Caring at Home: How to Find Help: Part I Home Care
Anyone caring for someone with dementia needs a lot of support. As a patient’s needs expand, it is not uncommon for the primary caregiver to fall ill from the stress and exertion required. Bringing help into the home can alleviate caregiver burnout. But it takes time and a plan to find the right person to be a regular part of your family’s life.
Home Care or Home Health Care?
To be clear, this article offers advice on selecting someone to provide home care services, which is not the same thing as home health care, even though the terms are often used interchangeably.
Home care services are sometimes referred to as companion care. No skilled medical care is involved and no license is required. Home care services include assistance with activities of daily life (such as bathing, eating, dressing, grooming, and transporting). It can also include errands, light housework and driving duties.
Home health care services are medical services that must be performed or overseen by licensed health care professionals, such as nurses, physical and occupational therapists. A physician must prescribe these services. They include medication management, diabetes management, and physical and occupational therapies.
An agency or an individual?
When seeking home care services, you have a choice between hiring an agency or finding an individual who will work directly for you. Both arrangements have their strengths and weaknesses.
If you hire an individual, you know who will be in your home, and you are more likely to be able to set your own schedule. However, you must do the background checks and provide your own insurance. Should your worker get sick, you will not have any back up.
If you hire an agency, you do not necessarily know who will be assigned to your home. You may need to contract for more hours of service than you want, and you may not have as much flexibility with the times of service. On the other hand, a reliable agency will do all reference and background checks, provide insurance, and provide substitute workers when necessary.
Getting Started: How to Locate a Suitable Worker
Many families find help by asking their friends in similar circumstances whom they use. It is an excellent starting point as word of mouth recommendations are often the most reliable. Other sources include your primary care physician, a discharge planner at a hospital or nursing home, or a geriatric case manager. Whether you intend to hire an agency or an individual, you will want to know the following information:
Does the worker have a criminal record?
In Massachusetts, prospective employers can file a request for a criminal background check, known as a CORI (Criminal Offender Record Information). Either you or the agency should do this check. However, be aware of its limitations. The report will only include convictions, not arrests, and it is limited to criminal records in Massachusetts.
Can the worker or agency provide references?
The prospect should be able to give you at least 3 references. Check them all, and have a list of questions to help you screen out candidates that don’t offer the services you need or who do not seem a good fit for your family. Ask some open- ended questions as well to give the reference the chance to tell you things that you may not have thought about.
What about insurance?
An agency should have liability insurance and workers’ compensation coverage, and its workers should be insured and bonded. An individual not working for an agency is not likely to have this coverage. You should check with your own insurance agent to add coverage for people working in your home.
What will happen if the assigned worker is sick or is not a good match?
One of the advantages of hiring an agency is that they should send an alternate aide in the event your aide is sick. Ask about the agency’s policies, and how long it will take to get a substitute.
Confirm that the agency will assign you the same worker consistently. Find out what the agency policy is if you decide the assigned worker is not working out.
Has the worker received specific training for dementia care?
An agency should send you someone with specific dementia training. Inquire about the training and confirm the worker’s knowledge. For individual candidates, ask if they have worked with dementia patients, and satisfy yourself that they understand the physical and behavioral issues that may arise.
What kind of help will the worker provide?
Be specific about what kind of help you are looking for and make sure that the worker is willing to take it on. If the work includes driving the patient to appointments and outings, check out the car that will be used, and the driving record of the worker.
How much will the help cost?
Most home care is charged by the hour. Find out that rate, how frequently it is adjusted, and whether there are additional costs associated with the work you request. Neither health insurance nor Medicare pays for home care services. If you have long term care insurance, it may provide coverage, but you should confirm this in advance.
Many agencies require a minimum block of time, often 4 hours per day. Some agencies will provide coverage for as little as one hour, but the hourly rate is usually higher. Make sure you understand the policy of the agency you are working with.
Getting Off to a Good Start
Once you have hired some help, take the time to orient the worker and to get the patient accustomed to the worker’s presence. Plan to stay at home with the worker for the first day, and leave for only short periods of time in the beginning. Finding the right fit can take work, but the benefits of getting regular, trusted support are worth the effort.