Your Questions About In-Home Care Answered

  • When the subject of in-home care comes up, there is often a lot of confusion. I first tried in-home care when it was a very new concept, at least in my area. That was in the early 80s when my elderly neighbor, Joe, whom I'd been caring for, fell and dislocated his shoulder. While at the hospital, we were offered help at home for Joe, so we happily accepted, thinking it was part of Medicare. When the eye-popping bill came, I realized that I was lacking some important information. The hospital had its own in-home care service and they were less than forthcoming about other options, as well as costs.

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    Sure, that was years ago, but some things don't change that much. People still have questions about in-home care. I'll try, here, to answer the most frequently asked questions.


    Q. Is in-home care covered by Medicare?


    A. In-home nursing care is generally covered when prescribed by a doctor. So, if a nurse comes to your home to check on post-surgery wound healing, that visit is likely covered. However, for many people, their greatest needs are what are known as Activities of Daily Living or ADL help. Showering, dressing, meal preparation, grocery shopping, light cleaning, errands - all those necessary elements of daily life - are ADL and generally not covered by Medicare. The person needing the help must pay the agency out-of-pocket.


    Q. Why go through an agency? Couldn't you find your own help cheaper? 


    A. You may be able to find a good caregiver on your own. You certainly have that right, and if you find someone you really like, that is great. However, please be aware. I wrote about this subject before in an article titled, "The Accidental Employer," which covers this more thoroughly. The gist of this article is that you, if you hire a person who is not employed by an agency, may find yourself responsible for employment taxes, workers' compensation insurance, Social Security and other employment costs.


    Also, you could be liable if the person is hurt. There have been people sued over a back injury, and such a thing is devastating to an elder and his or her family. If you choose to hire someone on your own, please do yourself a favor and check with your state laws so you know what your obligations will be. You may find the best person in the world this way, and that is fine. Just be aware of your responsibility. ALERT: Even if you hire an agency, ask if their workers are covered by worker's compensation insurance. Protect yourself from a lawsuit.


    Q. What happens when the person coming doesn't show up? 


    A. That's another good reason to hire an agency. If you hire just one person, that is what you get. If you're very lucky, that person may never fall ill or go on vacation, but that's not very realistic, so you'd need to make sure you had family to back you up should the caregiver not be able to make it. With an agency, you would have backup. However, quite frankly, I've known of people stranded, even then. So, ask about backup, too. 


    Q. How long has the company has been in business. Are they a local start-up or a chain?


    A. Neither is better than the other, but whichever you choose, a company that has been around awhile does have the advantage of a history, and likely has more employee backup.


    Q. What services can I get from the agency? 


    A.  Each agency is different, which is just one reason to check out several. Some may only agree to let their employees do light custodial work, but not offer bathing or shopping or other services. Make a list of the services important to you and your elder. Then call agencies in your area and read the list. Check things off. That gives you an idea of the type of agency you may want.

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    Q.  Are workers licensed? What kind of training do they get? 


    A.  Again, make a list and ask each agency. Or use this list of questions. Agencies differ in training requirements for their staff. Some offer Certified Nursing Assistant training (CNA), while others offer their employees little more than CPR training. You need to be an advocate and make sure you are getting what your elder needs, and what you are paying for.


    Q. What kind of screening do agencies use when they hire? 


    A.  A good agency will have done background checks, including a criminal background check. If you hire your own person, you should pay to do this. Be sure and ask the agency if this is their practice, as some may not do the criminal part of the check.


    Q.  Are services charged by the hour or on a per service basis? 


    A.  Ask the agency what their practice is and if you have choices. Maybe you want someone to come in and give companionship time with the elder, as well as do some light cleaning and other services. Or, maybe you just need someone to take the elder shopping, put away the groceries, or just do a quick morning and evening check for safety. Ask if they have packages or how they set up services. Ask, also, how much everything costs, so there are no surprises.


    Q. How many caregivers will my mother or father have to get used to? 


    A. This is very important. With the three people I needed some in-home help for (my neighbor, my uncle and my mother-in-law), each agency did have several people assigned. This would be necessary if daily care is what you are looking for, or any kind of longer term commitment.


    My uncle's service was the best, in this regard. He has three women who rotated. He like them all, though he had his favorite. If anyone else came, they'd be lucky to get in the door.


    Joe loved a young guy who'd come and chat about golfing, but locked out one woman he couldn't stand. And my mother-in-law sort of got used to one woman who came to bathe her, but was really upset when anyone else came.


    Realistically, you will have more than one person coming if you use the service very long, but you have a right to ask about turnover rates, and how big an effort they make to keep continuity with the staff giving care to the elder. Think how you'd feel letting a stranger in to give you a bath.


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    Q. What if my mother hates the caregiver that regularly comes? 


    A. Be upfront with the agency. Say, "It's nothing personal, but my mother is not fond of the person coming. Could you please arrange to have another regular caregiver?" If they refuse, look for a different agency. You may not keep the elder happy all the time, but with some effort, you should find a person they can accept.


    Q. Are there any financial resources available to help pay for custodial care?


    A.  You can ask the agency if they know of any. Veterans often get help, but you need to go through your local VA for that. They would then work with an agency to help the veteran. Check with your state and county and see if there are options to help pay for in-home care. Every state is different, and even some counties within a state can differ. That said, states are becoming more aware that helping pay to keep people in their homes is cheaper than nursing home care. So, I expect options here to improve.


    Above are the questions I hear the most. If you have other questions or suggestions about in-home care, please write about them below in the comment box.


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Published On: March 02, 2009