10 Questions Before Hiring Homecare

10 Questions to ask when Selecting a Homecare Company Portrait of young nurse sitting with a senior man

It’s not just all about rates! 

When looking for a homecare company, it’s important to ask the right questions. Many people just focus on the rates when there are many other important factors to consider.

Below are 10 questions to ask before hiring a homecare company. Following are explanations and more details.

  1. What areas do you serve? 
  2. Are your caregivers employees or sub-contractors?  
  3. Do you provide Nurse Delegation?
  4. Will the caregiver transport the client?
  5. What types of personal care are allowed?
  6. What is your minimum number of hours?
  7. What is your cancellation policy?
  8. What happens if I have a concern after business hours?
  9. How do you handle customer complaints or caregiver conflicts?
  10. What are your rates? 

For more info about each of the questions- read on!

  1. What areas do you serve?

Make sure the home care company serves your town or community. Ask them if they currently have clients in your neighborhood. Some home care companies will say they serve an entire city or region but most specialize in a local area. Companies that serve your neighbors will be less likely to have problems providing back-up staff if your regular caregiver is unavailable.

  1. Are your caregivers employees or sub-contracted?

There are four types of home care companies; employers, registries, referral companies, and independent caregivers.

Employers – Home care companies hire and pay their employees directly. All employees are covered by the workers compensation and liability laws of your state. Employers are subject to federal tax, Social Security, and Medicare withholding and applicable state and local income taxes.

Registries – Registries are companies that coordinate the scheduling of caregivers, but pay their caregivers as independent contractors. In these cases the caregivers are independent and responsible for their own taxes. The registry charges you and then pays the individual caregivers without withholding taxes or insurance. In some cases, the registry will use a split fee model where you write two checks each week, one to the registry and another to the caregiver.

The registry typically provides scheduling services. This model is designed to reduce overall expenses by reducing liability, benefits, and workers compensation costs. While you may see savings, this also may increase your liability. You need to make sure that your caregivers have appropriate coverage if they are injured while working in your home.  In some cases the caregiver could be considered your employee and you would be liable for withholding taxes, including social security and Medicare taxes.

Referral Services – Some home care companies only provide referrals and background screenings. These companies recruit and screen caregivers and place them in your home for a fee. The fee is typically a one time fee, then you become the legal employer. If the caregivers working in your home are being paid directly by you, you are obligated to acquire a federal employer identification number (EIN) and pay federal withholding, Medicare, state and local taxes as well as employer matches. In some states you will also be obligated to provide workers compensation insurance, family medical leave, and meet other state labor industry practices.  Referral Services can generate significant savings over the long term. However, many families feel the additional paperwork, tax and bookkeeping expenditures, and management time is a substantial burden. We strongly recommend that you consult an attorney and an accountant if you decide to become an employer.

Independent Caregiver – There are many individuals who sell their services as caregivers.  They place an ad in the local paper and make individual arrangements with families to care for a loved one.  Although this may be the least expensive option there are a number of potential liabilities that you face as the employer of an independent caregiver, including tax withholding, workers compensation, and unemployment compensation.

Understanding how your caregivers are paid can be critical to your safety and your potential liability.

  1. Do you provide Nurse Delegation? 

Nurse Delegation is a great way to receive some skilled services, but without having to pay RN rates. To be eligible for nurse delegation, the homecare company will have their RN do an evaluation and assessment- then they will delegate a caregiver (Certified Nursing Assistant) to perform the tasks.

Tasks that can be delegated are: simple wound care, ostomy care (wafer changes), straight catheterization/ bladder irrigation, bowel programs, suctioning (not sterile), tube feeding, medication administration and blood glucose monitoring (BS checks, insulin injections). The client must be in a stable and predictable condition per delegating RN. Client must not require frequent RN monitoring. 

  1. Will your caregivers transport the client?

A big need for many families is to provide transportation for their loved one to doctors appointments, physical therapy sessions, church or temple, social events, entertainment and recreation. Some agencies will allow caregivers to drive their clients in the client’s vehicle. Some agencies will allow caregivers to transport their clients in the caregiver’s vehicle. Some agencies own vehicles and provide transportation services. Each of these methods carry a certain amount or risk and different companies have different policies regarding client transportation.

To avoid liability, many agencies do not permit caregivers to transport clients. However, some agencies will allow you to sign a waiver of liability. Finally, when using your family’s vehicle, make sure to verify appropriate coverage with your auto insurance provider.

  1. What types of personal care are allowed?

There are three levels of care provided by home care companies; companion care, personal care, and skilled care.

Companion care includes meal preparation, light housekeeping, assistance with daily activities such as letter writing, reading, and entertainment. This level of care is designed to provide peace of mind for the client and the family. At the companion level of care the caregiver generally does not touch the client.

Personal Care includes the basic Activities of Daily Living (ADLs) – eating, bathing, dressing, toileting, transferring, and continence. This level involves hands-on care and requires a higher level of training than companion care.  Many states have specific licensure laws and regulations that govern personal care.

Skilled Care see question #3 regarding Nurse Delegation

  1. What is your minimum number of hours? 

Some agencies will provide only 1 hour of service at a very high rate, a few will offer 2 hours of care, but most have a 4 hour minimum. 

  1. What is your cancellation policy?

Occasionally you’ll have to cancel services with your home care company.  When this happens, you need to determine their cancellation policy. Try to look for an agency that treats its customers fairly. Most clients will cancel a caregiver from time to time.

  1. What happens if I have an issue of concern after business hours?

The rule of thumb in home care is that the worst situations only occur nights, weekends, or on holidays. Home care is a 24/7/365 business. You want your agency to have a very clear process for managing problems outside of regular business hours.

Some agencies use answering services, others use pager systems, and a few larger agencies will staff their office 24 hours a day. With today’s technology there is absolutely no reason that you should expect to not be able to reach someone at your home care agency within a few minutes.  You need to know how to contact them after business hours and how they will respond.

  1. How do you handle customer complaints or caregiver conflicts?

Almost everyone who receives care will have problems from time to time. A caregiver becomes unreliable, or the client and caregivers personalities may clash. Many families find it difficult to report these problems because they don’t know how the agency will handle the complaint. They don’t want to make problems worse by having an agency discipline a caregiver. Conversely, sometimes companies will refuse to discipline a caregiver and simply move them to a new client.

Be up front with your agency. If you acknowledge that possible conflicts may arise you will find that your agency will be more likely to manage your complaint effectively. Have an open discussion about “what if” scenarios and see how the agency reacts. Ideally your agency will take complaints very seriously and act as a liaison to resolve conflict quickly and effectively.

  1. What are your rates?

Some agencies charge an hourly rate, while other agencies have packages of service. You’ll want to find an agency whose services and packages fit your needs and your budget. The more home care you buy, the better your hourly rate should be. Most of the expenses incurred by the agency are for the first hour of service.

When you compare hourly rates to the pay rate of your caregivers, it’s not unusual to see a 100% difference. Providing quality home care is expensive and high-quality agencies will charge you accordingly. When asking about rates be sure to evaluate total value, not lowest price.  Make sure you’re getting what you need and you are only paying for what you get.

You’ll also want to have a clear understanding of the home care company’s billing procedures and payment due dates. Many companies bill weekly or bi-weekly and expect to be paid before the next billing cycle. These are small companies who must pay their caregivers and make tax deposits. They need to receive regular payments in order to meet their payroll.  Many companies have a defined policy of how long they will continue to provide service after the due date of the bill.  Often, the company will discontinue services if they are not paid on a timely basis.

 

Capability Homecare wants to be your trusted homecare provider. For answers to any of the questions above, or for more info- please call us at

425 679 5770. 

What is Live In Care?

What is Live in care?services_activities_image

Live in care is one of the most popular services we offer for those who need continuous help, but don’t want to live in a skilled nursing, assisted living or AFH. Live in care is a great solution for couples who want to remain together, or for anyone who wants to age in place. 

Why not just go to a nursing home? 

In a skilled nursing facility you have very little control over who the caregivers are, or what sort of schedule you are on. By receiving care at home- you are in control. You decide what to eat, when to sleep, when to bathe, what to watch on TV … it is all up to you- all in the comfort of your own home.

Most people do not want to live in an hospital like setting- they prefer the privacy, comfort and familiarity of their home. 

 

How much does live in care cost?

Live in care costs between $350-400 per day, depending on the level of care required- and with the stipulation that the caregiver gets 8 hours of sleep each night. 

What if the client needs to get up during the night? 
If the caregiver is called upon during the 8 hours of sleep time, then the client must pay an hourly rate for any amount of time the caregiver is working (for example, if they needed 10 minutes of help at 2am, the client would be billed for 15 minutes at $30/hour).  IF the caregiver is woken up many times and does not receive a minimum of 5 hours of uninterrupted sleep, the client then must pay for all 8 hours of “sleep time” at the hourly rate of $30/hr for that portion of time.  This is in addition to the $350/day. This would mean if the client wakes up frequently, worse case scenario would be $350/day + 8 hours @ $30/hr = $590 per day.

The second option would be to do the live in as above, but also bring in an additional caregiver who would be awake throughout the night to assist the client as needed. This would be billed at 30/hour, but ensures the live in caregiver will get the required 5 hours of uninterrupted sleep.  $350/day + 6 hrs @ $30/hr.= $530 per day.

A third option would be if the client either does not have space for a caregiver to sleep, or they require around the clock care ( 2-12 hour shifts or 3-8 hour shifts daily).  Then all 24 hours of the day would be billed at an hourly rate ($30 – $34/hour depending on level of care required).  This option is certainly the most expensive for families running at a minimum of $720 to a maximum of $816 per day.

Wow, that sounds expensive! 

Yes, care can really add up, but keep in mind that care in a private room in a Skilled Nursing can be as much as $8000-15,000 a month*, and unfortunately Medicare does not pay for this- unless you have had a qualifying 3 night hospital stay** , and even then care is only covered at 100% for 20 days. 

Many clients have Long Term Care insurance that will help with costs. Capability Homecare can refer you to a trusted LTC agent if needed. 

Would it be the same caregiver all week?

Because of overtime laws,  there would be 3 caregivers who would share the duties. Each would work 3 consecutive days to maintain consistency. 

Where does the caregiver sleep?

The caregiver must have her own room for sleeping. 

What are some of the duties the caregiver would do? 

Caregivers assist clients in a variety of ways-

  • incontinence/ personal care 
  • bathing 
  • dressing 
  • ambulation/ fall prevention 
  • medication reminders
  • meal preparation, assistance with eating
  • housekeeping 
  • transportation
  • and more

Who are typical clients?

We assist seniors who have Alzheimer’s, dementia, Parkinsons, Cancer, COPD, heart failure,   MS and more.

We also help those who have just been discharged from the hospital or SNF.

There really is no such thing as a typical client, which is why we create a customized care plan for each client. 

This sounds great- how do I get started? 

Call our office today to get started- 425 679 5770. Our friendly staff will gather as much information as possible, then we will schedule a home visit to do a formal assessment. Once we fully understand your needs we will write up a detailed plan of care and schedule your personal caregivers. 

sources:
*http://www.skillednursingfacilities.org/resources/nursing-home-costs/

**https://www.medicare.gov/coverage/skilled-nursing-facility-care.html

When you say…

services_activities_image When you say…

  • I get up several times a night to use the bathroom
  • I’m struggling with incontinence
  • I’ve had a few falls
  • I’m having trouble with memory loss
  • I can’t get out of bed or my chair on my own
  • I don’t feel safe at home alone anymore
  • I never want to move to a nursing home or assisted living
  • I’ve been hospitalized and am concerned about going home without help
  • I’m scared to drive
  • All I eat are frozen meals or fast food
  • I’m on multiple medications and need reminders
  • I don’t want to be a burden on my family
  • I can’t do the things I used to do without assistance
  • I’m lonely
  • I have a new medical diagnosis and feel overwhelmed
  • I can’t keep up with my housework
  • I need help with bathing and personal care

We can help! Capability Homecare provides trusted caregivers to assist in the home. We will do as little as 4 hours a week to overnight, around the clock care. Call us today to learn how we can help you stay safe in your own home. 425 679 5770

Above and Beyond

Sheila

Sheila winning a door prize at the Alzheimer’s conference last year.

It’s important to highlight what makes Capability Caregivers so special. When you’re choosing someone to care for your elderly parents, it helps to know this person will go above and beyond what’s expected.

 

Take for instance our amazing caregiver Sheila.

Sheila has been caring for the same couple for over a year and a half. She provides live in care– meaning she spends 4 full days living in their home- helping them with day to day tasks (ADL’s) such as making meals, helping with bathing and dressing, personal care (assisting with toileting and catheter care) providing companionship and keeping them safe in their home.

She also takes them for walks, drives to doctor’s appointments, runs errands, takes out the trash, gets the newspaper each day, takes care of light housekeeping, keeps the kitchen stocked and more… all the tasks that we take for granted, but have to be done to keep our homes running smoothly.

Sheila has been a caregiver for 8 years- she is a trained CNA (Certified Nursing Assistant) and on her own time takes extra CEU classes to further her education and skill set. Last year I remember running into her at the Alzheimer’s conference- she had attended on her own so that she could learn more about caring for her clients.

Sheila says she loves working with Mr and Mrs S because she learns so much from them- they are interesting to talk to- and more importantly, they are still so in love with one another. Their love for one another brings a smile to Sheila’s face because she knows that she is helping them stay together in their home to live out their old age.

The hardest part of Sheila’s work day is recognizing that Mr and Mrs S both have dementia- and they are slowly slipping away from their former selves which makes Sheila sad.

Sheila’s passion is cooking- as was evident the day I went over to visit and interview her for this article. The house smelled delicious! She had prepared an omelet with green peppers, fresh cottage cheese with berries, sausage links, toast, coffee and juice (keep in mind she had no idea I was coming by, she cooks like that every day!).

What I noticed more than the amazing food- was that on the table were decorations for St Patty’s day. She had 4 leaf clovers scattered around, confetti strewn on the table, pictures of leprechaun and other little nick knacks on display. On a white board next to the table was written the day of the week, the schedule for the day and a little note reminding them that St. Patty’s day was coming up.

I asked Sheila about this- and she replied that she does this each month as a reminder to Mr and Mrs S about whatever holiday is coming up. It helps them stay in touch with the outside world and brings them a little joy. It also adds a festive element to their home- making it seem like a party every day!

I was so touched by this- because to me- it goes above and beyond what would be expected. She truly cares about Mr and Mrs S and treats them as if they were her own parents.  Her devotion to them is so evident in the loving way she cares for them. I know Mr and Mrs S (and their adult children) are grateful for all that Sheila does to help them live comfortably at home.

Sheila exemplifies the core values that we live by at Capability Homecare- honesty, integrity, empathy and compassion.

5 Ways to Prepare for Homecare

Once you’ve made the choice to provide in-home care for an elderly member there will be many things you need to take care of. At first, your decision may overwhelm you and create a lot of stress. But with a little knowledge and planning, some of this stress can be relieved. Here are some tips that will help you provide better and hopefully make the transition a pleasant experience for everyone involved:

Accept the Change

The very first step is to accept that there will be a change. Depending on the level of care there may be dramatic changes to your lifestyle, or negligible ones. Whatever the case may be, it is necessary that you accept and embrace the change that will soon be coming your way.

Keep Your Family Involved

Your decision to provide in-home care needs to be discussed with your family. The effects of ageing in an in-home care situation are very prominent, and will affect your family members in different ways. Take into account everyone’s opinions on the matter, so that you can prepare for any potential challenges. Make sure responsibility is divided equally so that no one person is stretched beyond their limits.

Eliminate Clutter

A messy environment in general makes it hard to get things done. This will become more of a hassle in an in-home care situation. Obstructed pathways and all round clutter pose challenges and risk the safety of your loved ones. Thus, a good way to prepare for in-home caregiving is to minimize clutter, and organize your surroundings. Having a neat space will make caregiving much easier for you, and will also be greatly appreciated by your elder family members.

Modify the Home

Sometimes, your home may need certain adjustments to make living more comfortable for your elder loved ones. Consider what modifications you may need, from installing a walk in-tub to investing in grab bars to promote stair safety.

Remember Yourself

Caregiving can take a toll on anyone. In the process of giving care, make sure not to neglect yourself. Caregiving is very demanding, even if you are helping your own family members. Neglecting oneself often happens subconsciously, but can have negative repercussions. As a care provider, it’s important to look after yourself so you are in the best condition to provide care for others. Remember to eat and sleep well, stay healthy, and take a break every now and then, giving yourself the attention and care you rightly deserve.

Keeping these things in mind will lessen the anxiety and stress that often accompanied in-home care giving in its initial stages. Ultimately, you will find that in-home care giving is a wonderfully fulfilling process – not only for your dearly loved elders, but also for you.

Written by Akshata Mehta, who has also written for Not Now Mom’s Busy, The Small FootPrint Family, Family Groove

Everyone Has a Story to Tell

merleA fascinating man lives in Redmond, WA- and I had the pleasure of meeting him last week. His name is Merle Fister, and he is a 3 time war veteran, having served in WWII, the cold war, the Korean War, Vietnam and the Pentagon.

Mr. Fister, or Merle, as he would like me to call him, came from humble beginnings. He was born in 1921 to a farming family in Nebraska. As a child growing up on the farm he was surrounded by 160 acres; which included horses, cows, chickens and pigs. However, when the dust bowl hit- his family was forced to move west, landing them in CA. There, his father worked for GE and Merle started a lawn care business.

After finishing high school, Merle got a job working for Northup Aircraft building airplanes- which turned out to be a stepping stone for a career in the military. He enlisted as Army Air Corp and was assigned to Atlantic City as a permanent party guard. He spent his nights on the boardwalk, carrying a WWI rifle with a bayonet looking for German spies.

A few months later, he applied for Ariel Gunnery School- but ended up in pilot training instead. Once he learned to fly- he discovered a passion for it and loved flying acrobatics in his tiny single engine open cockpit plane. In Salt Lake he learned to fly the B 24 and also merle 3met his crew of 10 men. They were sent to Italy to fight in WWII. Their  mission was bombing bridges. His regiment, the 454th Bomb Group, was part of the famous bombing of the Polesti Oil fields. This was a very dangerous mission- and his plane barely made it out in one piece. They were hit by enemy fire and lost multiple engines, having to do an emergency landing with little fuel, no brakes and only one working engine. Miraculously, no one was hurt! His group went on to fly over 50 more missions in three months.

His career went on from there- he went to radar school, then on to Germany to run radar for the military, including during the infamous Berlin Air Lift. He became an Engineering Officer, an instructor in air science and tactics for ROTC cadets, and also became Commandant of Cadets. He then went to advanced radar communications training in Mississippi and then became a Captain in the Korean War working as an advisor for electronics command. He traveled all over the world serving as Electronics Commander and was responsible for controlling the B52’s that were in flight daily to protect the US.

From there he went on the Turkey to be the Long Haul Communications Director- collecting information on Russians. Then he went to Tinker Air Force base in Oklahoma City and provided communications for central air command- controlling all air traffic for military flights in central US. He also went to school and finished is bachelor’s degree. During this time, Vietnam broke out- and Merle was sent to Hawaii to work with the Navy to stop the spread of communism.

The Pentagon was next on his career path- where he worked with high level planning and programming communications for troops around the world. We worked on the Worldwide Command and Communications System providing a secure voice of teletype in Vietnam. Finally, after a long and distinguished military career, he retired in 1970 as a full Colonel from the Pentagon.

Rather than simply rest and enjoy retirement, he then went on to get his Master’s degree in Public Administration and started a completely new career as a business man- owning a tax and accounting firm and then eventually owning beauty shops, rental properties and dry cleaners. He had a successful career as a businessman and helped develop a major housing community in Tempe, AZ that had over 1500 homes. He served as the Director of the Homeowner’s Association for two years.

Merle is a man who is extremely intelligent, extremely humble and clearly a very hard worker. Even in his retirement- he stays active and involved in his community of Fairwinds– a senior community in Redmond, WA. Here he runs the Men’s Breakfast Club, Chairs the Garden Club, Serves on the World Affairs Club, created the People Helping People Club and also started a Resident’s Association- of which he wrote the by-laws for.

Unofficially, he is called ‘the Mayor’ of his community- and it is evident why! He knows merle 2everyone, has a smile for everyone and works harder than any 94 year old I’ve ever seen! Merle is so well liked and welcoming- that he would make a perfect mayor! His mission in life is to serve; he is constantly looking for ways to make things better, get people involved and to give back to his community.

What’s fascinating to me about Mr. Fister is that he truly exemplifies what many refer to as the best generation. He is an excellent example of hard work, street smarts and perseverance. With only a high school education- he later went on to get several degrees- including his Master’s Degree and served our country in a long and distinguished military career- starting as a Private and ending his career as a Full Colonel in the Pentagon. It was such a joy to hear his life’s story.