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There comes a moment for many older adults — or for the family members who love them — when living independently starts to feel harder than it used to. The grocery shopping takes more out of you than it once did. Getting in and out of the shower has become something you think about. You are managing fine, mostly, but you are also aware that “managing fine” is requiring more effort than it used to. This is exactly the moment when in-home care is worth knowing about. Not because something has gone wrong — but because the right support at the right time can keep things from going wrong. And because staying in your own home, in your own community, surrounded by the life you have built, is something worth planning for.

This post is a guide to in-home care services available to older adults in Happy Valley and Clackamas — what they are, what they cost, how to find them, and how to pay for them.

What Is In-Home Care?

In-home care is a broad term that covers a range of services provided in a person’s home rather than in a facility. It’s helpful to understand the two main categories, because they are different in important ways.

Non-medical in-home care — sometimes called personal care or home care — is provided by trained aides who help with the activities of daily living: bathing, dressing, grooming, meal preparation, light housekeeping, errands, transportation to appointments, and companionship. These aides are not nurses and do not provide medical treatment, but they provide the kind of practical, daily support that allows many older adults to remain safely and comfortably at home.

Home health care is medically oriented and is typically ordered by a physician following a hospitalization, surgery, or significant health event. It may include skilled nursing visits, physical therapy, occupational therapy, speech therapy, or wound care — provided at home by licensed medical professionals. Home health care is generally time-limited and focused on recovery or rehabilitation. Home health care agencies are licensed by the Oregon Health Authority; a list is available on the OHA website.

Many people use both at different points, and the two are not mutually exclusive. Understanding which kind you or a family member needs is the first step in finding the right services.

What Non-Medical Services Are Typically Available?

Non-medical in-home care services generally include some or all of the following, depending on the agency and the care plan:

Personal care assistance — bathing, dressing, grooming, toileting, and mobility support. Meal preparation and feeding assistance. Light housekeeping, laundry, and errands. Medication reminders — note that aides typically can’t administer medications, only remind. Companionship and social engagement. Transportation to medical appointments, grocery stores, and other destinations. Respite care — temporary relief for family caregivers who need a break.

The hours and frequency of care are customizable. Some people need a few hours of help a few mornings a week. Others need care for most of the day. A small number need round-the-clock support. Most agencies can accommodate a wide range of needs, and care plans typically evolve as needs change.

How Much Does It Cost?

Cost is one of the most important and least-discussed aspects of in-home care, and it is worth addressing honestly.

Home care is typically charged at an hourly rate, with costs varying based on factors like time of day, overnight or weekend rates, and whether care is around the clock. Rates in the Portland metro area generally range from approximately $28 to $40 per hour for non-medical care, though rates vary by agency and the specific services involved. For older adults who need substantial daily support, costs can add up quickly — which makes understanding your payment options essential.

Private pay — paying out of pocket — is how many families cover in-home care, at least initially. If you have long-term care insurance, now is the time to review your policy carefully, as some policies cover non-medical in-home care. Oregon DHS offers tips and resources for those planning to pay privately (you’ll need to scroll down the page past the information about Carina).

Medicare generally does not cover non-medical in-home care. It does cover skilled home health care — nursing visits, physical therapy — when ordered by a physician and provided by a Medicare-certified agency, but this coverage is time-limited and tied to a specific medical need.

Medicaid can cover in-home care for qualifying lower-income Oregonians through several programs, including the K Plan and the Consumer-Employed Provider program. Eligibility is based on income, assets, and functional need. If you think you or a family member might qualify, the Clackamas County ADRC is the right place to start — more on that below.

Oregon Project Independence has two versions worth knowing about. The original Oregon Project Independence program — a non-Medicaid option for older adults 60 and over who would not otherwise qualify for assistance — is currently closed to new clients. However, Oregon Project Independence — Medicaid (OPI-M) remains open and available. OPI-M provides in-home care services to qualifying older adults, including personal care assistance, home care, chore services, assistive technology devices, adult day care, respite care, skilled nursing care, and home-delivered meals. Income eligibility for OPI-M is more generous than standard Medicaid — in 2026, applicants can have monthly income up to $5,320 — making it accessible to older adults who might not qualify for other Medicaid-funded programs. To find out whether you or a family member qualifies for OPI-M, contact the Clackamas County Aging and People with Disabilities office at 971-673-7600.

Veterans may have access to additional benefits through the VA to help cover in-home care costs. Contact the Clackamas County Veterans Services office at 503-655-8388 for guidance on what may be available.

How Do You Find a Reputable Agency?

There are more than 150 home care agencies serving Clackamas County. That number can feel overwhelming. Here is a practical framework for narrowing it down.

Start with a referral rather than a search engine. The Clackamas County ADRC — the Aging and Disability Resource Connection — can provide information about agencies serving your area and connect you with programs you may not know about. Reach them at 503-650-5622, Monday through Thursday, 8:30 a.m. to 5:30 p.m.

The Oregon Home Care Commission maintains a registry called Carina that matches Medicaid recipients with available home care workers. If you or a family member receives Medicaid, Carina is a valuable resource for finding individual home care workers outside of an agency setting. Note that Carina is available only to Medicaid recipients — it is not available to private-pay individuals.

When evaluating an agency directly, ask the following questions: Is the agency licensed and bonded in Oregon? Home health agencies in Oregon are licensed through the Oregon Health Authority, Public Health Division, Health Facility Licensing and Certification Program. You can verify an agency’s license status through the OHA before engaging their services. Are caregivers employees of the agency — with background checks, training, and workers’ compensation coverage — or independent contractors? What happens if a scheduled caregiver cannot make it? How is care supervised and how is the care plan reviewed over time? Can services be increased or adjusted as needs change?

It’s important to check the credentials and qualifications of each provider, make sure they are state certified, and determine whether background checks are performed before caregivers are hired. Reading reviews from families who have used the agency is also worth doing — not to find a perfect score but to understand how the agency handles problems when they arise.

A Note on Hiring Individual Caregivers Independently

Some families choose to hire a caregiver directly — through a personal referral or a community connection, — rather than going through an agency. There are genuine advantages to this approach. The cost is typically lower, since you are not paying agency overhead and markups. You have more direct control over who comes into your home and when. And the relationship between caregiver and care recipient can sometimes be more personal and consistent when there is no agency layer in between. For families with limited budgets, independent hiring can make the difference between affording care and going without it.

The tradeoffs, however, are real and worth understanding before you make that choice. When you hire independently, you take on responsibilities that an agency would otherwise handle. You become, in effect, an employer — which means you are responsible for verifying the caregiver’s background, checking references thoroughly, and confirming that they have the training and experience the situation requires. You are also responsible for payroll taxes, which surprises many families who assumed a cash arrangement would be simpler. If the caregiver is injured in your home, your homeowner’s or renter’s insurance may not cover it without a specific rider. And if your caregiver calls in sick or becomes unavailable, there is no agency dispatcher to send a replacement — the gap in coverage falls on you or your family to fill. None of this means independent hiring is the wrong choice. For many families it works beautifully, especially when the caregiver comes through a trusted personal referral. But going in with clear eyes about the responsibilities involved — and ideally consulting with an elder law attorney or the ADRC before you begin — will help you avoid the surprises that catch families off guard.

Having the Conversation

For many families, the practical questions about in-home care are easier than the conversation that leads there. An older parent who values independence may resist the idea of having help in the home. An adult child may not know how to raise the subject without it feeling like an accusation. A spouse may feel that accepting outside help is an admission of failure.

None of those feelings are wrong. They are honest responses to a situation that is genuinely hard.
What tends to work better than a single difficult conversation is a gradual approach. Introducing the idea of help with something specific and non-threatening — a few hours of housekeeping, a ride to an appointment — before the need becomes urgent makes the transition easier for everyone. It also gives the older adult a chance to get comfortable with having someone in the home before the stakes are higher.

The goal, always, is to support independence rather than replace it. The right in-home care arrangement makes it possible for someone to stay in their own home, on their own terms, for longer than they could have otherwise. That is worth a difficult conversation.

The need for in-home care almost always arrives before families feel ready for it. The best time to learn about these options is before you need them urgently — when you have the time and clarity to make thoughtful decisions. We hope this guide is a useful starting place.

What If You Don’t Have Family to Help?

Not everyone has a spouse, an adult child, or a nearby family member to help navigate this process — and it is worth saying clearly that going it alone does not mean going without help. The Clackamas County ADRC exists precisely for this situation. A certified Information and Referral Specialist can walk you through your options, help you understand what programs you may qualify for, and connect you with services that fit your situation — all at no cost and with no obligation. If you are not sure what you need or where to start, a single phone call to the ADRC at 503-650-5622 can accomplish what might otherwise take weeks of research on your own. Oregon 211 is another first call worth making — trained specialists are available around the clock to connect callers with local services and can help you identify options you may not know exist.

Beyond these two resources, some older adults find it helpful to work with a professional geriatric care manager — an independent specialist who assesses needs, coordinates services, and serves as an advocate for older adults who don’t have family in that role. Geriatric care managers typically charge for their services, but for someone navigating a complex situation without family support, the guidance can be well worth the cost. Your doctor’s office or the ADRC can help you find one serving Clackamas County. Whatever your situation, the absence of nearby family is not a barrier to getting the support you need — it simply means that the first call goes to a professional rather than a relative.

Do you have experience with in-home care — as a recipient, a family member, or a caregiver? We would love to hear what you learned. Leave a comment below or write to us at info@theelderbeat.org.