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As some of you know, I've been looking for a private duty company to provide nonmedical home care, focusing on dysphagia support, with some minor housekeeping tasks. I'm amazed at what I'm learning, and am also becoming discouraged because I feel as though there are a lot of agencies with minimum qualifications but an intent to get as much as they can from the family. I'm beginning to realize this might be a real boon for companies that want to target the senior population, and which feel they have the upper hand b/c they're providing the services.

So I'm interested in other's experiences, especially on these issues:

Fee for "assessment" ranges from $75 to $200. This includes "assessment" of the patient, ADL needs, what they feel is necessary, etc. I find $200 to be pretty steep.

Deposits; most require 2 weeks deposit, which isn't held in an interest bearing trust account and is allegedly either refunded on termination of service or used as the last 2 weeks of service. If hours are changed or increased during the term of care, the deposit is increased accordingly. Has anyone had any difficult getting their deposit returned?

Although these agencies have highly qualified staff (according to their websites), they would need training on pureeing food for dysphagia management. I would be training staff, apparently being paid for and their hourly rates charged to me. Essentially, I would be paying to train them. Maybe I should plan to hire out my services to train their staff?

Many are franchise operations, but the individual ones have authority to determine whether or not to take charge, which many don't. They require weekly or semiweekly payments either by check or cash. No way do I pay anyone in cash!

Background checks can be done to state level, or more thorough ones to the federal level. If only to the state level, I wonder how they might identify someone like some of the scammers I've read about here who move to different states. I'm not particularly comforted by this.

Service agreements are onerous, sometimes restrictive, and always in favor of the company to the point that there's no balance of equality of standards or obligations. E.g., one company requires several days written notice of termination but it can terminate w/o any previous notice at all. Has anyone ever had to invoke contract provisions, or been penalized for alleged violations of terms?

Liability of workers is capped, in one case at $1,000 for all incidents, not only for the workers but for the staff of the company which doesn't even participate in the home care work. In another, liability doesn't exist at all.

Have any of you ever taken action against companies you hire, for whatever reasons? It might be that a really good company isn't going to generate any liability, but I don't like waiving recourse before care even starts.

Any other concerns, advice, suggestions for an equitable relationship with a private duty firm?


Thanks for any thoughts, suggestions, recommendations, etc.

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GSA, VNA was one of my first choices, but I found that things haven't changed since a few years ago when I learned some of the VNA groups had been become for profit operations. My first experience with them in that new corporate form was not favorable. The wonderful cooperation and supportive attitude was gone, replaced by an "it's not my job" attitude.

Specifically, the representative refused to contact a doctor regarding a script, required b/c I had interviewed 2 care agencies when Dad was in the hospital, but couldn't decide as they were both impressive. Then n suddenly I was advised Dad was being released that Friday. The hospital discharge planners advised that I only had certain number of hours to retain a caregiving agency. After that a new script was required. I missed the deadline.

The scripting doctor was out of town; his office staff just "left a message" on his desk but wouldn't ask his partner. (I complained about them to the doctor later).

After getting the "not my job" attitude from VNA, which refused to contact the doctor, I contacted one of the two agencies I was considering, they got to work, contacted the office staff, persuaded them to get the partner to sign, and we had a script in a few days.

About 10 days later (I have a fairly good memory on that) VNA called and asked if I was still interested in hiring them. Ha! Fat chance!

I did contact more VNA offices this time and learned that in our area some of the offices chose to remain nonprofit (and were such a pleasure to deal with) but they didn't offer private duty staff. Bummer.

Another disappointment was learning that the most progressive hospital in the tri-county SE Michigan area had home health care, but that it wouldn't serve Dad's area. It also had a maximization policy: serve one county only, trips to clients take less time and more clients can be served and more money billed to Medicare.

That was a real disappointment; it's a top notch hospital and I expected the home care staff would be as well.

Back to the drawing board (or rather to the "calling" tasks.)

I do think VNA made some suggestions but I'd have to check my call records to see.

Thanks for the suggestions.
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Garden, have you thought about Visiting Nurses Association to suggest agency? It's not quite skilled nursing but they might also have some ideas and I believe they are nonprofit.
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FF, thanks to Ashley who added space between paragraphs, so the post is now readable!

GSA, you offer some interesting insights. I don't recall ever having been given an estimate by a mechanic, and in fact wish I had gotten them when I had my Jetta. At that time it was a "foreign car" and the repairs were expensive, even at a foreign care specialty service.

I have gotten estimates for body work, but that's for insurance purposes. For the last decade and a half I've used the same mechanic, so I've never been in a position to want estimates from others as this company is really top notch and I wouldn't go anywhere else.

I've been thinking over the estimates I've gotten for home repair, and they've all been free. Perhaps there's more competition in my area and home repair companies don't charge for estimates b/c of the likelihood someone else won't and they'll lose work? I do pay service fees that are included when my plumber comes; I expect that.

The most expensive house repair I've had was when I had my roof reshingled and the garage sided, but I already had checked out the contractor, gotten a reference, and knew I would go with him.

What I have found is that contractors won't even come over if the area is outside of their service area, and many of them define that quite narrowly.

You've raised an interesting point though. I'm going to be wandering down memory lane for awhile and try to remember if any contractor ever tried to charge me a fee for an estimate.

It's interesting that people use assessments to apply for other benefits. I never thought of that, but other than VA benefits, no others apply. Actually, the one agency I did have come for an assessment tried to sell us a different medic alert service, then made a pitch for nonrelated house repair and lawn car work!

My approach might be different from that of other families though. I do extensive research before I even call anyone, for any service. I don't want to waste my time either, which is why I also use a checklist when I call, think over the call, and call again a few days later with further questions. I want all issues identified and addressed before I spend time interviewing someone while my father struggles to hear what they're saying.

You've given me food for thought. This is why I wanted insight from others.

As I reread one of the contracts for an agency with which I'm very comfortable, I can see why some of the provisions are there. Prior to that, I thought the contract was really quite onerous.


Thanks for the thought and suggestions you and FF have offered. It really helps add perspective to our situation.
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GardenArtist, I remember your original posting was all nicely spaced out, very easy to read, as are all of your postings.... kinda looks like the software could have messed it up :(
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Garden, I have a friend who works in home health care. The reason for the assessment fee is the same reason that mechanics will charge you a "checkout fee". I've seen it where I work - "what's wrong with my car? Oh, I'm not fixing it here. Too expensive". But now I've got a list of parts and problem description that I can give someone else to repair cheaper using YOUR dime for mechanic's analysis and labor. My boss gives a break on the check out if you get the repair done here. A/C companies, plumbers, they all charge you a fee if they come to your home to evaluate a problem, and you don't always get it back even if you choose them for repair. There are labor and travel charges that have to be paid for; and its costs that can't always be recovered on increasing another patient's bill - you wouldn't want to pay for someone else's evaluation time, right? Lots of people are shopping around for home health care. Some are using the assessments not to get and pay for private care, but to apply for state or long term insurance benefits using the agency that sent its person out and not pay the agency for the evaluation or use its personnel. A good agency will refund you the fee or find a way to discount or reimburse you for it later. It's the abuse of "evaluations" that has led to the fees. Honestly, it's why most accountants won't evaluate a tax return or do the initial work without getting a contract. You have a trained professional that you are paying to go out and do assessment - if you don't get hired, who pays for that?
Yes, there are people who abuse it - there are banks who abuse fees because the interest on accounts is so low. If you want a "reputable agency" - do what a lot of folks do with mechanics - ask a friend. Check out with church members. Make friends with a social worker or volunteer a at a nursing home and ask their staff - they know most of the agencies. Find a stroke survivor caregiver's group - family members there probably have a reference. High need patients that want to stay home will require high need care that won't come as "cost-effectively" as turning them to face the light or microwave and put food on table. Most at-home patients are moved to nursing homes (as you found) when they need this level of care. The nursing homes train staff in bulk; you are looking at 1-2 folks that may never have another patient with the issues to care for. The agencies are businesses - they are not going to spend money they don't have to. My son's needs as autistic person were best met by me training professionals at his school and I did most of the legwork for transition. I had to do the heavy lifting if I wanted my son kept out of Short of institutional care, and he has done well. I'm sorry that your father's deteriorating condition leaves both of you in this position, but the care will be more intensive and expensive as his condition changes. This is why my MIL is in assisted living now - catheter and Parkinson's related eating issues.
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First of all, something changed the format of my OP and everything is now run together. All the paragraph spacing has been deleted and reading is difficult. And, it's just a mess!

If the Admins can't correct it, I'll repost it.


FF, thanks for taking the time to respond.

I found the assessment fees to be offensive, and from now on will ask about the onerous conditions first so I don't waste any more time.

Still, more and more I think these companies have moved in on a lucrative segment of elder care and are exploiting it. Not sure what I can do about it except let these companies know I'll take my business elsewhere.

Pressure to find help quickly also gives them an edge. I'm glad though that you were able to find a good agency right away. I think that what I'm experiencing now isn't providing any relief, rather it's complicating it.

I'm seriously thinking of alternatives to these private duty companies, but going private and hiring individuals w/o coverage or backup isn't a good option either.

I can understand an admin fee, but it was a one-time fee, so that's not as bad as these assessment fees, including if the level of service changes.

As to backup, I've never yet been told that a staff member would fill in. And some of the answers I've gotten on this as well as other issues don't really provide insight into whatever plans exist.

There's got to be a better way of finding home care help.
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GardenArtist, I was surprised that you found some Agencies wanted to charge an "assessment fee". Imagine if other businesses did that to give an estimate on fixing something or a Realtor requesting a fee to see if they wanted to list your house :P

For getting an Agency, my Mom was in the hospital and the Case Manager gave me a list of Caregiving Agencies, so I called two of them. One called me back within 15 minutes, and I was in a panic as Mom was being discharged from the hospital, etc. They worked with me, came out to see my parent's home, interviewed me and Dad, and in turn I interviewed them. Thus, I only talked to one Agency and decided to give them a chance.

I did have to pay $100 Admin fee to get my parents into their system, paperwork, copies of POA's, etc. and for the Agency to set up automatic pay from my checking account. I used my account because Dad would drag his feet on putting enough money into his account, I didn't want any bounced checks.

The Agency I used was very cooperative when I had to cancel service after 3 days... my Mom wanted NO part of having any caregivers in her home. Nope, nada, never.

Then 2 weeks later, I needed the same Agency to once again help out around the clock when my Mom fell and wasn't able to return back to home, and Dad couldn't be left home alone as he was a fall risk. They were more then happy to work with me.

At the beginning, when a caregiver wasn't able to make his/her shift, one of the Staff members would come over to fill in. It took some time to get the schedule in place where the same people would come during the first shift [Dad picked who he liked the best], second shift and third shift Dad was just happy to have someone in the house.

It was like finding gold at the end of a rainbow... right place at the right time. Had the Agency for over a year for my Dad :)
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