For Caregivers
Caregiver Agencies
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There are two primary types of agencies that provide care for persons requiring assistance within the home:Home Health Agency
Primarily provides services under Medicare. They offer skilled services which must be ordered by a physician, not custodial care. These are the kinds of skilled nursing services persons may need when discharged from the hospital or an acute rehabilitation center. Home Health Agency caregivers have training that qualifies them to do skilled nursing tasks such as dressing changes, catheter care, feeding tube care, and respiratory care. They also provide in-home therapies, medical equipment and supplies. All Home Health Agencies are Medicare certified and may also have accreditation from the Joint Commission for Accreditation of Health Care Organizations (JCAHO). Individuals eligible for Home Health Agency services must be homebound (unable to be transported out of the home for the same care) and have a skilled care need.
Home Care Agency
Provides custodial care and other types of personal care in the home. This type of agency provides assistance with activities of daily living, transportation, and help with cognitive or behavioral management. It provides supportive services that persons need to live their lives in homes and communities over an extended period of time. Some Home Care Agencies also offer skilled nursing, but most do not. Not all Home Care Agencies are licensed – it depends upon the requirements in each state. Families should confirm the status of an agency before contracting for services.
How do you find a good Health Care or Home Care Agency?
A good agency will partner with the family and client in providing and overseeing services. How the agency interacts with you during the initial contact gives the first indication of whether or not to explore that particular organization further. When you call, how do they answer the phone? If the agency is unable to hire front office employees who are polite and courteous, their ability to hire competent employees in more critical areas is doubtful. The first contact sends a strong message about the agency’s priorities and commitment.
If you move to the inquiry stage, be aware of your reactions. How do they make you feel? Are the individuals knowledgeable? Do you sense a level of trust and confidence? The following questions touch on the key information a family needs to know before hiring an agency:
Other Questions to Ask
- How long have they been an operating business?
- Is the agency licensed? Many states don’t regulate homecare services. The Department of Human Resources or other regulatory body in each state can provide information regarding the licensure requirements for homecare agencies. The Council on Aging can provide information as to the reputation of a particular agency.
- Is the agency accredited? Accreditation is an option that implies a higher standard of care. It should come from a nationally recognized body such as CHAP (Community Health Accreditation Program) or JCAHO (Joint Commission for Accreditation of Healthcare Organizations).
- Are they approved to provide services through any state or federal program? Agencies must meet higher standards of training and financial accountability to participate in these programs.
- Do they offer 24-hour/day, seven-day/week services? Does the agency provide a 24-hour/day, seven-day/week supervisor to call for problems which may arise outside of the normal business hours?
- Do nurses (RN) oversee services such as the client’s plan of care? At what frequency is the individual evaluated and the plan of care updated?
- What are their employee hiring requirements?
- Do employees undergo the following:
- Criminal background checks?
- Psychological evaluations?
- Drug screening?
- Validation of driver’s license?
- Validation of licensure or certification?
- Do their employees have CPR and First Aid training?
- What competencies are expected of the caregiver they send to the home, i.e., lifting and transfers, wheelchair safety, van use, homemaking skills, personal care skills (bathing, dressing, toileting), training in behavioral management and cognitive support?
- What is their policy on providing a substitute caregiver in the event a regular caregiver cannot provide the contracted services?
- What if there is dissatisfaction with a particular caregiver? Can he/she be replaced “without cause”? Less reputable agencies claim their only responsibility is to provide a person, not a match for the person or family seeking a caregiver.
- What are their billing practices:
1. What do they charge? Check various agencies in your geographical area for customary rates.
2. Will they bill insurance companies for their services?
3. Will they identify and bill government agencies that may cover the homecare services required?
4. How do they arrange for payment? Cash, credit card, check?
5. How do they charge?
6. Do they require a pre-payment in advance to initiate the case? A credit card is often required to establish billing. Advance payment may be required if credit card validation is problematic.
7. Do they have scheduling fees? This may be a red flag as these agencies often make more money on scheduling than keeping customers satisfied with their services.
8. Do they require you to sign a contract commitment for a period of time? This is another red flag. Agencies committed to the client service do not need a contract to keep their clients. Often they attract business by offering services for lower rates but make up their costs in other ways such as additional fees. There may be less of a commitment to work toward a good fit between the client and caregiver when a contract guarantees an agency your account. If a choice is made to sign a contract, what is your recourse if unhappy in the future? The specific contract negotiations should be provided in writing and signed by both the agency and the customer or client.
9. If you terminate your agreement and the agency owes you money, how long is it before your money is refunded?
- What is the mission statement of the organization? This should give you an idea of their philosophy of customer service and commitment to the clients they serve.
- What is their process for establishing a service relationship? Typically, agencies will have the individual seeking homecare be evaluated by a nurse and provide information regarding the anticipated level and intensity of services for which they may benefit.
- Is the agency willing and able to accommodate any special requests you have for the caregiver? There are many circumstances in which a family needs a caregiver to have certain skills, abilities and/or characteristics beyond their caregiving qualifications. What if another language is spoken in the home? What if a teenage girl prefers only female caregivers? What if a person needing care is exceptionally tall or heavy—can you request that only caregivers of sufficient size and strength be assigned? If so, these agreements between the client and agency should be placed in writing. (There is a big difference between caregivers who are needed as “sitters” and those who must be able to address the physical, cognitive and behavioral needs of an individual.)
- Does the agency support the rights and responsibilities of the client as well as the agency? Request a written document with the client rights and responsibilities during the initial meeting and document in writing any alternations to the rights and responsibilities outlined.
- What is the reputation of the company?
- Check business references: Better Business Bureau, Chamber of Commerce, State Medicaid Agency, Council on Aging, State Brain Injury Association, and/or the most recent social worker/case manager who worked with the client.
- Check personal references. Ask people you meet in the rehabilitation and social settings which agencies they have used and inquire about their experience. Was the agency easy to work with? Were they honest? How was their customer service? The best resource for finding a good agency is persons who are in the community for a while and have used such services. Informal references are often the most valuable.
Ms. Buchanan serves as the Director of Clinical Services & Safety for Southern Home Care Services. Through its state-licensed and CHAP*-accredited offices, Southern Home Care Services provides personal support, respite, homemaker, skilled nursing services, and a variety of specialty services to clients of all ages. In her corporate capacity, Ms. Buchanan oversees clinical operations for all of the Southern Home Care Services’ offices. A Registered Professional Nurse, Ms. Buchanan achieved specialty certification in Critical Care Nursing as well as in Nursing Administration and worked for many years in acute care hospital settings.
Southern Home Care Services is a wholly-owned subsidiary of ResCare, Inc., a leading provider of residential, therapeutic, job training, educational, and in-home support services to populations with special needs, including persons with developmental and other disabilities, including those caused by acquired/traumatic brain injury and spinal cord injury.
www.hahc.org - National Association for Home Care which provides articles about choosing a Home Care Provider
www.medicare.gov/HHcompare - A Medicare website offering comparisons of home health providers identified by zip code.
https://cms.hhs.gov - A Medicare and Medicaid website which offers information regarding the differences between home health and home care and provides information regarding available waiver programs which may reimburse for home-based services.
www.aoa.dhhs.gov - An Administration of Aging site which links to the Eldercare Locator and area agencies on aging network.
www.eldercare.gov - a site which links to caregiver resources and information about hiring in-home help.
www.jcaho.com - The Commission on Accreditation of Health Care Organization site which offers information regarding home health standards and agencies which have received JCAHO accreditation.
www.chapinc.org - The Community Health Accreditation Program site identifying home health agencies which have received CHAP Accreditation.