As a professional servicing seniors for the past 10 years, I have recognized the importance of clarity of information for both caregivers and seniors to properly discern the services that are needed both immediately and in the future. My analogy has always been that, when you are young parents, you have no clue as the choices, cost and requirement of child care services until you are there frantically calling around searching for the right options that are both safe, convenient and within your budget.
The same holds true for senior care. People rarely plan in advance for the choices that seems so far off into the future. Let me begin by explaining Home Care options.
Although most forms of home care are bundled into that one phrase, there are extreme differences when comparing, medical and non-medical options.
Non-medical home care is basically caregiving paid on an hourly basis to provide general assistance with activities of daily living. These might include assistance with cooking, cleaning, showering or even medication assistance. This type of home care is paid for privately with typically a minimum number of hours per day or week required by the provider.
Medical home care, also referred to as skilled nursing care, includes providing nursing assistance along with physical/occupational and speech therapy if needed. Home Health Care is paid for by either Medicare/Medicaid or a private insurance if the eligibly is met. The criteria includes:

• Doctor’s orders for referral
• The patient is having difficulty leaving the home without assistance (home bound)
• A change in medical status

If the patient meets this criteria, then a nurse will go to the patient’s home to evaluate, treat and educate them to eliminate a relapse or readmission into the hospital.
To better explain medical home health care, here is a complete explanation provided by Medicare.gov establishing what it is and what to expect:

What is home health care?

Home health care is a wide range of health care services that can be given in your home for an illness or injury. Home health care is usually less expensive, more convenient, and just as effective as care you get in a hospital or skilled nursing facility (SNF).

Examples of skilled home health services include:

• Wound care for pressure sores or a surgical wound
• Patient and caregiver education
• Intravenous or nutrition therapy
• Injections
• Monitoring serious illness and unstable health status

The goal of home health care is to treat an illness or injury, to regain your independence, and become as self-sufficient as possible.

If you get your Medicare benefits through a Medicare health plan, check with your plan to find out how it gives your Medicare-covered home health benefits.

If you have a Medicare Supplement Insurance (Medigap) policy or other health insurance coverage, tell your doctor or other health care provider so your bills get paid correctly.

If your doctor or referring health care provider decides you need home health care, they should give you a list of agencies that serve your area, but must tell you whether their organization has a financial interest in any agency listed. The decision on what agency to select is the patient or family choice.

What should you expect from home health care?

• Doctor’s orders are needed to start care. Then the home health agency will schedule an appointment and come to your home to talk to you about your needs
• The home health agency staff will also talk to your doctor about your care and keep your doctor updated about your progress.

Examples of what the home health staff should do include:

• Check what you’re eating and drinking.
• Check your blood pressure, temperature, heart rate, and breathing.
• Check that you’re taking your prescription and other drugs and any treatments correctly.
• Ask if you’re having pain.
• Check your safety in the home and teach you how to take care of yourself
• Coordinate your care with Physician

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The second case showed problems at the opposite end of the spectrum.  In that case[2] BNY started with $403,000 in a trust.  The trustee expended almost $60,000 per year only $3,253.03 was left at the time of the accounting.  The court held that the trustee breached its fiduciary responsibilities to the beneficiary by failing to make decisions based on the long-term needs of the beneficiary that would extend the life of the trust for as long as possible.   BNY breached its fiduciary duty by authorizing each and every discretionary disbursement requested by the infant plaintiff’s mother.  A significant portion of the trust assets were expended on caregivers.  The court held that the trust had an obligation to inquire as to whether those services could be covered by Medicaid.  BNY did not show a good faith effort to seek Medicaid’s assistance for home health services.  BNY claimed that it was aware of communication that others had with Medicaid.  The court held that it was the duty of BNY, not the plantiff’s mother, to pursue Medicaid.  The court pointed out that considerable funds were expended on taxi services, i.e., in excess of $50,000 over four years.  The court held that this expenditure was excessive and inappropriate.  Funds were also expended for security deposits for housing, but when the beneficiary’s mother moved from one residence to another, no effort was made to obtain a refund of those security deposits from the landlords.  It was noted that notwithstanding the fact that the beneficiary was on SSI and Medicaid (excluding Home Health Services) considerable trust funds were expended for medicine that should have been paid by Medicaid.  The court also held that BNY breached its duty by failing to investigate whether $400 monthly payments to the beneficiary’s mother for food and clothing could have a negative impact on the beneficiary’s SSI and in turn on their Medicaid benefits.  The court pointed out that BNY made no effort to consult a professional on government benefits or assistance programs as required by the trust.  The conclusion stated that as one trust representative stated, “It was easier to accede to Mrs. Beltres’ monetary requests than to deny them.”