Home Care Services. Alzheimer s Association Greater Illinois Chapter 05/25/11 Page

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1 Home Care Services Home care refers to a range of services brought in to a person s home to provide care and support. Families with a loved one with dementia often seek home care services for a combination of the services below: Companion assistance with companionship, activities and supervision. Homemaker assistance with light housekeeping, shopping, cooking and laundry. Personal Care assistance with bathing, dressing, toileting, eating, medication reminders and other daily living tasks. Skilled care services nursing services, injections, therapy, medication management, etc. Hospice a combination of personal and skilled care services provided to keep a person safe and comfortable in the final stage of life. The average rate for companion, homemaker or personal care services is approximately $20 per hour. While non-medical care is most commonly paid for through personal finances, the following sources are sometimes used to cover the cost of home care services: IL Department on Aging Community Care Program, Veterans Administration benefits, Medicare, Medicaid, Private Insurance and Long Term Care Insurance. Medicare reimbursed home care services must be prescribed by a physician as part of a home health care plan; the patient must be homebound and in need of skilled nursing or therapy services and the services must be provided by a Medicare certified agency. The services are reassessed every sixty days. For additional information you can speak with your doctor, a Medicare certified home care agency or contact Medicare directly at or It is helpful to begin by evaluating the type and amount of assistance your loved one needs. Consider the attached Care Needs Assessment Tool to assist you with this step. It s important to determine what your priorities for care are. There may be a number of types of assistance at home that you would like your loved one to receive; however, if your loved one is resistant to home care services, it s often best to introduce services gradually, starting with a minimum number of hours and with tasks that the person will more willingly agree to accept help with. Over time, it will be easier to increase the amount and types of care. It s also important to consider the values and preferences of the person receiving care. What personality traits of the worker will be the best fit for your loved one? If the worker will be assisting with personal care tasks it may be important to consider preference for a male or female worker. Culture and language may also play a role in finding the right fit. Paying attention to these details from the beginning will help to ensure the success of the arrangement. When hiring a home care worker you have two main options: contracting services with a home care agency or contracting services with a private individual.

2 Arranging services through a home care agency You can obtain a listing of home care agencies serving your community from your local senior service office (The IL Department on Aging can provide contact information for your local office ), Area Agency on Aging, hospital discharge planner, the Alzheimer s Association or other health/aging organizations in your community. When you arrange services with a home care agency, the agency is responsible for screening, interviewing, hiring/firing, insuring, paying, supervising and training the worker. The agency is also responsible for complying with all applicable state and federal labor, health, and safety laws and regulations, including payroll tax and social security withholding requirements. The cost of care is typically more, but the responsibility and liability is significantly less for the family. It s important to ask some key questions when looking for a home care agency: How long has your agency been in business? Is your agency licensed, bonded and insured? Is your agency Medicare/Medicaid certified? Does your agency offer the level of care and services needed? Is there a minimum/maximum hours of service per day or week? If specialized medical care is needed, are your employees licensed to perform it? Does the agency provide a written care plan for each patient? What kind of experience, certification and training do your workers have? Do you provide dementia training for your workers? Will the same worker be providing care each time? Does the worker have reliable transportation? If the worker will be providing transportation what vehicle will (s)he use and who is responsible for insurance, gas and other expenses? Do you check driving records regularly? Do fees vary during nights, weekends or holidays? What kind of quality control checks are made by supervisors and how frequently are they made? How do you monitor worker arrival and departure times? Who is available if problems arise and how quickly will they respond? Is a registered nurse available to workers 24/7 to handle emergency calls? In case of illness, vacation or emergency does the agency replace the worker? Are local and national criminal background checks performed on all employees? How often? Do you do drug testing on employees? How often? Are your workers trained in first aid and CPR? Are your workers licensed, bonded and insured? Covered by workers compensation? Do you pay social security and employer taxes? Are employee references checked? How many? Is a list of agency references available for you to check the level of client satisfaction? Arranging services through a private individual When arranging services directly with an individual, it is even more important to screen carefully. You can work with a registry (an employment agency that matches home care workers with patients for a finder s fee), find someone through referrals from family/friends or advertise locally (newspapers, bulletins boards, faith communities, local colleges with nursing/cna programs, etc.).

3 When you arrange services with a private individual you are responsible for interviewing, hiring, wages and supervision. You may also be responsible for complying with all applicable state and federal labor, health, and safety laws and regulations, including payroll tax and social security withholding requirements. Verify accident coverage for a household employee under your home insurance policy. Your responsibility for complying with tax and social security payments is based on whether the worker is considered an independent contractor or an employee. According to the IRS, an independent contractor carries out tasks as agreed upon without direct supervision and has control over the details of how work is to be done. An employee, on the other hand, performs services that can be controlled by the employer that is the employer directs what will be done and how it will be done. Since home care services are difficult to define under these guidelines, it is best to seek guidance and to clearly document the relationship and responsibility of each party. You can get more information from the IRS at ( and/or an attorney or accountant. It will be helpful to prepare the following documents: 1) Pre-screening questionnaire these are the questions you want to ask before you schedule an interview and might include: availability, job experience and a brief summary of the responsibilities. 2) Application for individuals who meet your initial criteria you may want to have them complete an application that would include their full contact information, education/training, experience as a home care worker (contact information for previous home care employers, dates of employment, and reason for leaving), employment history (contact information for employers, dates of employment and reason for leaving) and references. 3) Interview questionnaire once you have pre-screened an individual(s), you will want to schedule a face-to-face interview(s). It may be best to schedule the initial interview at a neutral location such as a restaurant, library or other public place in order to avoid sharing your loved one s contact information with someone who may not be a good fit for the position. It may also be helpful to have a family member or friend present for moral support and to help remember and evaluate the information obtained during the interview. During the interview you will want to: Provide an overview of the position, hours needed, and type of care required. Review the tasks that you will be asking the worker to assist with or manage and ask if (s)he has any concerns or limitations that might impact those tasks. Ask about transportation how will the person get to work? If transportation is one of the services needed discuss whose vehicle will be used, driver s license, permission to check driver history, insurance, etc. Ask about any training including CPR and if (s)he is a Certified Nursing Assistant (CNA). Have the applicant describe his/her work history and a little bit about herself or himself. What does (s)he like the least/most about being a care provider? Ask questions about his/her experience with dementia care. Provide a couple examples of situations that might arise and ask how s(he) would respond (for example: If the person you are caring for starts yelling at you, how would you respond? If the person you are caring for is trying to get out of the house,what would you do?). Ask under what conditions (s)he would contact family and/or 911? Allow the applicant to ask questions during the interview and take note of what (s)he asks. Be sure to check the references provided. Ask the references how long they have known the applicant, what type of work the person did for them, how much supervision was required, how the worker treated the person in his/her care, was the worker reliable, was she trustworthy, strengths, weaknesses, any problems with drugs or alcohol, is (s)he still working for the reference, would the reference rehire the worker, etc. Consider conducting a criminal background check through the State Police. Consider checking the applicant s driving record through the Secretary of State. Consider having the applicant meet the person (s)he will be caring for so you can observe how s(he) interacts with your loved one and how your loved one responds.

4 4) Employment Agreement once you have offered the position to an applicant and the applicant accepts, an employment agreement should be signed. The employment agreement should state that both parties agree on the following terms and conditions of employment: Employment start date Termination (how much notice, reasons for termination without notice, etc). Work schedule (Hours and days including provision for time off). Pay rate and pay schedule (include agreement on mileage for transportation/errand services provided and changes in rate for holidays if applicable, etc) Employee benefits if applicable (for example: meals provided, vacation, holidays, etc) Job duties Any other terms or conditions of employment Signature and date of both parties. You may also consider having a planned trial period with a reevaluation and potential to earn benefits such as an increase in wages, paid day off, etc. Making the arrangement work Whether you arrange services through an agency or a private individual, it is helpful to spend some time preparing both for your family member and for the worker. If possible, spend a day with the worker to walk him/her through the routine and to help him/her get comfortable with the home and any equipment or appliances (s)he will need to use. Provide information verbally and in writing about your family member including: Illnesses/injuries and signs to look for that require medical attention Likes and dislikes Medications and how/when they should be taken Assistive devices including dentures, glasses, canes, etc Best ways to communicate (for example, Don t talk to Sarah before 10 AM she is not a morning person, Never interrupt John during Jeopardy, use non-verbal cues when communicating, don t ever call mom Honey, etc.) How to best prevent and respond to possible behavior challenges Mobility concerns Special dietary issues, preferred foods, least favorite foods Therapeutic exercises Emergency contact information Pay close attention to details in the beginning and address issues as soon as possible. It is critical to make your expectations clear and to provide adequate training to meet those expectations. Observe how the worker interacts with your loved one is (s)he comfortable, patient & respectful? Identify people who will see the care provider and your loved one together (neighbors, friends, medical providers, etc) and ask them how they think the arrangement is working and to let you know if they have any concerns. Treat the caregiver respectfully and encourage him/her to communicate with you. Be approachable and available. Become partners in the care of your loved one. Find opportunities to express appreciation and satisfaction for the job the worker is doing. Treat him/her like part of the family, including him/her at dinners and holidays. Remember the worker with a card and/or gift for birthday and holidays. We all like to be appreciated and recognized for doing a good job. Remember, a little praise goes a long way. Hiring a good caregiver is a big task, but it is worth the time and effort. A paid care provider can improve the quality of life of the person requiring care and family members by providing necessary support and respite from care tasks.

5 Care Needs Assessment Tool Bathing Activity Accomplishes Alone Needs some Assistance Needs a lot of Assistance Assistive Devices Used Notes Dressing Grooming Toileting Eating Mobility (walking, getting out of bed, out of a chair) Using the telephone Shopping Transportation Managing Money Laundry Housekeeping Meal preparation Managing medications and other healthcare tasks Being Alone Notes