Getting In-Home Help for Seniors: Practical Options and How to Start

Many families reach a point where a senior needs help at home but doesn’t want (or need) to move into a facility. “In-home help” usually comes from a mix of public programs (Medicaid, veterans’ programs, local aging offices), private home care agencies, and sometimes independent caregivers.

The fastest way to find out what is available where you live is usually through your local Area Agency on Aging and your state Medicaid office if the senior has low income or limited assets.

1. What “In-Home Help” Usually Means in Real Life

In-home help for seniors usually falls into three buckets, and one person can use more than one at the same time.

Common types of help:

  • Personal care/home care aides – help with bathing, dressing, toileting, walking, grooming, basic exercises.
  • Homemaker/companion services – light housekeeping, laundry, meal prep, errands, supervision, companionship.
  • Skilled home health – nurse or therapist visits ordered by a doctor (wound care, injections, physical/occupational therapy).

Public programs (especially Medicaid home- and community-based services, or “HCBS waivers”) can pay for in-home aides, while Medicare mainly pays for short-term skilled home health after illness or hospitalization and usually does not cover long-term daily care. Rules and available services vary by state and individual situation, so local verification is essential.

Key terms to know:

  • Activities of Daily Living (ADLs) — basic self-care tasks like bathing, dressing, eating, toileting, and moving around.
  • Instrumental Activities of Daily Living (IADLs) — tasks needed to live independently, like cooking, cleaning, shopping, and managing medications.
  • Area Agency on Aging (AAA) — local or regional office that connects older adults to services, often called “Office on Aging” or similar.
  • Home- and Community-Based Services (HCBS) — Medicaid programs that offer in-home care and other supports to avoid nursing home placement.

2. Where to Go Officially: Your Main System Touchpoints

Most in-home help options flow through two main systems: aging services and health/Medicaid.

Typical official touchpoints:

  • Local Area Agency on Aging (AAA) or County Office on Aging – does intake, basic needs assessment, and referrals to programs such as home-delivered meals, homemaker services, respite care, and sometimes sliding-scale in-home care.
  • State Medicaid office / Medicaid Long-Term Services and Supports unit – handles financial eligibility and enrollment for in-home care programs that can cover personal care aides and home health under Medicaid waivers.
  • Secondary but important:
    • Medicare-certified home health agencies – accept referrals from your doctor if the senior qualifies for skilled home health.
    • Local Veterans Affairs (VA) medical center or VA social work office – for veterans who may qualify for in-home care, respite, or assistance through VA programs like Homemaker/Home Health Aide or Aid & Attendance.

A realistic first official action you can take today is: Call your local Area Agency on Aging and ask for an in-home services assessment or options counseling. If you don’t know the number, search for your county name plus “Area Agency on Aging” and look for a .gov site or a state-sponsored .org to avoid scams.

3. What to Prepare Before You Call or Apply

You’ll move faster if you gather basic information before you contact the AAA or Medicaid office, because they commonly ask the same questions.

Documents you’ll typically need:

  • Proof of identity and age – such as a driver’s license, state ID, or passport, plus Medicare and/or Medicaid card.
  • Proof of income and assets – recent Social Security benefit letter, pension statements, bank statements, and information on any retirement accounts or life insurance with cash value (especially for Medicaid-funded services).
  • Medical and functional information – doctor’s contact information, medication list, hospital discharge papers (if recent), and a short written note of what the senior can and cannot do alone (ADLs and IADLs).

Also helpful:

  • A list of current supports (who already helps, how often).
  • A rough idea of schedule needs (e.g., mornings only, 7 days a week, or just 3 afternoons).
  • Any safety concerns (falls, wandering, leaving the stove on).

When you call an official office, a simple script you can use is:
“I’m calling about in-home help for a senior. Can you tell me what home care or home support programs are available and how to start an assessment?”

4. Step-by-Step: How to Start the Process and What Happens Next

4.1 Basic step sequence for most situations

  1. Identify your local AAA and Medicaid office.
    Search online for “[your state] Area Agency on Aging” and for “[your state] Medicaid long-term services supports” and confirm you’re on a government or official partner site (look for addresses ending in .gov or official state-sponsored organizations).

  2. Call the AAA for an intake or options counseling.
    Ask specifically about in-home services, personal care, homemaker programs, and caregiver support; they may complete a basic intake over the phone and schedule an assessment, or refer you to another office that handles your area.

  3. Prepare and attend the assessment.
    A social worker, nurse, or case manager typically visits the home or calls to assess needs: they’ll ask about ADLs, IADLs, health conditions, safety, and available family support; this assessment often determines whether you qualify for subsidized or Medicaid-funded in-home help.

  4. If income is limited, complete a Medicaid application or long-term care screening.
    The AAA may connect you with the state Medicaid agency for a financial eligibility review; you’ll usually need to submit proof of income, bank statements, insurance information, and ID, either online, by mail, or at a local benefits office.

  5. Choose or be assigned a home care provider.
    If approved, the program will typically give you a list of contracted home care agencies or, in some states, allow you to hire your own caregiver under a “consumer-directed” program; you then work with the agency (or program coordinator) to set a visit schedule.

  6. Start services and confirm the care plan.
    The aide or nurse begins visits based on an authorized number of hours per week; the case manager or care coordinator usually follows up after the first few visits to confirm services are appropriate and make any early adjustments.

  7. Expect periodic reassessments.
    Most publicly funded programs reassess at least annually, and sometimes more often, to confirm continued need and adjust hours; you may need to provide updated financial documents for Medicaid-funded programs.

5. Real-World Friction to Watch For

Real-world friction to watch for

One common snag is waiting weeks for an assessment or for Medicaid financial approval, during which no in-home help is authorized. If that happens, ask the AAA or Medicaid worker whether there are short-term stopgap options such as volunteer chore services, caregiver respite grants, or sliding-scale private pay hours from an agency while you wait.

6. How to Handle Costs, Safety, and Extra Help Options

Costs and funding sources for in-home help often end up being a patchwork.

Typical funding combinations:

  • Medicaid home care / HCBS – For seniors who meet income, asset, and functional criteria; can cover ongoing personal care and homemaker services; you must go through your state Medicaid office or local benefits agency and cannot apply through information sites like this one.
  • Medicare home health – For short-term skilled care ordered by a doctor after a medical event; typically does not cover long-term daily personal care, but a home health aide may visit a few times a week for limited personal care tied to a skilled plan.
  • VA programs for eligible veterans – Through a VA medical center or VA social worker, veterans may qualify for Homemaker/Home Health Aide services, Home-Based Primary Care, or Aid & Attendance benefits that can help pay for in-home help.
  • Private pay home care – Directly hiring a licensed home care agency and paying out of pocket; some long-term care insurance policies will reimburse if you follow their rules and use approved agencies.
  • Local grants and nonprofit programs – Some city or county aging programs, faith-based groups, or charities offer a few hours of free or reduced-cost homemaker or respite care, especially for caregivers under strain.

Because these options involve money and benefits, be alert for scams: only give Social Security numbers, bank details, or card numbers to verified government agencies or licensed providers; avoid anyone guaranteeing quick approval for a fee, and look for official .gov addresses or well-known nonprofit agencies when searching online.

If you’re stuck or unsure which direction to take, another realistic action is to call your state’s aging and disability resource center (often connected to the AAA) and say: “I need help sorting out in-home care options and what we might qualify for; can you walk me through the programs for our situation?” Once that call is made and initial intake information is given, the system typically starts moving toward assessments, eligibility reviews, and concrete service offers.