Moving On…

Megan PhotoWhen my husband and I started Capability Homecare back in 2008, I never imagined what an amazing and wonderful journey this would be. Throughout the years I have experienced firsthand the gratitude, joy and relief families have expressed as a result of our caregivers helping their loved ones. It’s been incredible seeing how even just a little bit of help can make all the difference in the world. I can’t tell you how many times we have heard the phrase ‘you guys are lifesavers’!

What a wonderful and rewarding career this has been!

But now it’s time for me to retire. Last March, Home Care Assistance acquired Capability Homecare- creating the largest home care provider on the Eastside. The Capability team (Director of Operations, HR Manager, Care Manager, Staffing Coordinators and Caregivers) all remain- and have joined with the Home Care Assistance team to change the way the world ages.

As for me, it is with heavy heart that I say goodbye. Fortunately, I’m leaving knowing that Capability Homecare (now Home Care Assistance) will continue to provide top notch service to seniors and their families in the Greater Seattle area.

Thank you to everyone who has been a part of my journey. I will miss you.

If you would like to learn more about Home Care Assistance, click here! And for even more info, check out their blog and a Facebook page!

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What to Expect When You’re Expecting

what-to-expect

I would bet that most moms have read this book.  Back when I was pregnant it seemed like this was the ‘go to’ book to prepare for what was yet to come.  Personally, I remember reading and highlighting the pages, trying to ready myself for this enormous change that was about to happen to my life. I loved that book because it prepared me for the unknown. By the time my baby arrived I was armed with information- I was ready (or so I thought!).

On the complete opposite end of the life spectrum it seems like we are less and less prepared for growing old. It’s almost as if aging sneaks up on us. Maybe it’s denial that it’s happening, or maybe it’s because we are so busy thinking about everything else- but it seems like we could use a “What to Expect When You Grow Old” book?

If I were to write such book, I’d include a chapter on what to expect when hiring homecare. Hiring help in the home can be a wonderful way to ‘age in place’. People can receive care similar to what they would get in an Assisted Living, but in the comfort of their own home. And as with any new thing, it’s helpful to know what to expect.

Below are my top 10 tips on – “what to expect when hiring homecare”.

  • 1.Expect a to have an assessment the homecare agent will spend a couple of hours asking questions and gathering information on what exactly the client is looking for. They need all of this info so that they can then write up a plan of care tailored to the particular client.  This is also a great opportunity for the client to get to know the homecare agency. They can ask questions and learn more about who they will be working with.

 

  • 2.Expect several days between the assessment and when care actually starts. Many people assume that caregivers are available at a moment’s notice, but this is unrealistic. In some emergency cases agencies will be able to provide a caregiver with little notice, but for most clients finding the right caregiver, who has the appropriate skill set and availability, may take time. We’ve had clients expect care immediately- and when we aren’t able to provide that they move on to another homecare agency- only to have the exact same situation. Be patient… we want to make the best possible match and that might take time- but it will be worth the wait.

   

  • 3.Expect communication– the homecare company should communicate with you on who will be caring for you or your loved one. They should also communicate to you any changes in scheduling or concerns the caregiver has about the client’s health or status. They should be available 24/7 to answer emergency calls.

 

  • 4.Expect trained caregivers who are certified nursing assistants. If you are receiving 24 hour, overnight or live in care- expect that there will be more than one caregiver caring for you. It is impossible for one person to work that many hours!

   

  • 5.Expect the agency to do all they can to provide consistency. Expect that sometimes the same caregiver might not be available (people do get sick or have emergencies), but expect the agency to have a back up caregiver to provide service.
  • 6.Expect that homecare is paid for privately- or with long term care insurance.  Unfortunately, it is not covered by Medicare.

 

  • 7.Expect that the caregiver might not look busy 100% of the time. Many people hire caregivers to assist them with their daily needs and help with light housekeeping or transportation- but there will be some down time when the housework is done and the client is asleep or comfortable. The caregiver may be reading a book or watching TV. They are there and ready to assist as needed- but know that they may not look busy all of the time.

   

  • 8.Expect to be able to make changes to the schedule– you decide how much care you want, when you want it. Most agencies have a 4 hour minimum- but otherwise it is up to you to decide how much care is necessary.  As a courtesy, if you are cancelling care- you should call at least 24 hours in advance avoid being charged.

 

  • 9.Expect that English may not be the first language of the caregiver. In our 9 years of providing care we have found that some of the best caregivers were born in different countries. However, it is always our goal to hire people who can communicate clearly.

 

  • 10.Most of all, expect compassion, professionalism and respect. Expect a relationship you can trust. 

Knowing what to expect when hiring homecare can help alleviate any concerns. Having a realistic view of what to expect makes the whole process much smoother. 

Please let us know how we can assist you or your loved one. Capability Homecare strives to be an industry leader in providing safe, compassionate care in the home.

Call us today 425 679 5770.  

What does a 26 year old and a retiree have in common?

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Celebrating our 20 year anniversary last summer in England.

Alone and miserable thousands of miles from home- what’s a girl to do?

 

That was me 20 years ago when I first got married and moved oversees for my husband’s job.

Technically I wasn’t alone- I had my new husband- but he was working 18 hour days.  I had no job, no friends and no family. I was miserable.

I wasn’t happy for many reasons- first off, I was lonely.  I had always been surrounded by people- and my social life had been full. Moving so far from home and not knowing anyone was scary.

To make matters worse, I was questioning my purpose in life. Back in the states, I had been a teacher- but I had to give that up for our move- and not having my career anymore made me wonder what value did I have? What would I do all day? What was my purpose in life?

So what’s a girl to do?

Luckily I had a friend who sent me a book titled Simple Abundances. This book changed my life! Among many things, it encouraged me to keep a gratitude journal and to write in it every day things I was grateful for.

Honestly, some days that was really hard. But the more I looked- the more I began to actually see the many blessings that were all around me. I started with simple things- seeing the beauty in nature, appreciating my good health and being thankful for having a roof over my head.

Every day I would list 5 things I was grateful for. Some days I would write the exact same thing that I had written the day before- but over time it became easier to see the many blessings in my life.  Being appreciative slowly started to bring me out of my depression and enabled me to make some necessary changes in my life.

First off, I knew I had to make an effort to make friends.  I reached out to neighbors and invited them to meet for coffee. I joined a local softball team, and found an American’s Abroad support group.  Slowly, I built up my social life- one friend at a time.

Next, I reached out to a local school and applied as a teacher’s helper. Amazingly, I got the job! Using my teaching gifts again was important.  It gave me a sense of being a part of something, my self esteem improved, and I enjoyed making a little money!

I also started walking daily.  Getting outside and getting my body moving made me feel so much better- both physically and mentally.

I share all of this because what I experienced at age 26 is actually quite similar to what many seniors experience in their retirement. Many move far from home to be near their children, leaving what was familiar to them and starting over in a new place.

It is also common for seniors to lose their sense of identity as a result of not having a career anymore. Having a purpose in life is essential to everyone.  Losing that can cause depression and anxiety.

So what can we do?

  • Encourage seniors to express daily gratitude. Teach them how to notice small things- and how to recognize little blessings. Practice mindfulness by keeping a daily journal.
  • Help seniors find their purpose- whether it’s volunteering, creating a scrapbook recording the family history, or knitting hats- everyone has a purpose and helping find it is important.
  • Look for ways you can help seniors to be social. Whether it’s meeting for coffee, going to the senior center or inviting someone to lunch- daily interactions with people help us feel connected.
  • Make exercise a priority in seniors lives! Only a few minutes a day can vastly improve mood and health. Sit and be fit classes are perfect for those who have limited mobility. If possible, encourage seniors to join a walking group or find an exercise class at a local senior center- where they can make friends and exercise at the same time.

Through gratitude, friendships, work and exercise I was able to avoid true depression. And for that I am truly grateful.

Happy Thanksgiving.

People Are Talking…

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People are talking about Capability Homecare– and we couldn’t be prouder! Here’s what they are saying…

“You matched my needs perfectly with choice of caregiver .”

“I was pleased with the quality of the caregiver. Most were able to step in and do anything that my husband needed. Some even helped with my tasks which I appreciated but did not expect. Caregivers were experienced and knew what to do when I didn’t. My husband was really struggling and this help was critical.”

“We were not expecting the excellent professionalism, energy and personality that our caregiver put out toward us. She contributed enormously to M’s dying in peace.”

“I appreciate the patience Mo and Laura had in finding the best person to care for my mom. I know it was challenging. I also appreciate the flexibility of care, it made it easier for me to be able to take mom to appointments.”

“Both caregivers were ever so gentle and efficient in caring for S. We highly recommend Capability Homecare and their caregivers to anyone in our situation.”

Capability Homecare was able to step in on short notice and the caregivers were fabulous with my aunt.”

“We mainly used one caregiver, K, who was always on time, cheerful, willing to help in any way she could, flexible and enjoyable.”

We love hearing from our clients- thank you for letting us know what we are doing right! If you need help keeping your loved one safe at home, give us a call 425 679  5770.

 

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 around $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 $400/day. This would mean if the client wakes up frequently, worse case scenario would be $400/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.  $400/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, stroke, 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