When is Home Care Needed?

Getting a "care assessment" is the best way to determine when an elder needs home care services. Caregivers can do it by themselves or get help with the process by calling their Area Agency on Aging (AAA) or a geriatric care manager (see Geriatric Care Management).

Activities of Daily Living (ADL)

An assessment is based on different kinds of information, starting with your elder's ability to manage ADLs. These are the basic tasks involved in personal care and household work. See the Caring for Your Parents Checklist of Activities of Daily Living (PDF) to help you determine what assistance is needed. The checklist can help you answer questions about physical limitations and memory problems affecting an elder's ability to:

  • Do housework, laundry, shopping, and cooking
  • Maintain personal care, such as bathing, dressing, and using the toilet
  • Manage medical appointments and medications
  • Handle personal finances and legal issues

Filling in the checklist before calling your AAA or a home care agency will make the conversation more useful and productive, so that you can move ahead with home care decisions.

Physical Health Considerations

Planning for home care also involves an assessment of health issues affecting both physical and mental health. Caregivers may want to consult with the elder's primary care physician (PCP) or a geriatric specialist to evaluate an elder's physical capacities. Issues to consider include:

  • Mobility: The ability to safely move around one's own home and neighborhood is often compromised with advancing age. For a professional assessment, ask the elder's doctor or get a referral to an occupational therapist. To make your own assessment, you can use a tool developed by the Society of Hospital Medicine.
  • Vision: Vision impairment is common among the elderly and often leads to reduced social interaction and quality of life, depression, and injuries from falls. But since elders often do not report their vision problems to their health care providers, vision screening is recommended. Treatment for many vision problems common in older adults, such as cataracts and refractive errors, is available and can greatly improve quality of life.
  • Hearing: Hearing deficits are also common among older adults and can affect quality of life. Assistive technology, such as hearing aids and cochlear implants, can be used to help basic hearing loss, while more serious conditions may require specialized medical attention.

Mental Health Considerations

Assessing the mental health of the elder in your care can be challenging. The line between memory problems that naturally occur with aging, and memory problems that occur in the early stages of dementia and/or Alzheimer's can be hard to distinguish. If an elder seems more confused than usual, has trouble completing daily routines, or has difficulty keeping track of daily medications, house keys, and other personal items, these may be signs of cognitive impairment.

The signs of depression are also difficult to sort out; low energy, loss of appetite, and lack of interest in others can come from a variety of causes. Getting a geriatric mental health assessment can give you a clearer picture of what is going on and whether home care is advisable. For advice on having this kind of assessment, ask your Primary Care Physician, Area Agency on Aging, or Council on Aging.

Nutrition Considerations

Nutrition can be a major issue for elders remaining at home. Caregivers need to consider several questions about the elder in their care:

  • Is the elder getting the right kinds and amount of food to meet daily health requirements?
  • Is the elder capable of shopping for the right foods and preparing them?
  • Is the elder eating the food he or she prepares or that is prepared for him or her?

Healthy eating is a challenge for all of us, and elders may have additional issues that make healthy eating even harder: poor health, difficulty shopping or cooking, food insecurity (hoarding), loneliness, or depression. Malnutrition is one of the primary reasons that many elders can no longer live on their own. If your elder is having difficulty managing proper nutrition, there are meal services available.

The Elderly Nutrition Program is a federal- and state-funded program which allows local elder agencies to provide meals, nutrition screening, assessment, health education, and counseling. People age 60 or older, and their spouses, are eligible: there is no income eligibility requirement. A small voluntary donation is requested for those who can afford to pay. Your local senior center or Area Agency on Aging (AAA) can help you locate the appropriate type of meal program. There are two types:

  1. The "Congregate Meal Program" provides at least one meal per day at senior centers, churches, schools, and other locations. The group setting offers many elders an important opportunity for socialization and companionship. Transportation is often available for those who have trouble getting around on their own. Some programs also offer meals on weekends.
  2. "Meals on Wheels" are home-delivered meals of nourishing food for elders who are homebound and not able to prepare their own food. This subsidized home delivery program can also be supplemented with meals purchased through private services.

Putting It All Together

Combining information on these five elements—ADLs, mobility, vision, hearing, and nutrition—can help you make your own assessment about the need for home care services.

A useful assessment tool can be found in the Caregiver's Handbook: A Guide to Caring for the Ill, Elderly, Disabled…and Yourself produced by Harvard Health Publications. It includes a four-page questionnaire to determine needs.

Additional Information for Specific States

Below, you'll find additional state-specific information on home care and nutrition resources. The states included have high percentages of elders and/or high elder populations.


The Alabama Department of Senior Services offers congregate and home delivery meals for seniors, nutrition education and counseling, and a farmer's market program.


The state elder nutrition programs are run by Area Agencies on Aging and vary from area to area.


The state elder nutrition programs are run by Area Agencies on Aging and vary from area to area.


The Illinois Elderly Nutrition program provides meals served in group settings and delivered to people's homes. Local AAAs can provide more information regarding specific programs in your area.


Area Agencies on Aging offer caregiver support in the form of counseling and support groups. These programs vary from area to area.


The Nevada Division for Aging Services' have a regional offices Homemaker Program that offers community-based, in-home care. These services vary from region to region, and are based on a needs assessment by a social worker.

New York

More than 1,000 locations offer congregate nutrition (group meals) in New York State. In addition, home delivered meals are also available to eligible homebound older persons 60 and older. These programs are run through local AAAs.


The state elder nutrition programs are run by local AAAs and vary from area to area.


Senior community centers in Pennsylvania serve meals at noon Monday through Friday, and many offer home-delivered meals. More information regarding adult day services can be found in the day services section of the Pennsylvania Department on Aging website.


Area Agencies on Aging offer home-delivered meals, congregate meals in senior centers on weekdays, and nutritional programs/counseling.

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