Q My father recently was released from the hospital. At a moment’s notice we were told he was coming home and would need care. The immediacy was created because a family member insisted my father be released quickly. Because of my father’s poor eyesight and fragile state, we immediately started to look for home care. We didn’t know if we should work with an agency or hire someone independently. We tried the agency route. It took us three tries to get one that met my father’s needs. In retrospect, what should we have considered?
A Dear J.L.:
You’ve raised a good question.
Your first contact should have been the hospital’s discharge planner, which would have a written plan of care for your father and some agencies to call. You could have chosen a CNA (certified nursing assistant) from an agency or someone who works independently. The hospital also should have a list of home care providers.
Let’s compare two options.
USING AN AGENCY
Advantages: The agency takes responsibility to screen, train and supervise the individual. If something goes wrong, such as the home helper is sick and cannot work, the agency provides a backup. Also, the agency takes care of tax withholdings and other responsibilities of being an employer.
Disadvantages: You likely will pay more since the agency needs to cover its overhead plus more. Turnover often occurs, making it difficult for the older person to continually adjust to a new care provider.
Advantages: The cost is likely to be less. If the aid is good and you like the individual, a personal and consistent one-to-one relationship can be developed.
Disadvantages: You are responsible for screening and checking references. You also are responsible for working out problems. If the person you hire becomes your employee, you must meet the legal obligation of an employer, such as withholding and reporting income taxes and paying Social Security taxes.
WHAT TO ASK
Here are some questions to ask when working with a home care agency that should be helpful in evaluating the agency or even an individual:
• How long have you been serving this community?
• Do you have literature that explains your services, eligibility requirements, fees and other sources of funding?
• How do you select, screen and train your employees? Do you provide ongoing training?
• Are nurses or therapists required to evaluate the patient’s needs? Do they consult the physician or family members?
• Will you provide a replacement if the person cared for finds the original aide incompatible? Will there be a replacement if the scheduled person does not show up?
• Do you include the patient and family in developing the plan for care?
• Do you monitor the quality of service? How is this done?
• Do you provide a bill that lists all of the services that were given?
• Who is my contact person for questions about care? For questions about billing?
• What motivated you to choose this position as a career?
• How do you handle emergencies? Are your caregivers available 24 hours a day, seven days a week?
• How does your agency ensure patient confidentiality?
• Will you be able to determine if my family member needs medical home care that requires a doctor’s order and a plan of care?
• Are you clear on what you can and cannot do?
Although not typical, some personal behaviors may require coaching.
Years ago when my husband was ill, I wrote the following to a new care provider: “Please respect the physical environment of our home. If items such as supplies or food are used up, note it so they can be replaced. Also, since some previous nurse assistants have unintentionally written with a ballpoint pen on our leather chairs, please use pencils when writing notes and be careful. If you have the need or desire to bathe, please wait until your shift is over and bathe when you return home. One nursing assistant took a bath and washed her hair during her evening shift.”
Mutual respect among the nursing assistant, patient and adult children is imperative. Saying thank you and showing appreciation is equally important.
Certified Nursing Assistants have experience and can help problem-solve. It is valuable to ask for their input.
J.L., I hope you won’t need such services again. Given our aging society and families, it’s likely that many of us will rely on some type of home care for a loved one. Consider creating a file for this column and label it “just in case.”
And thank you for your good question.
Send emails to Helen Dennis at firstname.lastname@example.org, or go to www.facebook.com/SuccessfulAgingCommunity