FAQs on Home Care

You Asked, We Answered

We asked the members of the CAHC team to discuss some of the top issues and concerns that families should address when choosing a home care agency. The following insights and advice are based on many decades of their collective experience in the home care field. You can scroll down as you read or CLICK on the questions

There are typically two scenarios when home care services
are needed. The first scenario is when someone has a stroke, accident, or other
type of acute medical episode and needs home care for a defined period of time
after a hospital stay.

The second scenario occurs when someone gradually becomes
ill or frail, and it becomes obvious they need help in the home.

In the first scenario, typically the family can speak to a
hospital discharge planner, nurse case manager, or social worker while the
patient is still in the hospital. These professionals can assist you in setting
up services for the short term through an appropriate source from a Medicare
certified provider. You should also talk to the physician about coordinating
care after the patient is discharged from the hospital.

Unfortunately, families sometimes get very short notice
about the patient’s discharge and are overwhelmed about the type of care that
may be needed at home. So, it is important to be proactive about getting the
discharge planning help you need. The hospital may suggest a few home care
providers, but they generally cannot suggest just one or “the best
one” if asked.

In the second scenario, our listing of CAHC accredited agencies in good standing is a good place to start. But before you call, you need to determine what your care needs are and any other considerations, like language, that are important. That way you can select an agency whose services are a good fit for your situation. You can make the arrangements for care directly with the agency.

We strongly recommend that you use the CAHC website to get a list of accredited agencies that service your county. Click the “Home Care Providers” tab at the top for our listing of accredited agencies. These agencies are required to follow federal, state and local regulations.  Agencies or ‘freelance’ home aides that are not accredited do not meet the same standards of professionalism, safety, or quality of care.  Depending upon your State, such “freelancers” may be operating illegally.

If you are entrusting someone to perform home care services for a family member, you want to be sure the person entering your home is thoroughly screened. While accreditation is not a guarantee of employee performance, it provides an important safeguard for home care clients.

Homemaker-home health aides and nurses employed by CAHC-accredited agencies have been interviewed, have provided references, and have all current licenses or certificates as required by your State.

Screening also includes an initial physical examination and screenings for tuberculosis and other diseases.

In addition, accredited agencies are required to supervise their homemaker-home health aides and nurses. They need to ensure that aides, LPNs, and RNs delivering home care have the necessary skills to take care of their patients. Freelance agencies may not have this level of supervision. Homemaker-home health care aides from accredited agencies are supervised by an RN, who visits the home to establish a care plan. The patient and family participate in the development of the plan of care. The RN then supervises the aides to ensure the plan of care is followed as it should be. Again, this may not be the case with a “freelance” agency.

Home care is a very specialized area of healthcare. The staff at CAHC are home care experts who try to ensure that agencies deliver on their promise of service, meet industry standards, and follow best practices for care. We pride ourselves on being the eyes and ears for the home care industry.

You can begin by determining if the person needing home care is eligible for Medicaid or one of the special state assistance programs for home care.  If you have money saved to pay for care yourself, you will be able to privately pay for home care services.

If the person is not eligible for State assistance, contact your insurance company to see what they will or won’t pay for. If they will pay for home care, what agencies will they allow you to use?  Sometimes, insurance companies will restrict you to selected providers.  Other times, they will allow you to use any licensed, accredited provider in the State.

Supervision is the difference between working with an accredited agency and a freelancer, even if the freelancer was recommended to you by a friend or family member.

Home care is a very autonomous role for the professional and paraprofessional. Unlike a hospital or assisted living facility where many others work with them, nurses and aides work alone in the home with your loved one who may be quite vulnerable.

A key consideration is the amount of oversight or supervision that the caregiver receives. Is there an assurance that care is conducted the way it should concerning safety, infection control and similar issues? Is there someone who is monitoring the care? The advantage of using an accredited agency is that you know that the employees are screened, supervised and a registered professional nurse is monitoring the level of care.

Whether you have a certified homemaker-home health aide or a freelancer, the family has to have a presence in the home. They have to be aware that there is a non-family member in the house, and that they are leaving a loved one who is vulnerable and frail alone with an aide or a nurse. The family has a responsibility to be involved in the home care process and to monitor it.

A simple precaution is to drop by unannounced periodically to check what goes on during a typical day. Another important safeguard is to talk to the person receiving home care without the caregiver present. Ask them for feedback.

Make it clear that they don’t have to be afraid that you are going to take the caregiver away, but you really want to know their perspective.

Sometimes older adults feel like they have to accept whatever they get. It is important to allow the older adult to feel like they are empowered to give real feedback and, if the situation is not okay, that you will do something about it. Sometimes a person with dementia may accuse their caregiver of stealing. One way to prevent this situation is to be sure that valuables such as jewelry, cash, or important papers are safely secured.

It is also important to remember that the home care arrangement is a work arrangement and that the caregivers are not family members. Aides, nurses, and the elderly often develop close, personal relationships. There’s a level of intimacy in the relationship that can develop when the aide or nurse is taking care of very private needs.

Your loved one is grateful for the support he or she receives and often comes to feel that their aide or nurse is a member of the family. You have to draw the line and ensure that your senior does not give them money or other valuable items or share confidential information with their aides or nurses.

If your nurse or homemaker-home health care aide is from an agency, you should start by reporting your concerns to the agency. One of the questions you should ask when choosing an agency is how they handle complaints or concerns. Accreditation standards require that consumers are given information about how to file a complaint. It should state clearly who to contact – whether it is the owner, director of nursing, or director of operations, etc. – and how to do so. So, your first step should be contacting the agency.

CAHC accredited agencies are required to have an internal process of investigating grievances. If you make a complaint and you are not satisfied with the internal process, you can contact your appropriate State agencies that license home health care agencies.

If you suspect theft or fraud, you should also contact the police. If you believe physical abuse has occurred, you should contact your local police department and your local Adult Protective Services unit which is usually located in the social services department of your county. In the event of child abuse, you can contact Child Protective Services.

One caveat to keep in mind is that people with dementia or Alzheimer’s Disease may imagine they are having items stolen or that someone is acting abusively. You need to assess the situation to determine how to respond. Does the person have bruises? Have you looked for “missing” items? When an agency has an internal process to investigate your concerns, it may prevent you from jeopardizing a good care-giving situation by making unfounded accusations. Additionally, having a clear process to address your concerns allows you to act effectively if an abusive or fraudulent situation actually exists.

If your aide is a “freelancer,” you have fewer options. If someone is a freelancer, and you suspect criminal behavior, then contact the police. If you have a concern about the aide’s credentials or whether the aide is certified, contact your State’s licensing authority.

In the above situations, if the agency is CAHC accredited please contact us so we are aware of the problem.

Everyone wants good home care for the person they care about. They want to be able to trust the care-givers that come into the patient’s home. They want to be assured that the patient is getting quality, compassionate care.

Choosing an accredited agency is a very important first step to ensure that good home care is being provided, but it is not an absolute guarantee. It is essential that as a healthcare consumer or advocate for a home care client, you remain attentive and monitor the care that is being provided.

Good home care begins with knowing who’s walking in your front door. It is knowing that the person that you or your insurance is paying to take care of your loved one has had adequate training, is being supervised, and that the level of care has been determined by a registered professional nurse. Good home care means that the person has been properly screened.

Good care is knowing that your care is being evaluated and assessed by a registered professional nurse, and that there are changes to the care based upon that professional’s evaluation as well as input from the patient and family.

A good agency is one that is responsive – that responds quickly to concerns and addresses them right away.

Bad home care is the opposite. You don’t know who is coming into your home. You don’t know what screening or training the aide or nurse has had. There are also liability issues that most consumers don’t think about. What if the person falls or is injured in your home? What about disability, workers’ compensation and employment taxes? Some people pay privately “under the table” for home care services, but there are pitfalls that come with that choice.

“Registration” is permission granted by a competent authority to engage in a business or occupation. In selecting home care services for a loved one, an important first step is to discover if the agency is registered with the State.

“Accreditation” is a voluntary process in which the provider has allowed an independent, outside entity to evaluate its operation before earning the “seal of approval.” When an agency is accredited, it is voluntarily submitting its operation for examination and must meet specific standards of care to qualify. The provider must undergo annual site surveys to ensure ongoing compliance with the Accreditation Standards before accreditation is renewed each year. CAHC providers may receive accreditation for Companion Care, Personal Care and Skilled Nursing, or all of them.  In selecting home care services for a loved one, ensure that the agency is both registered and accredited.

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