Services such as in-home care and, especially in-home respite services, are two of the top supports cited by caregivers as most beneficial in their ability to continue to provide good care for a loved one. Caregivers are frequently the only people caring for their loved ones and may be doing it in addition to caring for a child, a spouse, and/or working a full-time job. In-home services and in-home respite offer a needed time for the caregiver to take care of other needs including their own.
The Caregiver Friendly Communities Assessment scores this domain in two primary service categories:
Expand the categories below to find the scoring factors and recommended practices for each. You can also download a pdf of the Best Practices Document to save and share.
In-home services were assessed based on the array of in-home services available to all residents in your region, their associated cost structures and whether or not they were identified as being available immediately (without being placed on a waitlist).
Array of Services
Helpful in-home services include: housekeeping/homemaking and other indoor chore services, home/yard maintenance, minor home repair, meals on wheels, private duty nursing, home health/personal care aides, and shopping assistance.
Recommended Practice: review the variety of in-home services available to all residents in your community, identify gaps and work with community partners to find existing services or develop services to fill the gap.
Resource Highlight: In a small study of 40 participants, in-home monitoring systems were found to greatly support older adults living at home and their caregivers. In-home systems further need to be affordable, simple to install, reliable, be able to detect falls, user friendly, accommodate individual needs, and be able to provide reports to the patient and the caregiver (Larizza, 2014).
A focus on access was one of the four guiding principles of the Creating Caregiver-Friendly Communities project. Finding services that are affordable is essential to being able to use them.
Recommended Practice: Catalog the available in-home services available to residents in your community, noting services available at reduced cost and services that are only available at full-cost. Work with community partners to identify ways to offer needed services at reduced cost.
Resource Highlight: Insurance will sometimes cover the cost of services, however, in a study interviewing 52 family caregivers, caregivers stressed the challenges of direct care workers only being able to do tasks explicitly outlined in their care plans by some employers, even though the task may be less important than another and also stressed the value of direct care workers having a warm and social relationship with the care recipient, being permitted to have a cup of coffee together or play cards (Sims-Gould, 2010).
With a focus on access, having to wait for a service reduces a caregiver’s ability to access that resource, putting additional strains on them. Finding services that are immediately available or which have no wait lists is crucial.
Recommended Practice: Catalog the available in-home services available to residents in your community, noting services that have a waitlist. Work with community partners to identify ways to offer needed services without the waitlists.
Michigan Disability Rights Coalition (MDRC)
The MDRC’s Assistive Technology Program helps people access low-cost, free or insurance-covered assistive technology devices and equipment, such as specialized eating utensils and mobility aids, which can help people of all ages live more independently despite physical disabilities. copower.org/
Elder Helpers Program
A nonprofit organization that connects volunteer helpers to older adults needing in-home services. elderhelpers.org/
Senior Corps Senior Companions
Volunteers 55 and over who provide assistance and friendship to seniors who have difficulty with daily living tasks, such as shopping or paying bills. The program aims to keep seniors independent longer and provide respite to family caregivers. nationalservice.gov/programs/senior-corps/what-senior-corps
Volunteer Caregiver Respite Program
The Area Office on Aging of Northwestern Ohio developed program, which helps family members caring for frail, aging loved ones alleviate stress by providing them a temporary break. Each week, a Retired Senior Volunteer Program member visits with the aging loved one at home for two to four hours so the caregiver has some time off. The new relationships formed benefit the volunteer and care recipient while the caregiver gets a much-needed break. The Volunteer Caregiver Respite Program merges two existing programs—the National Family Caregiver Support Program (NFCSP) and the Retired Senior Volunteer Program (RSVP)—to provide evidence-based training through Respite Education and Support Tools (REST) and coordination for caregivers. Costs and overhead are low, as the program involves a small extension of tasks already being performed by staff. Training for volunteers is subsidized by grant funding. Operating costs are provided by current funding sources. RSVP funds cover supplies, recruitment and training material printing, telephone and computer costs, and volunteer expenses (travel and meal reimbursement, recognition and uniforms). Older Americans Act Title III E funds cover assessment and caregiver/volunteer coordination. Contact their office for more information about this innovative project:
Respite care provides short-term relief for primary caregivers. It can be arranged for just an afternoon or for several days or weeks. Care can be provided at home, in a healthcare facility, or at an adult day center. Respite services were scored based on 1) the array of respite options available: in-home, and out-of-home – including adult day and out-of-home extended stay; 2) the stay length; 3) affordability; and 4) geographic proximity.
Array of Respite Options
Having access to an array of respite options better supports caregiver needs. The primary options available include in-home respite and out-of-home respite.
Recommended Practice: Review the variety of respite services available to residents in your community, identify gaps and work with community partners to find existing services or develop
services to fill the gap.
Resource Highlight: In a study on adult day services, clients who attended the adult day program were less likely to need emergency services and had fewer hospital visits; when in the hospital, length of stay was also decreased as compared to those not in an adult day program (Kelly, 2017).
Respite can be offered for just an afternoon or for several days or weeks. Some services have limited evening and weekend hours, if offered at all. Having an array of options when it comes to the timing of respite care is important for supporting the lives of caregivers.
Recommended Practice: review the respite care options available and their varied coverage lengths. Advocate for short and long-term stays, as well as evening and weekend coverage. Work with community partners to find existing services or develop services to fill the gap.
In a review of 557 adult day services across the country, research showed they effectively support caregivers. The majority were found to have trained and knowledgeable staff and more than half (55%) were funded through public funds. Top funding sources included Medicaid, Community-Based Waiver Program, and the Veteran’s Administration (Anderson, 2012). It’s important to work to find funded or partially subsidized respite services for caregivers.
Low/No-cost Volunteer Programs
For out-of-home respite and adult day services, location of the facility in proximity to the caregiver’s needs is of utmost importance since respite service effectiveness may be reduced with prolonged travel to and from respite services. Some respite services may offer transportation assistance.
Recommended Practice: Review the available out-of-home respite options available in your community and consider transportation to and from. Aim to identify providers within a 20 minute drive or that offer transportation services.
ARCH Respite Network
The ARCH National Respite Network includes the National Respite Locator, a service to help caregivers and professionals locate respite service. archrespite.org.
The Help Guide
This website discusses the types of respite care regarding chore services vs. personal services, working with providers vs. working with independent contractors, exploring natural supports, how to engage family/friends in caregiving, how to employ respite workers, how to find a good match, and strategies for mediation of respite disputes: helpguide.org/articles/caregiving/respite-care.htm.
Respite Care Planning Guide
A respite care plan is a collection of documents and instructions that help to prepare a new caregiver to fill in for a primary caregiver. blog.ioaging.org/caregiving/what-is-a-respite-care-plan-a-strategy-for-compassionate-caregiving.
The Texas Respite Coalition (TRC)
A statewide alliance working to promote the development and expansion of quality respite programs throughout Texas. Read about their process here: hhs.texas.gov/sites/default/files/documents/about-hhs/communications-events/meetings-events/adrcac/nov-2019-adrc-trac-agenda-item-6.pdf.
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