Home is where the heart is. For many seniors it is also a cherished cornerstone of their independence, identity and overall quality of life. Remaining in the comfort and familiarity of home, as a part of the community, and close to loved ones can be very beneficial, and home care is an excellent option for those who require special services, but value the freedom of living independently.

In-home care is now a robust and well established industry. According to the National Association of Home Care & Hospice, more than 7.5 million Americans currently receive home care, provided by over 17,000 different agencies across the country. The following home health services are likely available in your area:

• Skilled nursing care
• Homemaker/Health aides
• Physical, Occupational and Speech Therapy
• Respite care
• Hospice

Skilled Nursing In-Home Care

This type of home care is usually prescribed by a physician. Services can include post-operative care, wound care, injections and intravenous drug therapy, ventilator care and cardiovascular disease management. Though the most expensive type of home care, it is the most likely to be covered by Medicare.

Homemaker and Health Aides

Home care provided by homemakers or health aides is typically less intensive, but covers a broader range of services. Health aides provide assistance with basic needs like dressing, eating, bathing and toileting. Some agencies offer health aides who are qualified to perform simple medical tasks under the indirect supervision of a registered nurse. Homemakers specialize in maintaining the household: grocery shopping, cooking, cleaning and laundry. Homemakers do not provide hands-on help with personal care.

Physical, Occupational and Speech Therapists

These home carers work with patients who have suffered a stroke or are recovering from major surgery. Physical therapists work to improve the patient's muscle strength and mobility through exercise, stimulation and massage. Occupational therapists help seniors regain or improve their ability to perform basic household routines, using special techniques or equipment. Speech therapists assist in the restoration of speech, and also work with patients on their breathing, swallowing and facial muscle control.

Respite In-Home Care

This in-home care option can include any of the above services, and is designed to provide intermittent professional care in situations where a spouse or family member is the primary caregiver. It gives the primary caregiver an occasional break, a mental and physical respite from the rigors of daily care. It also allows the patient space and time apart from the primary caregiver, and helps ensure that the he or she receives a consistent quality of care.

Hospice Home Care

End of life care involves significant cooperation between family members and health care professionals. Hospice at home requires a team approach and round-the-clock care. Home carers can work with family and hospice volunteers to ensure the patient is comfortable and attended at all times.

In-Home Senior Care Costs and Other Considerations

Seniors and their families often rely on licensed home care agencies when seeking in-home care. Alternatively, they can solicit independent senior care professionals by placing ads in newspapers or online. Both approaches have advantages and disadvantages.

Independent home care workers can be less costly, but families will be responsible for pre-employment screening such as background checks and drug tests. Depending on the laws of your state, you might be responsible for income withholding, unemployment, and household employment taxes. However, you ensure that your home care is generally provided by one person, who will get to know you, your routines and special needs.

In home care provided by an agency will typically be more expensive, but because the agency is responsible for screening, training and employee benefits, going this route is usually less of a headache. The downside to agency home care is that it will likely involve a rotating cast of professionals, with no guarantee the same person comes back the next day or the next week. Turnover at agencies is high, and scheduling can be driven by who is available, not whom you prefer.

According to the 2009 Cost of Care Survey published by Genworth Financial, the national average rate for an agency in-home health aide is $18.50 per hour. This figure jumps to over $46 an hour if you contract with a Medicare-certified home care agency. However, if you are Medicare eligible, and your home care is recommended by a physician, and is limited to 28 hours a week (or 35 hours in special circumstances) Medicare will pay most if not all of the cost for senior care, including skilled nursing and rehabilitation therapy. Click here for detailed information about Medicare home health care benefits. Additionally, Medicare offers a Home Health Compare tool designed to provide you with information on how well the home health agencies in your area care for their patients.

If you or the services you need are not covered by Medicare, there are other resources worth exploring. You may be eligible for Medicaid or VA benefits, which also subsidize certain home care services. Homeowners concerned about the out-of-pocket costs for any type of senior care would be well-advised to look into reverse mortgages, available from the Federal Housing Administration and many commercial lenders. Alternatively, Private policies like Medigap and long term care insurance can provide comprehensive home care coverage to seniors who want to plan ahead for potential future expenses.

Senior Home Care Glossary

Activities of Daily Living (ADLs): everyday personal care tasks, like dressing, eating, toileting.

Adult Day Care: a center that provides daytime programming for seniors.

Aide: personal care aides help with ADLs and/or with housekeeping duties and errands; home health care aides typically work for a licensed agency, work under nurse supervision, and can help with basic medical tasks like monitoring temperature or pulse.

Alzheimer's Care: a number of choices exist, such as home care, or specialized units in assisted living facilities or nursing homes.

Assisted Living: a senior housing option that provides help with ADLs (and sometimes can monitor medication taking), but doesn't provide the skilled medical care of a nursing home.

Board and Care Homes: small-scale facilities that are comparable to assisted living communities in the types of services they offer (though some accept residents with more intensive medical needs); often a smaller resident-to-staff ratio than an assisted living facility.

Congregate Housing: the term has lost its specificity and now is often used to describe the same type of care one would receive in an assisted living facility.

Continuing Care Retirement Communities (CCRCs): the most all-encompassing of senior housing options, CCRCs include independent living, assisted living, and nursing care in one facility so residents can receive whatever care they need under "one roof."

Custodial Care: synonymous with personal care; help with ADLs and not with medical issues.

Home Care: hiring help that travels to your home to provide services; help can be medical, therapeutic, custodial, or housekeeping in nature.

Independent Living: a senior housing community that offers residents security, peer companionship, and often activity programming and housekeeping services, while allowing them to live independently.

Long-term Care Insurance: offered by private companies to cover long-term care expenses like home care or senior housing.

Nursing Home: a senior housing facility that provides medical care as well as assistance with personal care.

Medicare: public medical insurance for seniors or the disabled; only covers home and nursing care for a short period of time following a hospitalization.

Medicaid: publicly-funded health coverage for the low-income that covers some assisted living or home care costs; also covers nursing home care, though not all facilities accept Medicaid patients.

Personal Care: see custodial care.

Respite Care: provides a "break" for family members acting as primary caregivers.

Reverse Mortgage: allows senior homeowners to borrow against the value of their homes; no repayment is required until the homeowner is deceased, has moved, or sells the house; some publicly-funded lenders limit what the loan can be used for, with senior housing being one option.

Special Care Units (SCUs): an area of an assisted living or nursing home facility dedicated to special needs care; often attends to the needs of dementia/Alzheimer's patients.

Supplemental Security Income (SSI): government financial aid for low-income seniors or the disabled; funds can be used for basics needs including housing.