Help Choosing a Home Care Service
Nearly one out of every four U.S. households (23 percent, or 22.4 million) provides care to a relative or friend aged 50 or older. The majority of these caregivers are baby boomers. In the twenty-first century the demands placed on family and other informal caregivers are likely to escalate, affecting nearly every American family. Since most persons prefer to stay in their own homes and live independently for as long as possible, this column addresses questions and concerns regarding these issues.
Question:
I would like to hire someone to be with my father during the day while
I am at work, but I’m not sure where to begin. I have asked around
and found that there are agencies that provide care at home. Where do
I find one? What do I need to know before I call? What kinds of questions
should I ask, and how do I choose one?
Answer:
This is one of the most common questions being asked. Those who haven’t
had a need for this type of service in the past may not be aware that
it is available. A place to begin may be to check with your local Department
of Aging, or a social worker at a hospital or long term care/rehab facility.
They may be able to give you a list of agencies that they work with or
refer to. If you have friends who have used this type of service, ask
them about their experiences. Most agencies are listed in the phone book
under Nursing.
Before You Call
You'll save time if you know what type of services you're looking for.
A number of agencies provide primarily nursing and medical services, others
specialize in non-medical or companion care only, and some offer both.
Some agencies require doctor’s authorization, and others are essentially
referral services. Find out up front if their services will be right for
you. Use the following points to help you get a handle on your basic level
of need. Then use the questions below as they may apply to your situation.
What is needed
- Personal care (e.g., help with bathing, toileting or incontinence, eating, dressing, getting out of bed, out of a chair, or being lifted)
- Medical care (e.g., wound care, injections, monitoring health conditions like diabetes or blood pressure or heart disease, assistance with medical equipment like dialysis, indwelling catheter, naso-gastric (NG) tube feeding or a ventilator).
- Companionship Is it important for the person to provide good company? Or to provide supervision to someone who is confused/has memory loss?
- Housekeeping (e.g., preparing meals, doing dishes, light housekeeping, laundry)
- Transportation assistance Will the worker be expected to transport your loved one to activities, shopping, medical appointments, etc.? If so, will the worker drive her own car? Your car? A special wheelchair accessible van?
- Hours of care Try and have a basic idea of what hours you will need care for (day, evening, all-night, etc.).
Get the basics on their business practice
- How long has your agency been in business?
- Are home care workers your agency’s employees (e.g., agency is responsible for employee’s taxes, insurance, etc.)? Or contractors (e.g., private individuals on a referral registry)?
- Is your agency bonded (insured against theft)? Does your agency carry malpractice insurance?
- Must the client have a doctor's authorization to receive your services?
- What levels of care does your agency provide? Medical Nursing Care (RN and LPN), Personal Care (Trained Nurse Aides and CNAs) non-medical care (strictly chores or companionship)
- Can your agency accommodate my loved one's needs? Note: describe person's diagnosis, age, special needs (e.g., administering medications, using home medical equipment, personal care, meals, housekeeping).
- What are your fees (per hour, per day or per visit)? Note: this may vary significantly depending on the level of care needed.
- Is there a minimum shift? What about a maximum shift? Can a shift be split (e.g., two hours in the morning and two in the evening)?
- Will a nurse evaluate the client's needs? If so, what does this entail, is there a fee?
- Are there any restrictions against accompanying the client outside the home or driving a car?
Ask about worker qualifications
- What are the minimum training/experience qualifications that you require for hiring workers?
- Do you screen your workers? If so, what type of background checking is done? Criminal Checks, Child Abuse Checks?
- Are your workers certified in CPR?
- Do you require your workers to have annual physicals and TB tests?
- Does your agency require workers to have regular evaluations and training?
See how their service quality measures up
- Are workers available 24 hours, seven days a week?
- Can I cancel or change the hours of service at any time?
- Is there always someone available at your office to take a call?
- Will I have the same worker every time, or a different worker each time?
- Can a known agency worker be requested by name?
- Can a different worker be requested, if there was a problem with the first one?
- Can a replacement worker be called if the worker does not come or cannot complete a shift?
- Can I interview prospective workers?
Learn about financing and payment
- Does the agency pay the worker's social security and taxes? If not, do I need to pay this?
- Does payment go to the agency? Or the home care worker directly?
- When is payment due? (e.g., at the end of each visit? weekly? monthly?)
- Is there a charge for overtime, if the worker stays late? What about Holidays?
- Are there any additional costs for travel time or extra services (e.g., doing laundry or errands)?
- Do you accept long term care insurance? Will you bill the insurance directly?
- Do you require a retainer payment up front before service is provided?
Reviewing these questions should help you to narrow down what is important to you in a service provider, and to find one that will fit your needs!