Winter 2009
How To Be An Informed Home Care Consumer

There is a great deal of confusion about home care services. We receive calls from family members wanting to know: Who pays for services? What can a home care worker do and not do? What should you look for in a home care provider? This newsletter is dedicated to explaining the different kinds of home care and how to select the services that are right for your family member or client.

What Is Home Care?

There are basically two types of home care: Skilled services and Private duty services.

Skilled Home Care Services: are comprised of health care services provided by Licensed professionals: Nurses (RN, LPN), rehabilitation therapists (OT, PT) and social workers and dieticians. The para-professional home care services are provided by certified home health aides. Most often the professional (skilled) home care services are deployed after a hospitalization or an acute event covered by Medicare, or private insurance. These skilled services are generally time limited and focused on rehabilitation.

Private Duty Home Care: focuses on long-term care needs and is often used once the skilled services have been discontinued. This type of home care is paid for out of pocket or by long-term care insurance (see newsletter on LTC Insurance on our web site) or the Medicaid program for people of limited means. There are two types of Private Duty home care providers: The first is an agency which provides companion/non-medical services and is licensed by the state as an Employment Agency. The second type of agency is a Health Care Services Firm, which can provide companion and hands-on patient care. The Health Care Services Firms must employ Certified Home Health Aides (CHHA) and provide a Registered Nurse for supervision of the aide and client.

The remainder of this newsletter will focus on private duty home care services, where there is more choice and less regulation, and therefore, a greater need for informed consumers.

What can you expect from your home health aide / companion?

Prior to the worker starting in your home, a representative from the agency (an RN if it is a health care services firm) will conduct an assessment of the client’s health status and needs. Based on this assessment and with input from the family and client, a care plan will be developed. This care plan will serve as the job description for the home care worker.

Companion/Non-medical (Employment Agency) staff can perform the following tasks for the client: meal preparation, light housekeeping, transportation (if agency allows), grocery shopping, companionship, medication reminder and laundry. This type of agency is NOT allowed to have the worker engaged in any hands-on client activity (see below).

Certified home health aides (Health Care Services Firm) can perform all of the duties listed in the above paragraph as well as hands on care such as: assistance with bathing, dressing, toileting, physical therapy exercises, and wheelchair transfers. An RN, who conducts a mandatory every other month home visit, supervises the aide.

To avoid any misunderstandings, remember that the home care worker is hired to serve the client; this means that their responsibilities must be directly related to the client and the client only. It is inappropriate to ask the worker to cook, do laundry or clean the house for the benefit of other family members. As with all human relationships, it is important to have clear expectations and boundaries and to keep the channels of communication open.

What to look for in a Home Care Company

The first essential question to ask the home care company is: Are the home health aides/companions employees of your company? If the workers are employees, the agency is paying employment taxes, worker’s compensation (in the event the person gets hurt on the job) and conducting background checks and checking references. Beware of any company that requires you to pay the worker directly and then send the agency a separate check. Companies that use this practice are treating the worker as a subcontractor and are not paying taxes. You therefore, are considered to be the employer.

The second question should be: What kind of supervision and support does your company provide? A nurse, prior to services starting, should complete an assessment of the client and an individualized care plan. You should also ascertain how the worker and the client would be monitored to address changes and ensure quality. Health care services firms are required to conduct home visits every other month. Ask if a nurse is available for non-emergency consultations or medication management. (Note: home health aides are allowed to remind clients to take medications but cannot pour medication.) Ascertain the agency’s availability for evening or weekend medical or scheduling emergencies. The agency should have 24/7 availability. The agency should also provide coverage in the event the worker is unable to work the established schedule for your family member.

Frequently Asked Home Care Questions

Should I hire a home health aide privately rather than through an agency?

This is a complicated question and it depends on how involved you want to be in the employment issues of the home care worker. If you hire the worker directly you must: check references, do a criminal background check, set up payroll tax deductions and provide supervision and scheduling. In our experience, most family members have difficulty in managing these responsibilities, and if neglected they can consume time, financial, legal and emotional resources. While you may save some money paying privately, you may pay in aggravation. We advise families to spend time with their loved ones and leave the business of home care to the agency.

Can a certified home health aide give medication and other treatments?

A certified home health aide can remind and supervise a client taking their medication. In most cases a family member or a nurse will set-up a medication box for the client and the aide will monitor and remind the client to take the medication. An aide is not allowed to take the medication out of a pill bottle and give it to the patient. We often get questions about clients who need to take insulin for diabetes. The aide is allowed to check blood sugar levels with a glucometer and to hand the client the insulin but the clients must be able to administer the injection on their own. A certified home health aide may not insert a feeding tube or catheterize a client; these are activities that require a nursing license.

What can I expect from a live-in home health aide?

A live-in certified home health aide will provide personal care (bathing, dressing etc.), medication supervision, grocery shopping meal preparation, companionship, home management, laundry, recreational activities, and assist with physical therapy and exercises. A live-in is not a house cleaner but will pick-up and clean up after the client. All of these duties are specific to the client and do not include spouses or other family members unless the rate of reimbursement has been adjusted to accommodate serving a second person.

As the name suggests, a live-in is in the client’s home 24/7. It is important to note that labor laws regarding overtime still apply. A live-in person is available to the client on an intermittent basis throughout the day for eight hours. They are not expected to work around the clock.

A live-in will typically work 2 or 3 weeks and then take off 4 to 7 days off and it is the agency’s responsibility to provide coverage. The family is responsible for providing a private sleeping arrangement, and food (the aide is responsible for any specialty items).

A live-in can be an economical solution when constant supervision is not required and a 24-hour presence would provide peace of mind.