Family Caregiver's Guide to Private In Home Care

Many communities offer a range of services for older adults who wish to receive care while living in their own home,apartment or condominium. All services accept self (private) pay. Government-funded programs may provide services at noor lower cost to individuals with limited financial resources. Funding for services will vary in each community.

Individuals should explore financial assistance or insurance coverage for any needed service.

This guide includes: (1) service descriptions; (2) potential sources of payment for services; (3) a list of service providers; and(4) suggestions for choosing service providers.

If you determine you will need to pay privately for services, there are two principal ways to obtain them: (1) going through ahome care agency, or (2) hiring a home care worker privately. This guide will help you consider which of these options bestmeets your needs.

Free, professional consultation is also available to help you:

• Evaluate all long-term care options
  
• Determine which services are needed
  
• Determine what payment options are available to you
  
• Locate service providers

Nationwide: Eldercare Locator 1-800-766-1116 or www.eldercare.gov
In Ohio: Long Term Care Consultations 1-866-243-5678
In Central Ohio: The Central Ohio Area Agency on Aging 1-800-589-7277

Potential Sources of payment for home and community-based services:

Private

• Self-Pay

Third-Party (Private)

• Private Health Insurance
  
• Medigap Insurance
  
• Long-Term Care Insurance
  
• Managed Care Organizations
  
• CHAMPUS
  
• Workers' Compensation

Third-Party (Government Funded)

• Medicare
  
• Medicaid
  
• Older American's Act
  
• Veteran's Administration
  
• Social Services Block Grant Programs
  
• Community Organizations

Home and Community-Based Services
Care or Case Management/Care Coordination

Typically provided by a nurse or social worker who assesses the client's service needs, then coordinates and monitors allservices. Case management is provided for consumers enrolled in many government-funded home care programs (forexample in Ohio: PASSPORT, Franklin County Senior Options, and Delaware County Senior Choices).

For individuals not eligible for government-funded programs, it may be helpful to hire a private Geriatric Care Manager toprovide this service. To learn more about private Geriatric Care Managers and/or find a local service provider contact:

National Association of Professional Geriatric Care Managers
520-881-8008 or search their online national directory at www.caremanager.org.

Adult Day Services – also referred to as Adult Day Care

Programs offering social and recreational activities, supervision, health services, and meals in a protective setting for olderadults with physical or cognitive disabilities. Typically open weekdays during business hours. May provide transportation toand from the center.Very often helpful for family members seeking caregiver relief.

Chore Services
Assistance with heavy house cleaning, minor home repairs, and yard work.

Companions
Provide conversation, supervision and some help with meals or tasks.

Emergency Response Systems (ERS) (also called lifelines or personal emergency response systems)

A service that provides individuals with a call button, which alerts a call center to get help from family, friends, or emergencyservices. Services may include smoke detection and medication reminders. Services/units may be rented or purchased.

Home Health Aides (or Personal Care Aide)

Provide assistance with personal care such as, bathing, dressing, feeding, some minor medical care and light housekeeping.

Homemakers
Provide assistance with light housekeeping, laundry, cooking, and errands.

Home Modification
Changes or additions to the structure of a home to improve safety and accessibility. Examples include the addition of grabbars, hand-held shower units, ramps, or stairlifts. May also include widening doorways, re-fitting bathrooms, or relocatinglaundry facilities to the main level of the home.

Hospice
Services for the terminally ill provided in the home, a hospital, or a long-term care facility. Includes home health services,volunteer support, grief counseling, and pain management.

In home Therapists
Speech, Physical and Occupational TherapiesProvide training incommunication, physical movement or doing daily tasks.

Meal Programs
Meals delivered to homebound individuals or at group dining locations in the community. Typically provided five or moredays per week.

Nurses
Provide medical care and medical monitoring.

Respite Care
Short-term care provided for an older person to allow caregivers time away from their caregiving role. Provided by trainedprofessionals or volunteers in the home or by short-term admission to an assisted living or nursing facility. Adult day servicemay be another way to provide "respite."

Senior Centers
Provide social activities, information and a range of services. May be a community dining location, and may offertransportation to members living in their service areas.

Telephone Reassurance
Regular phone calls to check on the person's well being.

Transportation Services
Provide rides to appointments, shopping, and other activities.

Private Care Options
Families seeking private home care often wonder whether they should look towards an agency to provide services or hireindividuals to provide them. There is no right or wrong answer. Every family should find a solution which best fits theirsituation.

Considerations for hiring self-employed home care workers

As the employer you will need to:

• Locate private home care workers
  
• Interview the workers
  
• Check references, criminal background, driving record, certification/licensure (if applicable)
  
• Obtain liability insurance for worker injury in the home
  
• Train
  
• Supervise
  
• Review worker performance
  
• Arrange backup coverage for worker illness or other time off or hire more than one worker.
  
• Pay the worker, file and pay Medicare and Social Security taxes for the individual.
  
• If necessary, fire the worker.

Hiring a self-employed worker:

• May be less expensive than going through an agency - if paying privately.
  
• Provides more opportunity to choose a compatible worker.
  
• May allow more flexibility in scheduling.
  
• May allow more flexibility in the kinds of assistance the worker can provide.

Background checking self-employed home care workers – resources to help:

• Ohio Bureau of Criminal Investigation and Information (BCI&I)
  
• WebCheck – electronic fingerprinting system; can do both State of Ohio and National (FBI) background checks
  
• Available through county sheriff's offices, some police departments
  
• For other agencies offering the service go to: www.ohioattorneygeneral.gov/webcheck
  
• Results should be mailed to employer
  
• Fees vary slightly; approximate cost $60 for both Ohio and national checks.

Community Care Registry (CCR) (phone 614-462-4161):

• A registry and referral service provided by the Franklin County Office on Aging
  
• A free service that assists individuals and families with finding and hiring self-employed home care workers.Provides information on pre-screened, experienced home care workers whose qualifications, availability, and
  service fees match the needs of those seeking help with care.
  
• Program participants interview and select the home care worker of their choice

Considerations for hiring a home health care agency

The agency will:

• Handle the employer activities listed previously.
  
• Conduct an assessment by a professional and develop a plan of care to monitor your loved one's progress.
  
• Communicate with the doctor and alert him/her to any changes that may develop and obtain additional doctor's
  orders for medical treatments, equipment, and supplies.

Agencies may:

• Accept Medicare, Medicaid, or Insurance for some types of care.
  
• Give consumers limited choice in the home care worker assigned.
  
• Have less flexibility in scheduling.
  
• Have less flexibility in the kinds of assistance provided.
  
• Be more expensive if paying privately, due to administrative costs.

Choosing a Home Health Care Agency

1. How long has the agency been operating?
   
2. What services does the agency provide?
   
3. Is the agency licensed to operate in the state? (Not all states require agencies to be licensed. Licensure is usuallythrough the state department of health.)
   
4. Is the agency accredited? (This is voluntary, but does indicate the agency has met national industry standards.)Accrediting agencies are listed below.
   
5. Is the agency certified by Medicare? (Medicare-certified home health agencies have met federal minimum standardsand can receive Medicare and Medicaid payment for some services.) Keep in mind agencies may choose not to
   become Medicare-certified and still provide high quality care.
   
6. Is caregiving staff available 24 hours, 7 days a week?
   
7. What are the fees? What do they cover?
   
8. What payment sources does the agency accept? (Private self-pay, Medicare, Medicaid, Insurance)
   
9. What services are covered by my insurance, Medicare, Medicaid?
   
10. How are agency employees screened prior to employment?
    
11. Are all agency employees bonded and insured?
    
12. What kind of training/certification do employees receive?
    
13. Who supervises the employees? How often?
    
14. Does the agency require a nurse or therapist's assessment of the patient's home care needs?
    
15. Does the agency consult the patient's doctor regarding the patient's care plan?
    
16. Does the agency include the patient and family in care planning?
    
17. Are there a minimum number of hours required per visit?
    
18. Is there a maximum number of hours that can be scheduled per week?
    
19. Does the agency provide written statements that explain costs and payment options?
    
20. How does the agency handle emergencies?
    
21. How does the agency handle changes in staffing/schedules?

Request and call agency references. In addition to former clients, these might include referring entities such as hospital ornursing facility discharge planners, doctors, and community home care programs.

Accrediting Agencies:

• Accreditation Commission for Health Care, Inc. 919-872-8609
  
• Community Health Accreditation Program 212-363-5555 or 800-669-1656 ext 242
  
• Joint Commission on Accreditation of Healthcare Organizations 630-792-5000
  
• Homecare University 202-547-3576

Choosing an Adult Day Service
In choosing an Adult Day Service, consider the following:

What does your loved one want or need the service to provide?

• Supervision
  
• Social activities
  
• Assistance with eating, walking, toileting, medication
  
• Physical, Occupational or Speech Therapy
  
• Health monitoring (blood pressure, food or liquid intake, weight, blood sugar)
  
• Nutritious meals/snacks
  
• Special diet
  
• Exercise
  
• Mental stimulation
  
• Personal care – bathing, grooming

As the caregiver, in what ways can the adult day service help you?

• Allow you some free time
  
• Care for your loved one while you work.
  
• Provide transportation to the center
  
• Provide practical and emotional support
  
• Assist in planning for care

Before visiting a center, call and request brochures with the following information:

• Eligibility criteria
  
• Application procedures
  
• Monthly activity calendar
  
• Monthly menu

Questions to Ask:

1. Who is the owner or sponsoring agency of the adult day center?
   
2. How long has the center been in operation?
   
3. Is the center licensed or certified (not required in Ohio)?
   
4. What are the days/hours of operation?
   
5. Is transportation to/from the center available in your area?
   
6. What are the earliest/latest pickup and drop-off times?
   
7. What are the costs for all services including transportation?
   
8. What options exist to assist with the cost of services?
   
9. Can the center serve consumers with memory loss, limited mobility, or incontinence?
   
10. What are the credentials/training of center staff?
    
11. What is the ratio of staff to participants?
    
12. What activities are provided? Are there individual and group activities? Are activities individualized to fit
    participants' abilities?
    
13. Meals – can special diets be accommodated? Are meals appealing, balanced?

Make an appointment to visit at least two centers that might meet your needs.

• Did you feel welcomed by center staff?
  
• Did staff spend time exploring your needs and answering questions?
  
• Were services, procedures, and costs clearly explained?
  
• Was the center clean and odor-free?
  
• Was the entire facility wheelchair accessible?
  
• Are participants involved in planning activities – their care planning?
  
• Was the environment comfortable – spacious, well-lighted, comfortably furnished?
  
• Is there a place to isolate individuals who are ill?

Request references from the centers you are considering and check them out.

• Give your loved one an opportunity to "try out" the center for part of a day.
  
• Keep in mind it may take several visits for your loved one to become comfortable with the new setting and routine.

Central Ohio Area Agency on Aging
174 E. Long St., Columbus, OH 43215
614-645-7250 or 1-800-589-7277 (outside Franklin County)
www.coaaa.org / e-mail: coaaa@coaaa.org