Coming home again (Part I)

Since entering the eldercare field in the late 1980's I've seen home healthcare grow exponentially. By 2009, about 83,000 providers were serving 7.3 million Americans annually. Today, the number of Illinois in-home care providers is almost too long to count (a list of providers is 65 pages long). The popularity of this service is easy enough to understand. Most people prefer to remain in their familiar surroundings then to move to a more institutional environment.

Regulatory Authority:

Beginning in 2008, all Illinois in-home healthcare agencies were required to be licensed (required by the Home Health, Home Services and Home Nursing Agency Act.) The Act's passage assured minimum standards regarding staff, defines the types of care provided and defines the roles and responsibilities of the all the parties involved (i.e. client, family, placement agency, etc.)

Service Delivery:

The clients typically require either "personal" assistance with activities of daily living (e.g., bathing, dressing, grooming, etc.) or only "homemaking" assistance with instrumental activities of daily living (meal preparation, grocery shopping, driving, etc.).

The most common payment source for non-licensed home care is private funding from the income or assets of the client/family (or from a long-term care insurance policy). From the swank high-rises on Lake Shore Drive to the moneyed suburbs ringing the metropolitan area, non-licensed in-home care is an expensive option viable only for those with sufficient resources. Hourly rates vary and often 24-hour coverage is priced on a per diem basis. A home health aide is typically billed at $17 to $27 per hour and full-day coverage at $180 to $250 per day (home care workers are billed at a lower rate).


In general, these caregivers are non-union (SEIU is working to hard to organize these workers) employees and despite the additional compliance requirement of the Act, the barriers to open an in-home care agency remain primarily hiring/retaining qualified staff and establishingsufficient referrals to maintain adequate cash flow.

Although the Act requires the presence of a plan of treatment, if the client lives someplace other than in close proximity to their family (or responsible party) it may be necessary to hire a case manager to visit the elder regularly to assure the services are being and remain appropriate to their needs. In the future, Illinois regulators may review wether the current plan of treatment requirements (as well as other aspects of the Act) are sufficient. Increase regulation often leads to increased operation expense.

Next: Medicare home healthcare benefit will be discussed in Part II...

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    Bruce Lederman has over 25 years experience in the senior care field as a direct care provider and thought leader. Bruce was CEO and president of his own firm that operated skilled nursing facilities in Illinois. He is a former nursing home administrator and has consulted to numerous elder care providers on planning for strategic growth as well as process improvement. Recently he served as board chair of CJE SeniorLife, a leading non-profit elder care provider in the Chicago area. Bruce is currently employed as chief strategy officer for a company providing skilled nursing services in communities throughout Illinois and Missouri.

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