How to Choose the Right Home Care Provider
By Coker Day
In the last part of our series on home care
services, we discussed the difference between skilled and custodial home care
services, which is good preparation for this month's topic, the selection
process. Why? Because it helps to know what kind of care you need before
choosing the right home care provider for yourself or a loved one.
To
begin with, those needs are typically based on a physician's, case worker's or
your own assessment of what's needed. If both skilled and custodial care are
required, you could work with an agency that provides both, or just as easily,
hire an agency with certified nursing assistants that works directly with your
physician and/or nurse case manager. There are also individual or independent
caregivers with nursing backgrounds who may offer both kinds of care and who
work with other nursing professionals.
Depending on the scope of
services required, your first decision may be whether to go with an agency or
an individual, since the selection process for each will be quite different and
require very different time commitments. (See September's Senior Sun article on
the pros and cons of individuals vs. agencies.)
Spelling Out
Services/Fees/Hours When interviewing prospective home care agencies,
start by asking if they provide free estimates (surprisingly, not everyone
does). At the top of most people's list of the questions are fees: they may be
listed as hourly, daily and/or weekly. Ask if there are minimum and maximum
hours of service and if there are limitations as to the tasks and/or times of
the day when services are provided.
Some agencies provide a customized
plan of care, with all of the services, duties and responsibilities, including
financial arrangements, outlined in detail. Having a care plan can help you
keep track of the care being delivered to ensure it's what you expected and/or
what the doctor ordered. A care plan is especially important to adult children
who live away from parents for whom they've contracted services. On the other
hand, having a plan and executing it are entirely different things.
That's why at DayBreak, we developed a remote computerized system that
allows us to keep tabs on our caregivers using the clients' own telephone.
Caregivers simply dial into our computer and are automatically checked in and
out for the day. The system also helps us provide substitutes (often our own
supervisors), if the regular caregiver can't make it in one day; it matches
special needs with unique caregiver skills, as well.
A home care
company may or may not offer a contract, but before you sign anything, make
sure you carefully review it. For example, make sure you understand who will be
providing the care and whether they are home care specialists, licensed
practical nurses or registered nurses, and who will be supervising the
caregivers (preferably some type of nursing professional). With an individual
caregiver, chances are you will be the supervisor, so ask yourself if you'll be
comfortable in that role.
Third Party, Independent Quality
Measures Although many states require home care agencies to be licensed,
South Carolina is not one of them. So one way to judge the quality of an agency
is to ask what kind of training it provides caregivers and how often they
receive subsequent training to maintain their skills. You might also ask
whether the agency's caregivers are "W2 employees" or "1099" independent
contractors. Your preference should be for the former, since they are more
likely to have liability, workers compensation and other forms of insurance
coverage that contractors seldom have.
Among the most important
questions to ask: Are caregivers bonded? and What kind of background checks,
tests and screens are conducted (e.g., law enforcement, personnel, drug and
history of infectious disease)? You'd be surprised how many agencies don't
conduct criminal background checks and drug screens.
Find out how long
the agency has been in business, or if an individual, how much experience he or
she has in providing home care services (both on her own and working in a
facility or an agency). References for both individuals and agencies can
include health care professionals who know them by reputation and consumers who
have used the service (or know the individual); check every one
thoroughly.
Also, find out if any complaints have been filed with the
Better Business Bureau, state consumer protection agency or state attorney
general's office. On the positive side, another quality measure is whether or
not the agency staffs its phones 24 hours a day, in case you, your loved one or
a caregiver needs help for any reason.
To some, this may seem like a
long list of issues to consider. The truth is, I've barely scratched the
surface here. When you consider that you're allowing perfect strangers into
your home to perform highly personal services, I think you'll agree that it's
important to be thorough and to ask a lot of probing questions.
Of
course, uncertainty can be minimized by using a reputable agency, which can
screen, train and hire professional caregivers on your behalf, in addition to
protecting you against theft and other types of loss. What's more, if the first
caregiver doesn't happen to work out, you can always try another one from the
same agency, without having to go through the hiring process all over again, as
you would with an individual.
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Selecting Home
Care Services: A Checklist
Individual or Agency?
Fees o Hourly Daily Weekly Live-In o Minimums? Maximums?
Limitations? "
Plan of Care? Contract? o Who
provides care? When? Supervised by whom?
Caregivers o
Qualifications … Training/re-training … Background Checks
...Screens/Tests
Individual or Agency?