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When Caregiving is Not Enough - Finding Good Homecare

Wednesday November 07, 2012

Leah Pavela, LCSW

Today's Caregiver - Home health care, also known as domicilary care, is care provided in one’s own place of residence. This can include skilled nursing services, speech-language pathology, physical and occupational therapy, home health aide services, as well as medical social services and the provision of durable medical equipment such as wheelchairs or walkers for use in-home when ordered by a licensed physician. Anyone who has ever looked for home-based care for a loved one comprehends what a daunting experience it can be. Browse through the “home health agencies” section of the phone book and there are an overabundance of listings—some counties have over 200 home care agencies, with new ones opening, closing, and merging weekly. With so many choices, one might assume that the choice would be easy, but in fact it is not. What follows are some tips to consider when considering homecare for a loved one:


Find out if the agency you are considering is licensed and bonded. In the case of a home health agency, this means that the quality of care being provided has been surveyed/accredited by an outside accrediting agency such as Medicare or the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). The agency should also be licensed by the state in which it operates. Agency outcomes can be researched by going to www.Medicare.gov and going to their new “home health compare” tool, or calling the Medicare helpline at 1-800-MEDICARE.


In terms of employees, confirm that all home health employees (nurses, physical therapists, home health aides, and social workers) are certified or licensed in the state they are working (regulations may vary by state), in order to ensure they meet minimum requirements to perform their duties. Also important is to make sure that the agency does screenings of employees to ensure that not only do they not have a criminal background, but that they are free of communicable diseases which could affect the compromised immune system of a patient.


Ask what policies are in place to ensure patient confidentiality, and find out how far that policy extends. Many caregivers, particularly ones who arrange for assistance long distance, find themselves frustrated after they arrange for care for a loved one, only to be told that due to HIPAA regulations, the agency cannot provide information on their health status. At the outset of care, make sure of what the company’s policy for communication is and ensure that it is noted who may and may not receive information about the patient.

Kathy R. found communication a problem with one home health agency while caring for her stepmother cross- country. She faxed a durable power of attorney right to the home health agency but “they still wouldn’t tell me anything!” She states that “especially when you are working from a distance, your hands are tied when there is no communication.”


For most people, it is a far better choice to choose a “full service” agency which provides for all their needs (nursing, home health aide, physical therapy) than to pick and choose services from different agencies. This ensures that caregivers are free to communicate amongst themselves on a patient’s progress and work collaboratively to resolve any issues, rather than if they are all from different agencies and forced to stab blindly at problems as they arise.


Most patients fare better when they see one or two familiar faces rather than a steady stream of strangers passing through their lives. Find out if the same person will be caring for your loved one, or if they will see a new person on a continual basis. Having one or two familiar caregivers is particularly helpful in the case of people who are confused or frail, as this helps both the patient and caregiver get used to a routine. It also helps the caregiver know what is “normal” for a patient and what is not normal and warrants a call to the doctor. Also important to find out is what will happen should the regular worker call in sick. Will the person be forced to wait for assistance until the next day? Will a substitute come out at the same time? Will the person have to wait for hours until another worker has time in their schedule?


Find out what the procedure is if there is an emergency. Is there always someone on call? Will a patient need to wait until the next business day to speak with someone should an emergency happen after the regularly scheduled service is performed? A good agency should have someone on call 24 hours a day, seven days a week, so urgent matters need not wait until the next scheduled visit.
FINANCIAL RESPONSIBILITY – A reputable agency will not hesitate to address the patient’s financial considerations and should provide the patient/caregiver with a written statement explaining what is/is not covered by insurance/Medicare, and what services the patient will be responsible for out of pocket, if any.


Check with friends, your physician, ask people at your place of worship, or attend a support group and ask which home care agencies others are using. One of the best ways to assess how an agency performs in the home is to look past the glossy brochure and ask people how they feel about the service that has been given to their loved ones. Chances are that good or bad, people will be happy to share their experiences.


Many people who look for home care erroneously assume that if their loved one needs assistance in the home, Medicare will cover the service. This is not always the case. Medicare limits itself to “reasonable and necessary part time or intermittent skilled nursing care and home health services,” and does not include 24 hour care, services which are limited to “homemaking” services, assistance with transportation, or companion services. Unless a person has a long-term care insurance policy which provides for these services in the home, home care can be cost prohibitive. Although most people prefer to “age in place,” there are times that due to financial resources and the availability of finding good, reliable, continuous care, that an assisted living community may be a better choice than in-home care, both financially and for the assurance of the safety and health of a loved one.

As one popular commercial for menswear states, “An educated consumer is our best customer.” There is possibly no arena in which this is truer than in the search for good, reliable home health care. Ronnie Thomas, who is a part owner/administrator for a home health agency in Broward County, states that when a person is considering home health care for a loved one, one should make an informed decision and weigh all the options. She believes that first and foremost to remember is that the services the patient is receiving is paid for by insurance (usually Medicare) and since this is money the loved one worked hard for and paid into the system, they are entitled to and deserve good, quality care which puts the patient’s needs first, out of the system. “Attentive, kind, quality care from committed professionals who involve the family as much as possible,” are things she believes should be insisted on. Kathy R. believes the same. “Compassion and good communication between caregiver, patient, and the home health provider are paramount,” she states, and although she has had many sleepless nights worrying about her stepmother’s health, she knows that the home health provider she now uses provides her with one less thing over which to worry.