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Aging at Home with Agency Care

The costs of aging at home

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Ethel, nearly 80, has knee replacement surgery but falls and breaks a hip on the way to the basement laundry room. After two months in hospital and rehab, she and Graham face a very different scenario. During Ethel’s hospital stay, Graham continued with the usual supports but began to neglect his personal care and became depressed and increasingly forgetful.

The community care agency decides that Ethel and Graham need more help, so assistance with showers is increased and Ethel receives a total of two hours per day of personal care, as well as a weekly physiotherapy visit. Graham also needs help with personal care, cueing to prepare breakfast and microwave the frozen Meals on Wheels entrées, assistance on errands beyond what a taxi driver can provide, and general companionship.

The consequences of hiring a PSW

An eldercare consultant suggests that a permanent part-time personal support worker (PSW) should come in for a few half-days per week. She will provide morning personal care, prepare breakfast, do laundry and basic cleaning, heat and serve a hot lunch, check supplies and be sure Graham is clear about heating up dinner. She will also use their car to accompany them on errands. She will be hired from an agency so she will be more expensive, but the agency guarantees that she is bonded, insured and health and police-checked. She will also be automatically replaced if unavailable or ill and will be supported by an agency registered nurse for questions or concerns. All billing will be handled through the agency office at a rate of $25 an hour.

These new care requirements include reinstating the car expenses and increasing the car insurance for a non-family driver, for a very different monthly cost and a challenge to their current monthly income of $3,360.

To pay for the services of Cora, the new PSW, their son Peter looks into a reverse mortgage so that they can access the capital in the home. The payouts are tax-free, and Graham and Ethel need not begin repayments as long as they live in the house. However, they are leery of pledging the home they worked so hard to pay off. This is a major financial decision that they should discuss with a trusted financial adviser.

• If a reverse mortgage is chosen, the sum could then be used to purchase an annuity, which calculates monthly payouts based on actuarial estimates of longevity, to augment the monthly income.
• Assistance in municipal taxes may be available through the local revenue services department.
• The family should be sure that the disability and attendant-care tax credits have been applied for.

This look at home care vs. retirement living was last updated in 2017 - ed. 

Other articles in this series

• Aging at Home with Live-in Care
• Aging in Place vs. Moving into a Retirement Home
• Aging in Place is free, right?
• Aging at Home with Community Support