Having the 'what's next' conversation with an aging parent has to be one of the most difficult we will ever have. Suddenly, the long-ago parent/child relationship flips, which is emotional and awkward for all involved. As Baby Boomers prefer to 'age in place,' that means adamant seniors are declaring "Absolutely no nursing homes or assisted living facilities." Thus, the pursuit of the best possible solution begins.
That conversation leads to a seemingly endless cascade of questions, starting with whether the in-home service requires 'home health care' or 'non-medical home care.' Next comes the company vs individual decision. All told, taking the right steps and asking the right questions will determine if it is a great or not-so-great experience.
The decision to investigate in-home care may result from a medical emergency or a simple, but painful acceptance of reality. Whatever has triggered it will affect your investigation timeframe dramatically.
Once you define whether the care needed is medical or non-medical, the next question is whether to go with a company or to seek out an individual. There are positives and negatives with both options. Regardless which direction you take, your first step is to carefully define the precise needs of the senior being cared for, ideally developed with the help of that senior. Those needs will change with time, but the goal is to find the best solution for now, not to second-guess future needs and short-change today's solution.
Payment becomes a critical factor. Is there a long-term disability insurance policy in place? How much will it pay and under what circumstances? If not and if the need is medical, perhaps Medicare will pay part or all, if a doctor authorizes it and establishes the care plan. If the needs are non-medical, what are the resources available to the senior and the senior's loved ones? The final answer will go a long way in defining what options are affordable.
Next comes the interview of companies or individuals, depending on your decision. You should have a detailed checklist of questions prepared for use in each interview, so you can jot down and compare responses after interviewing three or more candidates.
In-home care can become a necessity in such a wide range of situations that its direct benefits are equally varied. Care for a senior who has suffered a medical emergency will be far more critical and will demand far more training from the caregiver that is selected. Care is very different when covering simple home tasks for seniors who are unsteady on their feet, who lack focus or energy, and who have declined beyond the safety net provided by a medical alert system.
Regardless, in any case, the benefits to the senior (and to loved ones) include:
- enjoying the peace of mind that comes from knowing that nothing untoward will occur without help being at hand;
- knowing that medical needs are being met;
- knowing that all basic comforts of nutrition and hygiene are being provided;
- feeling like less of a burden, which allows other family members to live their lives;
- having the companionship of regular human contact, instead of isolation which can be so debilitating; and
knowing that the caregiver, if correctly vetted, has the qualification and compassion to handle whatever presents itself, or the wherewithal to get the appropriate help.
You may decide to look at the well-known names among in-home care companies. These are typically national companies with local franchised operations. You also may look at smaller local or regional businesses, or even at individuals who offer such services.
In any case, when comparing the in-home care services available in your area, a major filter for you will be the cost. Next will be a warranty of services and whether they are flexible enough to change with the senior's changing needs. How easy it is to use the service is important, as is the ability to cancel a service without having to negotiate your way out of a difficult long-term contract. Lastly, you want to have easy 24/7 access to customer service to cover any foreseen or unforeseen issues.
Among many other factors, you also want to know that your loved one will be cared for by the same caregiver, with few unavoidable exceptions. You want to know the company will help with insurance matters if needed. Also, you want to know if the company's caregivers are qualified to provide medical services.
If you are selecting a company that will provide a caregiver for your loved one, you want to get personal recommendations, if possible, and check your local government's senior care office for company references. (The Better Business Bureau is not always an effective reference as quality can vary from franchise to franchise.)
You are paying a premium by going through a company. For that, you want confirmation that it screens its applicants for background checks, drug tests and legal status in the U.S. The company should offer training and handle all the paperwork, to include wages, State and Federal taxes, Social Security, Worker’s Compensation and required insurance. You want to see proof that the company is licensed, bonded and insured, and that coverage extends fully to its caregivers.It is also critical that the company be able to provide ready backups if your selected caregiver becomes temporarily or permanently unavailable.
On the other hand, if you are hiring a private caregiver directly you will have more control over the selection process itself. However, much more of the burden will fall on you. You may find the person through some specialized websites or your network of family, friends, fellow churchgoers or work colleagues.
You will have to do all the due-diligence, including carefully checking references and running background checks. You will have responsibility for insurance, taxes and all legal compliances. Paying someone in cash is both risky and illegal; the idea should not even enter your mind.
Besides having proven experience, a private caregiver has to have relevant training and credentials. (Some states require certain licenses and certifications for in-home caregivers as well.)
It is best to have a well-written contract that you both sign. That contract should spell out duties and responsibilities, all compensation and benefits, guidelines on using a family car, confidentiality with personal information, and notice and severance in case of voluntary or involuntary termination. Remember, you are hiring an individual who will be in the home of a loved one, without supervision. The need for caution and thoroughness cannot be exaggerated.
Lastly, if working with a private individual, you will be responsible for having a 'Plan B,' when the caregiver for some reason is unavailable.
Two areas are prioritized when obtaining services for seniors: age-friendliness and health-related value.
Regarding age-friendliness, often it is not the senior who will be negotiating with an in-home care company, so aging is irrelevant. However, the senior's demands and needs may evolve and lead to changes in the care plan. For example, if dementia is observed, the skills required of the caregiver may mean the caregiver has to be replaced, as difficult as that may be for the senior. Unfortunately, none of this process is easy.
As for health-related value, the value of a good caregiver grow as the senior's health declines. Depending on the nature of the health condition, again it may become necessary to change caregivers to ensure the person has the training and certifications required to provide more regulated medical care.
One factor to remember: as care becomes medically necessary, payment through Original Medicare Parts A and B may become available. Hopefully, that change in payment method will not lead to a disruptive transition away from whatever solution had been working for your loved one
It is unlikely that you would ever be able to go to the website of an in-home care company and determine the cost of caring for a loved one with sufficient accuracy to make any decision. To compare your options, you will have to obtain individual quotes after you have identified the exact needs you are seeking to cover for your loved one and after you have vetted the company (or individual) for all your other requirements.
True costs will be built on a care plan, which is a schedule of services that are customized to the senior's needs. (In some states, formal care plan development is required for each customer as a means of establishing responsibilities.) The actual services rendered, which will be billed by the hour, will presumably be rated differently depending on the level of care being provided and each caregiver's qualifications.
In developing the care plan, you will want to know if there is a minimum number of hours billed for each visit by the caregiver. If working with a company, the company's fees are included in the hourly rates, but you want to be certain that there are no hidden charges. You want the same clarity if working with an individual.
You will want to know about billing and payment policies: how often they bill, what payment methods they accept, if they accept long-term care insurance and, if so, whether you need to prepay and seek reimbursement, or if they will bill directly.
In hiring in-home care services, your initial evaluation criteria will include the cost, warranty of services, ease of use, ability to cancel and access to customer service.
Cost: Whether a cost is workable or not will depend on the resources you have available to cover the care plan defined for your loved one. Financial assistance may be available through Medicare, Medicaid, Veterans' programs and State non-Medicaid programs. If self-paying, options may include reverse mortgages and home-equity loans, life insurance policy conversions, home care loans and long-term care insurance.
Unfortunately, the duration of service is rarely known, unless it simply covers the recuperation from an accident, for example. So many factors go into in-home care being successful that you may not find the least-cost option to be the best one.
Warranty: The greatest warranty an in-home care service provider can offer is that they will be there when you and your loved one need them: days, nights and weekends. They can guarantee to work with you to be sure the assigned caregiver is the best available fit regarding skills and personality. If they do not fulfill that warranty, the alternative is to move your business elsewhere.
Ease: When a senior starts losing his or her independence, it is a difficult time for all involved. The in-home care service solution you select must be easy in all aspects: easy to engage, easy in the day-to-day interactions with the senior and easy to administer.
Cancellation: There is no reason for you to accept any obligation for any duration of service and you should be able to cancel at any time. However, it is only fair that companies have a cancellation policy, clearly defined as a minimum number of hours of advanced notice, so they can best utilize their caregivers' schedules. Penalties for failing to do so should be clearly stated. Notification typically must be made to the local headquarters (and not to the caregiver) during normal business hours.
Customer support: Caregiving is not an activity that happens nine-to-five. Assistance with administrative issues may be restricted to normal business hours, Monday through Friday, but support for issues related to caregivers and caregiving should be available by phone 24/7/365.
In selecting an in-home care service, you will want to know that one person will be assigned to your loved one, based on the qualifications of the caregiver, as well as on the caregiver's high level of compassion and dedication, and on the compatibility of personalities. The better the chemistry between the two people, the more successful the service will be.
Working with a company is easier than working with an individual when it comes to the insurance and financing options available. In-home care is an expensive proposition; the more resources you can bring to bear that lower the amount you need to self-pay, the better. It is unlikely, for example, that an individual would be able to receive payment from Medicare or Medicaid.
Continuity is very important when it comes to caregivers: as seniors become older and less healthy, they deal less well with change. Change may become necessary when a senior goes from non-medical (or custodial) care to medical care, as some companies simply do not offer medical care. You might want to consider this as you select a company early on.
When it comes to choosing among the large national companies that function through franchises, understand that they are quite similar. What counts is not how the company markets itself on its website. Instead, what counts is what people in your community say about the local franchise of that company. That is who you will be dealing with regularly, not someone at the parent company.
Get referrals from friends. Read local reviews. Check with the senior associations in town about who has the best reputation for trouble-free, life-enriching relationships with clients. You are opening your loved one's home to people who can make a challenging time much easier. Or much harder. It is up to you.