If you are in a position to possibly help with the care of parents or an older family member, home healthcare is a topic worth knowing about.

Your search for that care can start with the simple realization that someone is having difficulty climbing the stairs at home. At seeing this and other early warning signs, you should start to discuss caregiving needs and explore possible solutions. The earlier you start, the more choices you will have and the greater the possibility that you and your loved one(s) will be satisfied with the course of action you settle on.

The need, after all, is clear, because staying home is the desire of many seniors. Nearly 90 percent of those over 65 indicate on surveys that they would like to stay in their homes as long as possible.1

In terms of definitions, “personal care” covers routine personal hygiene or the so-called “activities of daily living.” Certified nurse assistants (CNAs) are trained to safely provide this kind of care and to look out for and prevent potential problems, from damage to the skin as a result of immobility, to choking hazards from food and drink.


It’s advisable to get ahead of the need for any care assistance and have a plan ready to go.

Often, unpaid caregivers already provide this care. And some long-term care plans will allow that family member to become employed by a home health agency and fill the role of the nurse-assistant under a physician-directed plan of care.

Housekeeping and chores may or may not also be provided by a CNA, depending on the terms of your arrangement. When an insurer compensates the CNA, approved hours may include only housekeeping, which is incidental to the personal care required, such as changing a bed after a bath.

“Senior-oriented” businesses, meanwhile, provide companionship and errand services. These services are appropriate when no physical contact is required for the senior to be safe. Companions are not usually trained as nurse assistants, and their services generally are not covered by any type of insurance.

So, should you use a home health agency? When skilled care (nursing and therapy care ordered by a physician) is required, and you have a health plan like Medicare, retiree insurance or long-term care insurance, it makes sense to use a home health agency.


Agencies are familiar with managing a physician-approved plan of care, making sure the insurance coverage rules are followed and the insurance company is billed. Here are several other important considerations to use when you evaluate different agencies:

  • Is there a system to verify and maintain staff credentials and training?
  • What types of background checks does the agency conduct?
  • Can the agency file health insurance plan claims on behalf of its clients?
  • Will the agency be able to handle scheduling, payroll, tax and risk-management issues so you don’t have to?

When choosing to pay a family member, friend or acquaintance, discuss these arrangements with an elder law attorney. Some health-benefit programs classify such payments as gifts or disregard the expense and delay or prohibit eligibility for benefits.

Health plans are much more likely to pay for medically necessary skilled care than non-skilled care. If staying home is not feasible, there are several types of residential communities to consider, as well. It’s advisable to get ahead of the need for any care assistance and have a plan ready to go than to be thrown into the situation suddenly and unexpectedly.

1AARP Survey of Aging, 2012.

Marie A. Moore is a Financial Advisor with the Wealth Management division of Morgan Stanley in Dallas, Texas. The views expressed herein are those of the author and may not necessarily reflect the views of Morgan Stanley Smith Barney LLC. Member SIPC. www.sipc.org. Morgan Stanley Financial Advisor(s) engage Worth to feature this profile. Marie A. Moore may only transact business in states where she is registered or excluded or exempted from registration, www.morganstanleyfa.com/themooregroup. Transacting business, follow-up and individualized responses involving either effecting or attempting to effect transactions in securities, or the rendering of personalized investment advice for compensation, will not be made to persons in states where Marie A. Moore is not registered or excluded or exempt from registration. The strategies and/ or investments referenced may not be suitable for all investors. Morgan Stanley Smith Barney LLC, its affiliates and Morgan Stanley Financial Advisors or Private Wealth Advisors do not provide tax or legal advice. Clients should consult their tax advisor for matters involving taxation and tax planning and their attorney for matters involving trust and estate planning and other legal matters. Certified Financial Planner Board of Standards Inc. owns the certification marks CFP®, CERTIFIED FINANCIAL PLANNER™ and federally registered CFP (with flame design) in the US. CRC 1455288 06/16

This article was originally published in the June/July 2016 issue of Worth.