Please share some experiences if you have any as well. Any information will help.

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I've worked with several home health care agencies, for my mother, sister and father, over a period of about 18 years. Most have glitzy brochures. You'll need to get behind the marketing blitz and to the real basic issues.

But I'm assuming that you want health care, not private duty, which doesn't provide health care but rather home assistance, such as light duty cleaning, meal prep, etc. There's no PT, OT, Speech therapy or nursing with these services.

These are some of the questions I ask of home health care agencies:

1. How long in business, who are the owners (medical or business), type of therapists (specifically speech). Are the nurses RNs or LPNs? Are the therapists assistant therapists or therapists? (I ran into this issue this summer, when I encountered an agency that provided an RN only for initial assessment, a practicing RN for the first visit and an LPN for interim visits, with the RN returning every 2 weeks (something like that; I don't remember for sure).

Therapy was the same: a physical therapist did the intake, then a therapy assistant came for 2 weeks, then the PT was back for an interim assessment.

This was the first time I'd ever encountered this convoluted and disjointed practice.

2. Do they provide the same therapists and nurses, or do they have a "night before" assignment policy in which whoever is available takes the assignment? This is a disaster, as you never know who's coming, and it becomes a stream of strangers coming and going. It's disconcerting and confusing, both for me and for my father. This lasted about a week before I switched agencies to one that wasn't a revolving door of people.

3. Do they have "advance" people, i.e., what I'd equate to marketers who have offices in hospitals or frequent rehab facilities, making the existence of their agency known to discharge planners and social workers? Some of these that do are more sophisticated in management than other agencies. There's more professionalism.

4. How they handle a situation in which an individual likes to keep things, not hoarding specifically, but just Depression Era saving? I always ask specifically not only how they would handle this but if they contact APS?

5. How do they handle a situation in which a therapist and patient do not interact well?

6. Now I want to know what their philosophy is on some specific things, such as whether or not a back brace would be helpful for someone with advanced osteoporosis.

7. What recommendations they might make for safety, such as ramps, more handholds/grab bars, etc.

8. Whether they'll contact me or my father for appointments and discussions of progress.

9. Will they provide printed exercises to be done after they're through?

10. New, based on the last and this year:

Do their social workers require that personal financial information be revealed? Two of them incurred my wrath when they insisted on access to specific personal financial information so they could "recommend" solutions. I suggested, at first politely, then more strongly, that they provide me with parameters of financial qualification and I'd make the determination whether to pursue specific options (which I'd already done over the last years) but I provide absolutely no specifics of financial data.

One became irate and insisted that she needed to see my father's financial data so SHE could determine what to recommend. I refused, she threatened; I reported her to the advance person and indicated that I wouldn't hire their agency again if she was involved.

Over the years, I've found the Visiting Nurses Agency to have very professional, personable, concerned and involved therapists and nurses, some who've gone out of their way to be helpful. Unfortunately, in Michigan, some of the VNA offices have gone from nonprofit to for profit status, and they have literally disappeared from the home care community.

I haven't yet even been to contact these reconfigured agencies. I can't get to anyone when I call, wind up in tiered, dead end, voice menu. Messages aren't returned, and eventually I just gave up.

My guess is that in the competitive home care market, an aggressive company is the one that absorbed them, and is allowing them to literally deteriorate and go downhill. It certainly eliminates some competition. And in fact there is such a company in this area, one with expansion plans.

If you're referring to private duty though, that's not real home health care, and involves a whole different set of issues.
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I hope you get some suggestions. I've never done it before, but, I might start with seeing if his insurance will cover it. Maybe, there's a list of providers.
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They should be licensed, insured and do background checks on all employees. That's minimum stuff. Cost will depend on needs. RN? LPN? CENA? Bath aid? They usually have a 3 hour minimum visit.

Many are large franchises but you can find some locally owned as well.
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