Choosing a Home Health Agency
One of the most difficult things we must do as adults is to decide when our parents are no longer able to care for themselves independently. Whether it is because of a diminished mental or physical capacity or a terminal illness, they cannot do everything they once did to provide for themselves. They may not recognize this and even deny the needed help, but it is our job as their children to make sure they receive the proper care.
According to a 2004 survey by the National Center for Health Statistics, over 1.3 million people receive homecare services in the US. Seventy percent of those are over the age of 65. Since most people wish to remain home as long as possible, that number will likely rise. And with over 18,000 home health agencies in the states, the choices can be overwhelming. How can you know which is the best one for your loved one?
The first thing to consider is what kind of assistance is needed. There are home health agencies that specialize in medical assistance such as physical therapy, skilled nursing, and providing medical equipment. Other home health companies provide assistance with basic personal care such as bathing and dressing along with running errands and light housecleaning. You must determine what your parents needs are.
The term skilled nursing encompasses a variety of things. These include wound care and dressing changes, catheter care, colostomy care, medication setup. Basically, it is any service that needs to be provided by a registered nurse or a license practical nurse under a registered nurse’s supervision. Sometimes this can be determined by the patient. For instance, a diabetic person would need skilled care for trimming their nails.
Personal care also includes a broad range of services. Listed in this category are bathing and dressing, preparing meals, running errands, teeth brushing, patient transfer, incontinence care, laundry, light housecleaning, respite for family caregivers, and much more. It’s important to check with each agency to see which services they provide as this can vary greatly.
Once you know what is needed, the next step is to determine how much time a caregiver needs to spend in the parents’ home. Agencies range from one hour visits to twenty-four hours of care. It is possible that a person will never go to a nursing home no matter how dependent they are. It is often least disruptive to gradually introduce a home health aide into the home first by performing non-personal services such as housecleaning, cooking or running errands. The loved one may better accept the assistance and often will come to depend on the aide the same way they have their child. It is important that they know that they aren’t being abandoned; instead this will give you both more time to enjoy your relationship.
After you decide what kind of care is needed, how do you choose which home health agency to work with? Unless you know someone who has personally used an agency, you will have to do research. Agencies have received a bad reputation in the past of taking advantage of their patients. Recent years have seen a change in that reputation by having more regulations and better controls to prevent neglect and abuse from taking place. Always check with the Better Business Bureau for any complaints against the agency. Of course, not all complaints are reported so that is not a guarantee. Also talk with your parent’s doctor for a recommendation or even a hospital social worker.
Also, during this time, you need to figure out who will be paying for the assistance. Different agencies accept various types of payments. If the service is required by a doctor, Medicare often will pay for a period of time. Medicaid also pays for some home health care, if the patient meets the requirements. More people are getting long term care insurance and it may pay for the care needed.
Once you have narrowed the list down to three or four agencies, start making calls. Have a list of questions to ask. Try to limit the questions to the highest priorities or initial requirements. You can ask more indepth questions in person later on. Some sample questions are:
1. What kind of services do you provide and for what periods of time? With this question, you should consider not only the care you need now but what might be required in the future. For instance, your father might only need assistance with fixing meals and grocery shopping but in the future he might need help with bathing and dressing.
2. Are the caregivers employees of the company or are they private contractors? This is important because if they are private contractors, you will be required to pay taxes on them. If they are employees of the company, then the company is responsible.
3. How are the caregivers screened? Many companies do background checks and some require drug tests and driving records. For your piece of mind, you have to be comfortable with the person coming into your family member’s home.
4. What if a caregiver calls in sick or doesn’t show? Will they send a substitute?
5. Do they have an on call service? This is important so that if there are problems after-hours such as a worker doesn’t show up, you can contact someone.
6. What is their process if you have a complaint against the service? Sometimes personality conflicts arise between the patient and the caregiver and you need to know that this can be resolved.
There are many other questions that you may want to ask during the in-person interview but these will give you a chance to decide if this is a company you can work with. A home health care agency can provide relief for the family caregivers if it is a good fit, but the wrong company can add to the problems.
Once the initial phone interview is complete and you decide on a company, you will have a meeting with the company’s representatives where you will sign a contract. You should receive a copy of the patient’s bill of rights at that time. It will show you what you can expect from the company.
Choosing care for a loved one is a major decision which can be overwhelming but knowing in advance what to expect can make the choice less traumatic for both the caregiver and the family member. It can allow you more time to enjoy being with your loved one.