What’s involved in deciding the best home care for your loved one?
68-year-old Martin had a stroke and is getting discharged in a couple of days after spending a couple of weeks in the hospital. Since Martin’s recovery is a long process, his family is faced with a daunting decision on how to plan for his care at home. Martin’s oldest daughter Sherry feels overwhelmed because she knows that her life has just changed—she has grade school children and works fulltime. The hospital discharge planner gives Sherry a list of agencies that included both assisted living facilities and independent home care agencies. Sherry is not sure if she should put Martin in a managed facility or take care of him herself or hire a caregiver.
Sherry’s situation is not unique. I also faced it first hand with my mother-in-law, who had a fairly severe stroke in August 2014. If you are facing this situation, the first decision to make is facility versus home. Hospital counselors or social workers usually have a list of agencies—be sure to ask—but they are not allowed to recommend a specific one for you. You should therefore visit the facilities yourself. You should also consider the patient condition and medical needs, physician’s advice, your time and budget. Although the hospital-affiliated assisted living facility may be a good choice for a few cases that require temporary (subacute) care, home is the preferred choice for most folks for long term care.
I discuss below 3 primary criteria that help you make the right choice of home care provider:
- Prepare yourself: How much you know directly affects your decision—so, educate yourself through online research, talk to friends and social workers. You will soon discover that you are not alone and there’s ample help. For example, review the questions listed by The National Association for Home Care (NAHC) to organize your thoughts and to better prepare yourself. There are two types of home care agencies: those that only provide custodial care and sitter services and those that include medical care (for example, administering medication, monitoring vitals, physical and occupational therapy) as well. You should also talk to your insurance provider to see what and how much is the coverage for home care. If you have Medicare, then you should select an agency that is Medicare certified. For Medicaid, check if you qualify for the Georgia Department of Community Health Programs. You should of course discuss payment options with the specific agency you are considering.
- Caregiver: Remember, since your loved one would be spending a lot of time with them you must make sure that you are comfortable with the caregiver that visits your home. It is natural that you have many questions and concerns; you should specifically address them with the homecare agency you are screening for potential engagement. You have already seen that the NAHC link given above includes questions about the caregivers. The quality of service you get from the caregiver depends on their experience and training. So, ask the agency about their caregiver selection process. Many factors are involved in the judicious choice of the caregiver. Just like you have spent time preparing yourself, you should expect the agency to be proactive and involve you in the caregiver selection process. Since every care situation is different, the caregiver selected for you should be specifically trained and orientated to provide the best services for you. Note that caregivers are not like babysitters and there are different qualification requirements for caregivers—those that are certified and trained to provide medical nursing services, those that are certified nurse assistants (CNAs) and those that are just companions. This is another reason you should ask the agency about the specific qualification and training of caregivers they would choose for you.
Your Cared One Caregiver* Medical Needs Qualification Mobility and Activity Needs Physical Ability Personality Personality Preferences (gender, language, culture) Preferences (gender, language, culture) Environment Family-Specific Orientation Frequency of Services Availability Home Location Travel Time
Note *Carefivers should be trained and orientated for each situation
- Caregiving Process: Keep in mind that the home care services you are seeking for your loved one is not short term. I therefore recommend that you diligently seek details about the agency’s caregiving process. You are in the driver seat and conduct yourself so. Besides the caregiver selection we already covered, ask the agency to walk you through how the caregiving process starts and runs. Remember that ALL home care services are regulated by the Georgia Department of Community Health and the care providing agency is therefore required to inform you of your rights—ask them about it. You should also ask about the agency’s quality assurance program. Find out about their policies and protocols for administration, record keeping, caregiver supervision and case management. Discuss with the agency’s policies and procedures regarding incident reporting, complaint resolution and client satisfaction processes.