Often, family members find themselves having to deal with a parent's deteriorating health from a distance. So, how do you do that, especially when you have no idea of what your loved one might need? Independence is the key. A geriatric care manager specializes in assessing an elder persons needs and making recommendations for their health, finances and legal needs. As a licensed in-home care agency we are more than happy to evaluate your loved one for in-home care, but sometimes the bigger picture needs to be addressed to. In these cases we will quite often advise a geriatric care manager be brought in. In the Hood River area we recommend "Age with G.R.A.C.E".

go to www.caremanager.org to find a qualified geriatric care manager in your loved one's area.

From January 2012, there are new requirements for training caregivers who work in Washington state. In summary, caregivers who are not exempt (e.g. certified nursing aides) will now have to have 75 hours of training within a few months of working with clients. It is a good idea for caregivers to have training. There is a huge responsibility in placing caregivers in an elderly person's home, where supervision is minimal by the nature of the job. It is essential that caregivers have the skills as well as the moral strength and character to provide such a needed service to the elderly. However, in my opinion this legislation could have some adverse effects.

Firstly, although 75 total hours training is required, only 5 hours have to be completed before a caregiver can be placed with a client (the remainder has to be completed within 120 days). If the aim of this legislation is to protect clients, then it seems to me that caregivers should have much more than 5 hours of basic training before being allowed to work, unsupervised, with their clients.

Training is not available on-line, but has to be done through recognized training centers throughout the state. In our case, this would mean sending our staff about 70 miles for training (from Hood River to Vancouver, the nearest training center), which would probably entail overnight accommodation as well as payment for the training, travel time and mileage. Training centers do not all offer the same courses, so staff may well have to go to different centers to get all the required training.

All this adds up to increased cost of service to clients, since companies will have to pass on the increased cost of employment. Even if agencies decide to employ only certified staff who are exempt from the training requirements, presumably they will demand a higher salary than a non-certified employee, and again, this will all equate to a higher cost for the client.

For some agencies all of this may be just too much, and they may decide to pull out of Washington altogether.

In the meantime, private, individual caregivers remain exempt from any of this legislation. They can charge a lot less than an agency (the client often does not realize that he or she is responsible for employment taxes, insurance etc just like any other employer), and they are unregulated. There are a lot of very good, private caregivers out there; but there are also people who are unscrupulous and see working with the elderly as an easy way to make some money. Only yesterday, we were approached by a gentleman whose mother had been befriended by a seemingly caring lady, who ultimately defrauded her of a large sum of money.

In summary, the worst case scenario is going to be a proliferation of unskilled individuals working as caregivers, which I am sure is not the aim of this legislation. When people have to have services from an agency, for instance if the care is being paid for by a long-term care insurance company, the costs are going to be much higher and this will impact on the amount of care that they can afford. All this does not add up to a better deal for the client.

For our part, we have looked closely at the training and credentials of our caregivers working in Washington state and intend to comply with the requirements. But we will have to consider carefully taking on any new clients, or caregivers, from Washington state.

These are my views based on my understanding of the legislation, which may be lacking. I welcome constructive feedback.

What is Home Care? Is it the same as Home Health?  Hospice?  How does Home Care work, and how does it relate to Home Health and Hospice?

 What is Home Care exactly?

Home Care is a service that provides the client with companionship and assistance with day to day activities. Typical services include: light housekeeping and laundry, planning and preparing nutritious meals, helping the client to take exercise, grocery shopping, incidental transportation, assistance with bathing and dressing.  Care is provided on a visiting basis wherever the client lives. Home Care is a good option when a client can no longer live alone effectively but is not ready to move to an assisted living facility. Think of it this way – home care is like having the benefits of assisted living brought to the client’s own home, tailored to his/her needs and his/her schedule so they get just the care they want when they want it.  Home Care is not covered by Medicare or Medicaid, but may be covered by a client’s veteran’s benefits or long-term care insurance policy, especially when the alternative is expensive assisted living.

How does Home Care differ from Home Health?

Home Health agencies provide skilled nursing services and at least one of the following therapeutic services:  Physical therapy; Occupational therapy; Speech therapy; Home Health aide services. As with home care, services are provided on a visiting basis, generally in a client’s own home or in a temporary residence. Visits by Home Health are generally short and intended to provide brief treatments or care.  Home Care, on the other hand, does not normally cover medical services, and the emphasis is on providing companionship and care on an ongoing basis. Both types of care are very necessary and complement each other.

How does Home Care work in a Hospice situation?

Hospice organizations can provide acute, respite and Home Care for a client in the final stages of life, as well as bereavement services and counseling for family members. They often do not have the resources, however, to dedicate a large amount of time to each patient, and an external Home Care agency can bridge that gap.

Home Care can be accessed on its own or in concert with Home Health or Hospice services.  Caregiving services can be very flexible and can be provided from as little as 2 hours per visit. Overnight shifts or even 24/7 care are available if needed. 

When you decide to bring a caregiver into your home to care for you or your loved ones, it can be a daunting task to pick the right person. As well as the obvious criteria, such as cost, you will have to weigh up whether this person is going to be a good fit, and whether they have the necessary skills and common sense to give you the confidence to leave them in charge for a period of time.

If you choose to interview a number of people (which is a good idea), its a good idea to have a list of questions to ask. You should ask the same questions of everyone, otherwise you are not judging "apples with apples". Interviewing can be a minefield, however, as there are a lot of questions that you cannot legally ask an applicant. A google search on 'acceptable interview questions" is a good start. Remember to ask situation type questions, which do not have a yes/no answer. Such questions may start "what would you do if....." or "what would you do in this situation....". You can then ask questions that are specific to your situation, to get an idea of how this person would react and deal with an event that may occur.

It is important to know that the person you bring into your home does not present any risks to you or your loved one, so it is important to carry out background checks and drugs screening tests. You will need to get the applicant's permission to follow up on references - again, have standard questions that you ask every referee. Be aware that most employers will not divulge a lot of information - it may just be limited to the employment dates. A good question to ask is "is this person eligible for rehire?"

Once you decide on the right person, be sure to put together an agreement or contract so there is no confusion about what the person is going to be paid, and how often. Try and nail down all the details as much as possible - is there a travel allowance? Is there time off for meal times? Paid holiday?

Finally, be aware that as an employer (which is what you are if you hire a private caregiver), you are responsible for the employees taxes and insurance. Insurance is a very big issue - if the caregiver falls or otherwise hurts him or herself whilst in your home, you could be responsible for costs of treatment or even lost wages.

If you are feeling that there is a lot involved here, then you are right. It can be a minefield to hire a private caregiver - although there is no doubt that it can work. The benefits are that it is a cheap option - and if you find the right person, it can be a great relationship. But quite frequently things do not turn out as well as hoped, and things can go wrong, leaving you feeling vulnerable.

Luckily, there is another option, and that is hiring an in-home care agency to provide your in-home care needs. A reputable agency will carry out all the interviewing and background checks that are required, including drugs screening, and will make sure that the caregiver is insured to work in your home. they should work hard to make sure that the caregiver is a good fit for your situation - and if it isn't, they should provide a replacement. You have a contract with the agency rather than the caregiver, so you never have to talk about money with the caregiver. There is also ongoing training and supervision, to make sure that the caregiver is doing what they are supposed to do. Make sure that the agency is licensed in your state, and has a good reputation. Do not be afraid to ask for references or testimonials, and take note of what other people might be saying about the agency. Make a point of meeting the owners or managers - if you feel comfortable with them then you will feel more confident with the staff that they send. Also, if you have long term care insurance, most companies will only accept care that is provided through a licensed agency.

The downside is that care is more expensive through an agency; but you do not have the burden and responsibility of being an employer.

When you choose a long-term care policy, your premiums are based on some decision that you make about the care you want. For instance, you will probably be able to set the elimination period to end after 20, 30, 90 or even 120 days - or may be able to choose a zero day elimination period. The longer the elimination period, the cheaper the rates will be - but you have to remember that you are responsible for covering the days of service before the insurance kicks in. Often times, when policies were taken out a long time ago, the client has forgotten the fine print - and it can come as a shock when they have to pay for services for a period of time before the insurance company picks up the bill. Many people actually cannot afford to do that - and so they never take advantage of their policies.

Also, you need to be clear about what will happen when you make a claim. Will your monthly payments stop automatically, or will you still have to make them while you are receiving care?

Another fine print item is the duration of care. There is usually a maximum term allowed under the policy - a cap if you like - so that the benefits may be used up and you still need the same, if not more, care.

One thing that can catch people out is the daily amount benefit in their policies. You may have a policy that entitles you to up to $100 per day - but that does not mean that you will automatically get $100 per day as soon as you need help. Like home insurance, there is often a "loss adjuster" involved, who takes a look at the Plan of Care, and sometimes doctor's notes, and decides how much the company will pay per day.  They will let you know in writing how much that will be, but communication from insurance companies can be slow and you may have already engaged services at the full rate. You will then be responsible for anything that the insurance company does not pay for.

If your needs change, you will typically need a re-assessment by the in-home care company to be submitted to the insurance company for approval.

It is a good idea to sign an "assignment of benefits" form as soon as you decide to have a home care agency work for you. Your long term insurance company will have their own form, but you can usually also use the company's form also. An assignment of benefits form will allow the in-home care company to invoice the insurance company on your behalf, and receive payments for their services directly. Alternatively, you can have the insurance company make payments to you instead - but you must remember to forward these on to the company that provided your services. In either case, you will be personally responsible for any services provided that are not covered by the insurance company. And that could be significant - if bathing assistance is a required ADL on your care plan, and you decline a bath, you will be responsible for the cost of that whole visit if the insurance company does not pay.

So, in conclusion, if you expect a long-term care policy to cover you for in-home care services, make sure you know exactly what the policy covers. Any reputable in-home care agency should be able to help you with reviewing your policy as part of their service.

Here at Hearts of Gold Caregivers we regularly work with clients who have long term care insurance. Often, policies were initiated many years ago, and the all important policy document long since filed and forgotten. However, the policy is really the starting point for us in assisting the client to have their in-home care paid by their insurance.

The first thing to note is that all policies are different, and all insurance companies are different, but there are some common threads.

Typically, the policy will include an "elimination period". That means that the client is responsible to pay the first days of service themselves. A common elimination period is 30 days. It is important for the client to check with their insurance company as to the elimination period, and also what qualifies. For instance, you may have a policy that covers 3 hours a day - but you may not have to have 3 hours of care per day during the elimination period. That can save you money.

Also, the type of in-home care that you need is important. Most policies will only cover you when you need assistance with "activities of daily living" (ADL's). There can be subtle differences between companies on what counts as an ADL but most include bathing, continence, toileting, eating, transferring (e.g. between a bed and wheelchair) and dressing. Further, the policy will require the policy holder to need help with a given number of ADLs per visit. We usually see companies requiring 2 or 3 ADLs.

So, how do you know if your needs qualify under your policy? If you are employing an in-home care agency, they should come and do an in-depth assessment of your needs. This could take between 2 and 3 hours, and should be free. From there the agency should draw up a Care Plan based on the assessment, that stipulates exactly what is needed each time a caregiver visits. The Care Plan should be submitted to the insurance company with your claim - any reputable in-home care agency will do this for you, and liaise with the company, if you have long term care insurance.

Next time, we will talk about other things that you need to be aware of when considering if your long term care policy will cover in-home care services.

I don't know about you, but I dread the thought of relocating to a new home.  Sorting through all of my stuff, packing it, selling it, giving it away or throwing it away would take days… weeks.  The longer I live in one spot the more stuff I accumulate and the deeper I find myself "dug-in".  I have lost track of the number of times I have had to pack and move.  To be sure, I do not look forward to the next time I have to move. 

 I think most people feel the same way.  Older folks are no different.  Many of our clients have been living in the same home for 20 – 40 – 60 years or more.  And at their age, with all the history that they have enjoyed in their home, there is no way that they are going to pull-roots and go live in some “home”.  Unfortunately, this is just what happens so often when older people reach a point in their lives when they struggle to properly care for their home or themselves.  Well meaning family, friends, senior service organizations, etc. will place older people into foster homes, assisted living or nursing care homes to keep them safe, healthy and hopefully – eventually – happy.

 Home care is a relatively new option that many people are still unaware of when it comes to providing care for seniors.  Enrolling a home care agency that provides caregivers who can provide tailored care for an elderly person is often the easiest, most cost effective solution to caring for seniors.  The best part is, the service will enable them to maintain their independence and in their own home for as long as possible.  And that’s what we’re all about.

 

The time has come for us to upgrade our website by adding a blog.  There is a lot of information out there to help seniors and the families of seniors.  We are committed to bring some of the more relevant information to you through this blog.  We hope you enjoy our blog and invite you to share your comments with us.
Best Wishes

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