When a loved one needs extra care, you may consider arranging care for them at home. Care at home offers the comfort of familiar surroundings, including continued support, interaction with pets and neighbors and other positives that help ease what can be a difficult time of transition for aging parents or others who need care assistance. But how do you know when home care is appropriate for your loved one? Factors like type of care required, qualifications of the providers and cost are all worth examining before taking the next step.
Know Your Needs
It is important first to establish the difference between "home care" and "home health care," as they are not the same service. Home health care means receiving skilled medical care from registered nurses, licensed practical nurses or certified nursing assistants, who are often affiliated with home health care agencies. Home care, on the other hand, is provided by a non-medical caregiver such as a personal care aide and tends to focus on companionship and assistance with daily activities.
"Both home care and home health care have the same goal: to keep your loved ones safe and as healthy as possible," says Ed Ukaonu, Certified Senior Advisor and CEO of FirstLight HomeCare's Atlanta locations. "Often, they work in tandem. A home health care nurse or physician's assistant will visit the home and potentially adjust prescriptions, while a non-medical caregiver will make sure these medications are taken on time. A physical or occupational therapist may design an exercise plan; a non-medical caregiver will help with these exercises throughout the day. A physician usually prescribes home health care when someone needs skilled care in the home. Both services require specific licensing and both assist with activities of daily living (ADL)."
Kinds of Service
The great benefit to home care is that it is truly customizable to each individual person and situation. "Our home care services are available to people of all ages wherever and whenever they need it," Ukaonu says. "This includes seniors that need some assistance to stay in their homes, care for the elderly who have chronic illnesses, families with members who have special needs or disabilities, people recovering from illness or surgery, new moms and families of deployed military personnel. We can even serve people who just need someone to talk to."
Some of the most common services provided include activities of daily living like bathing, dressing, eating, transferring (from a bed to a wheelchair, for example), toileting and walking. A home care provider may also address companionship and social needs by providing transportation to shopping, errands, medical appointments, social events, church, playing cards or board games and watching movies or television. In some arrangements, the provider may even do some light housekeeping or cooking to make life easier on everyone in the family.
Broaching the Subject
Discussing the topic of in-home care is often difficult for families, but having an open dialogue is key in identifying and providing the best care solutions. When you first bring up the topic to your loved ones, they may be resistant to accepting additional care. Try to speak candidly to the person about the issues holding them back from accepting assistance. Is it fear of losing their privacy and independence? Are they worried they are being a burden? Are they concerned about the cost? Once you identify the real issues behind someone's resistance, you are better equipped to rectify their fears or misconceptions.
A crucial element in addressing those fears and misconceptions is education, both for the family members and especially the person in need of care. David Solie, author of "How to Say It to Seniors: Closing the Communication Gap With Our Elders," shares, "In 20 years of working with seniors, I've come to know how deep the need for control is in that age group." He points out that, though they desire a reasonable measure of control over their lives and circumstances, seniors often wind up with very little control. That can be confusing at least and frightening at worst, but education about home care options can help significantly. Often, once patients understand their options, they feel more active in their care and appreciate the independence home care can offer.
Find the Right Care Provider
Once you and your family member agree that some sort of home care is needed, it's important to know what to look for from care providers. Whether you work with an agency or a private professional, knowing the right questions to ask can be a huge help in identifying the best person or group of people to provide the necessary care. Your starting place should include:
- Speaking with former and/or current patients and their families
- Confirming the agency or private professional's licensing
- Running background checks
- Ensuring there is a backup person available in the case that the individual you hired is unable to perform their job due to scheduling issues, emergency or illness
"You should have good communication with the agency," says Nancy Bour, co-owner of Synergy HomeCare of Metro Atlanta. "Are the owners accessible? Can you speak with the nurse if you have questions?" Accessibility can make all the difference in your experience as you select the right provider and move forward with care for your loved one.
Your primary care physician may be able to assist in providing names of qualified caregivers. Check with your local church or senior center; they may know qualified people looking for employment. You can also access the Eldercare Locator at www.eldercare.gov or at 1-800-677-1116.
13 Questions to Ask
- Does my state license home care? If so, is the agency licensed? If not, does the agency follow policies and procedures similar to those in a licensed state?
- Is the agency locally owned and operated? Are the owners on site actively managing the agency? If the agency is part of a franchise, what "watchdog" organizations is the franchise a member of?
- Are the agency's caregivers employees or independent contractors? (You might want an agency that knows its employees, not one that just acts as an employment agency.)
- Are caregivers bonded and insured? (They should be.)
- What criminal screening and background checks does the agency run on its caregivers?
- What sort of training do the employees receive? Is training ongoing?
- Will an agency supervisor evaluate the quality of care you receive? How often?
- How is billing handled? If private insurance will pay for some of the costs, will the agency bill them directly?
- If you have a family member who is involved in your care, how does the agency ensure they stay informed and included?
- What provisions are there for backup care? Who do you call if no one shows up? Does the agency have someone on call? After hours? What provisions are there for care during a disaster?
- Who can you call to discuss any issues and be sure to have them resolved?
- Are you committed to a long contract with the agency?
- Once you decide to work with the agency, how long will it take to get a caregiver?
—Information provided by Synergy HomeCare
Costs of Care
When it comes to costs, home health care is usually paid by Medicare, Medigap, Managed Care, Medicaid, Veterans Benefits and private pay, Ukaonu says. He says home care clients are generally private pay, although Medigap, Long Term Care Insurance (LTCI) and veteran benefits are available. Some health insurance plans can offer limited respite care coverage. "Home health care services are usually temporary (generally a short period of time) and with limited frequency (one to two hours per week), whereas non-medical home care can go on indefinitely."
Depending on the type of care provider you choose, you may also need to be prepared to deal with taxes and speak with your insurance company to insure your employee in case of an accident. You may want to consult an attorney to ensure you have all the bases covered when it comes to hiring an independent home care worker.
Quality of Care
No matter how thoroughly you've vetted the care providers, it's still important to be an advocate for your loved one and continue participating in their care. Keep an eye out for any changes in your loved one, such as a personality change that may be due to medications or a change in conditions like dementia, according to Bour. "Did the agency raise the issue to you? If not, you should have a discussion with them and ask what their caregivers have observed," Bour recommends. "When was the last nurse visit, and what were her observations? What do the caregiver notes show?"
Bour says communication and participation are key to the success of any caregiving situation. "I tell anyone who is managing someone's care not to abdicate your involvement. You still need to go visit Mom on a regular basis, whether she's still at home with home care services, in a skilled nursing facility or in assisted living."
So when it comes time to call in some professional backup, rest assured that you will still be involved in the care process. From starting the conversation in a respectful, loving way, to selecting and working with the right care providers, your advocacy for your loved one can make all the difference in their enjoyment of their years at home.
Nancy Bour, Synergy HomeCare of Metro Atlanta – www.synergyhomecare.com
David Solie, "How to Say it to Seniors: Closing the Communication Gap with Our Elders" – www.davidsolie.com
Ed Ukaonu, CSA, FirstLight HomeCare – www.firstlighthomecare.com