HisGrip Home Care

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How To Be An Educated Home Care Consumer

At HisGrip Home Care, we receive calls all the time from family members who have a lot of questions and misunderstanding about Home Care specifically non-medical care. Some of the frequently asked questions are “What should I look for in a home care provider?”, “Who pays for services?”,”I am not sure how many hours my mom will need?”, “What can your caregivers do and not do?” and my favorite of all the questions is “What does light housekeeping mean?”

In this issue, I will attempt to explain the different kinds of home care and how to select the services that are right for your family member.

What Is Home Care?
There are basically two types of home care: Skilled services and non-medical (or unskilled) services.
Skilled Home Care Services refers to health care services provided by nurses (RN, LPN), rehabilitation therapists (OT, PT) and social workers and dieticians. Typically, these services are provided after hospitalization or an acute event and are typically covered by Medicare, or private insurance. These skilled services are generally time limited and focus on rehabilitation.
Non-Medical (Unskilled): focuses on long-term care needs and is often used once the skilled services have been discontinued. This type of home care is either paid for out of pocket, by long-term care insurance or the Medicaid program for people of limited means. Non-medical care is provided by agencies who are licensed by the State to provide Personal Care and CompanionSitter services. These agencies, also known as Private Home Care Provider, must employ Certified Nursing Assistants (CNA) and Certified Home Health Aides (CHHA) and they must provide a Registered Nurse for supervision of the services provided.

Regularly Asked Questions
What should I expect from my caregiver?
Prior to the caregiver starting work in your home, the agency must 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 your caregiverr.
To avoid any misunderstandings, remember that the caregiver 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 should I expect from my care provider?
The Private Home Care Provider must ensure that all the employees are certified, licensed, insured and bonded. They must also have clear criminal background checks and TB test results. They must ensure that your caregiver is reliable, dependable and professional.

The Private Home Care Provider must provide supervision and support of the care provided. Prior to starting services, a Registered Nurse must 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. Private Home Care Providers are required to conduct regular home visits. Ask for the frequency of those visits. Ascertain the Provider’s availability for evening or weekend medical or scheduling emergencies. All Private Home Care Providers 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.

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. 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.

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