How does a home care agency decide what care tier someone needs?
Key facts
- Assessment duration
- 60–90 minutes, in the home
- Assessment cost
- Free — no obligation
- Who conducts it
- Care coordinator (often RN or MHA-credentialed director)
- Assessment inputs
- 6 ADLs + 8 IADLs + cognition + falls + meds + family capacity + recent events
- Reassessment cadence
- Every 60–90 days, or when the case changes
Tier decisions at a reputable Southeast Michigan agency are not phone-quoted. They come out of a free 60–90 minute in-home assessment done by a care coordinator, often an RN or MHA-credentialed director. The coordinator observes the parent moving through the house, not just what the parent says — the walk from bedroom to bathroom reveals what the questionnaire misses.
The assessment covers seven inputs: the 6 ADLs (bathing, dressing, transfers, toileting, continence, eating), the 8 IADLs (medications, meals, phone, transportation, laundry, housekeeping, shopping, finances), cognitive baseline (short screen for orientation and short-term memory), fall history and home hazards, medication list and adherence, family caregiver capacity, and any recent medical event (hospital, rehab, fall, diagnosis).
The output is a written care plan naming specific tasks, a shift schedule matched to when help is actually needed, a service band (Companion $27–$32/hr, Personal $29–$37/hr, Specialized $35–$42/hr, or Live-in $400–$500/day at typical 2026 Southeast Michigan agency rates), and a cost estimate. Nothing gets signed at the assessment — the family reviews at home and decides.
Tiers are not permanent. Care plans get reassessed at 60–90-day intervals and rewritten when the case changes. A Companion case that adds ADL work steps up to Personal Care; a Personal Care case that adds dementia behaviors or Hoyer transfers steps up to Specialized. The written plan follows the scope.
For the full breakdown, see the cornerstone: When is it Time for Home Care? guide.
Related questions
- Do I have to be there for the assessment?
- Yes if you are the decision-maker. Long-distance family members join by phone or video during the visit.
- How soon after the assessment can care start?
- Typically 24–48 hours after the family approves the care plan. Same-day starts are possible in urgent situations.
- What if the parent is uncooperative during the assessment?
- The coordinator adapts. Refusal to engage is itself an input; the plan documents what the family sees at home.
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