 3 hours of structured training prior to placement in the field.
  • HCOs are required to employ affiliated home care aides and abide by all federal and state payroll and employment laws.
  • Home care aides are required to be bonded and insured up to $1 million per occurrence.
  • HCOs are required to provide their aides with 5 hours of annual continuing education.

When shopping for a home care agency, first ask for their HCO number.  If they have one, they’re legally mandated to adhere to aforementioned regulations.

You may also inquire about:

  • How they train their staff (in person or online);
  • Who supervises their staff in the field (degreed/licensed/certified healthcare professionals or lay folk);
  • How long has the company been in business and have they received recognition for their service; And what are the costs associated with care.

Median rates for HCOs in the South Bay are between $23 and $28 per hour. Rates are generally determined by the level of care required and the city the client lives.  For a comprehensive list of questions to help you make a home care decision, visit

If you’re quoted below the $20/hour range, more than likely, the company is classified as a caregiver registry. Caregiver registries are unlicensed and unregulated organizations that provide consumers access to a pool of independent caregivers who contract their services.  Caregivers are not required to be registered with the Department of Social Services and registries are not required to provide insurance coverage to their pool of contractors.  Liability is the responsibility of the contracting party – that would be you!

What’s the benefit of working with a caregiver registry vs. hiring a caregiver privately? If your contracted caregiver happens to call out sick or isn’t the best personality fit or skill match, you can call the registry and they do the leg work of finding a replacement; though, probably not immediately.  Alternatively, if you hire a caregiver privately, you wouldn’t necessarily have easy access to a pool of available and hopefully vetted caregivers.

Of course there’s always word-of-mouth and private hire caregivers can be contracted to provide non-medical in-home care.  I recently asked one of our home health aides, who also rendezvous as a private caregiver, what the going private rate is. He reported somewhere in the $15 per hour range.  Compared to the median rates of HCOs, this sounds like a deal. But remember, if the contracted caregiver is hurt while providing care in the home, you will likely be liable for that injury.

If you intend to contract private caregivers through a registry or on your own, here’s my advice: make sure that your home owner’s or renter’s insurance policy covers contractors in 

the home and determine your coverage amount.  Many years ago, one of our caregivers was bitten by a Brown Recluse spider during her shift in Palos Verdes. She required three 

surgeries and was later classified as permanently disabled. Don’t leave yourself at risk of a lawsuit.  Make sure you’re covered if you go the private route.

Finally, non-medical home care is generally paid for out-of-pocket. Clients who qualify for Medi-Cal have some options through a program call In Home Support Services (IHSS) but for the most part, custodial home care is paid by the client.  Individuals who purchased long-term care insurance may also have a benefit for home care. Bottom line: the long term costs of home care be exorbitant but worth it for some of you!

For more information on non-medical in-home care options, feel free to send me an email.  I’m happy to forward you information that may help in your decision making process. You can also visit our website and take a quiz to determine your readiness for home care.

Wishing you all the best in life and love, today and tomorrow.

David Hart, Ph.D., is the director of clinical services at Always Best Care Senior Services in Torrance and is a faculty member in the Department of Counseling at California State University, Fullerton.  Hart, chair of the South Bay Dementia Education Consortium, specializes in working with older adults with dementia and their families. For more information, go to or contact him at or at (310) 792-8666.