What NOT to Do When Hiring Home Health Care

Years ago, when in-home health care was fairly new in our area, I had an elderly neighbor who hired an agency to stay at night so the wife of a man suffering from ill health could get some sleep. These people were in their 80s, but were mentally sharp. The woman caregiver was in fair health, but having someone there over night let her sleep better. Or it did until she got up one night to go to the bathroom and saw the worker asleep on the couch. It turned out that not only did this worker consider her night job to be an opportunity to sleep, but she smoked in the house, as well. Needless to say, the agency was terminated.

Shortly after, the man died, but the whole experience left this woman with a bitter attitude toward in-home care. In-home care is, in theory, what most elders want if family caregivers can't do all the work. And good care can be a lifesaver. I've met some wonderful people who work for agencies providing this service. Many need to cope with disgruntled elders who really don't like a stranger in their home. Others are lucky enough to find an elder who welcomes their company and they enjoy each other.

Either way, there's a lot to consider when you hire a home care agency. With in-home health care, you are letting strangers into your home. So, number one on the list is to go through a well-known agency. This doesn't necessarily mean you need to go through a large franchise, but get references from the agency you hire, and check those references. One reference isn't good enough. Any agency can have someone who was unhappy for some reason, or someone who is thrilled, only to find another person has different feelings. A good agency should give you a number of references.

Don't Assume They Provide Back-up Care

To help you decide on an agency, ask about backup care. One woman I know had to spend her entire Christmas Eve and Christmas Day sleeping on her elderly aunt's couch because the agency they had coming in didn't have backup for the holidays, and the caregiver who was to come got delayed by a late plane. People get sick. They have sick kids. They take vacation. Ask if the agency has sufficient backup staffing for emergencies and other occasions.

Avoid "Revolving Door" Caregivers

Next, see if they are diligent about getting the same caregivers to go to the home. Can you imagine a stranger showing up at your door saying, "Hi, I'm here to give you a bath!" Then think about how, once you've finally adjusted to this idea and get used to this person, someone else comes, and then again, someone else. Strangers, all of them. It's no wonder an elder gets upset. Agencies can't have one caregiver working seven days a week.

Also, since there are vacations and other times when a different person may need to come to the home, it's good to have elders get used to two or three workers. But an effort needs to be made to consistently send the same personnel. My uncle had eight hours daily of in-home care for quite some time. He had a rotation of three caregivers, all of whom he liked. He liked one best, but all three were okay with him. Occasionally, someone else had to come, as none of the three were available, and he found this very upsetting. But that is life. We were fortunate that he had three good people to help him and the agency did its best to be consistent.

Look for Hidden Costs

One major issue regarding elder care is the cost of home care. When my neighbor, Joe, came home from the hospital after an injury, we got a rather shocking initiation into the then quite new in-home health business. The hospital didn't even tell us we had a choice of agencies and I was really green at the time. I'd never dealt with this kind of thing before.

Joe was used to my daily company, and I continued running over and staying an hour or so each day. But, since the hospital said he needed certain services, we just took it as gospel. The people came. We figured it was part of his Medicare coverage, as no one told us differently.

Know What Your Loved One Needs and Only Get Those Services

Some caregivers were nurses who came to change dressings on his arm, but that was only for a few days. However, people kept coming, and we weren't too sure why. It was "advised" that he have this help. They didn't do anything I couldn't do, except someone slept there, which he hated. Joe had a personal alarm to call me, and I watched his window lighting at night, so I was very available. Finally, we called a halt to these strangers, even though we still thought Medicare was covering the cost.

Gotcha! Medicare pays for nursing care only. That was a fraction of the bill. Joe had to cough up nearly a thousand dollars to pay for the "custodial" care, the same kind of care that I gave him free. The person who watched TV with him (he was totally deaf and couldn't visit); the person who washed a few dishes, which Joe could still do, or I would; the person who made his bed – all of that was custodial care that Joe had to pay for.

As I mentioned, this was in the early days of in-home care, and the agency was owned by the hospital he was discharged from. I made it my business, after that, to learn what Medicare covered and what it did not. I also made it my business to check out different agencies and not just take the one suggested by the hospital or other medical person.

Understand Tax Laws

One more thing. If you are considering hiring someone who is not employed by an agency, you may find you are responsible as an employer for taxes and for liability, should the caregiver get hurt on the job. Tread very carefully, should you choose to hire outside of an agency. Get the facts you need from your state employment people, check references carefully, and make sure you are covered for worker's compensation and other risks. You may find the most wonderful caregiver in the world by hiring your aunt's best friend who was a nurse. But you also may be looking at a legal nightmare should anything go wrong. You may want to browse the site of the National Private Duty Association (www.privatedutyhomecare.org) for a little advice.

As with everything we do for our elders, in-home care agency hiring requires due diligence on the part of the family. We need to be advocates for our elders. We need to do our best to make sure they are safely cared for. We also need to understand the costs so we know up front what is out-of-pocket and what is covered by Medicare. The rules are in flux at this time, so stay on top of it.

Carol Bradley Bursack

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Over the span of two decades, author, columnist, consultant and speaker Carol Bradley Bursack cared for a neighbor and six elderly family members. Her experiences inspired her to pen, "Minding Our Elders: Caregivers Share Their Personal Stories," a portable support group book for caregivers.

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