Day 17: Home Care (Part 2)

Host Zack Demopoulos launches his 30 day preparation plan to care for an aging adult.  He continues with Day 17 where he talks about
hiring a professional caregiver.  Specifically how to choose a home care agency, what to look out for, what to ask, and how to protect your family. 

In Part 2 we will cover questions that you should ask a home care agency before you hire them, what the next steps are after you have identified the right home agency for your parent or parents, the different type of options for shifts including 24/7 or live in’s, how to protect your family when aides visit their home, what home care costs, and the pro’s and con’s of hiring a caregiver privately. 

 

This show is sponsored by ComForCare, a national home care provider that will help you live your best life possible.  https://comforcare.com/

 

This is Part 2 of Day 17 of the 30 Day Preparation Plan to care for an aging parent.  The Prep Plan is all about helping you the family caregiver provide your loved one with the best comfortable safest and efficient caring environment in which they can grow old in.

 

The topic we continue with today is one option for long term care which is home care.

 

If you have not had a chance to listen to Days 1 through 16, please go back to Season 1 and check out these episodes.  Also in Season 1 we introduce the 9 beginner steps in raising your parents.  http://raisingparentspodcast.com/page/5/

 

We also discussed on the Day 14 Episode how your parents can age in place—what to consider so that they can live at home independently as they get older in a safe environment and with dignity.  Be sure to check that show out to if you haven’t already.     http://raisingparentspodcast.com/episode-023-day-14-what-is-aging-in-place-for-mom-dad/

 

So now you have done your initial research and you have a few home care agencies that you want to ask questions.  Here are a list of example questions you should be asking a home care agency you are considering to hire: 

• What type of agency are they? Are the aides their employees that is they are W2’s and all appropriate taxes are taken out by them or are they more of a placement agency and the aides are independent contractors that is they are 1099’s.  Typically an agency will appear to be much less expensive but what might be happening is that they are just placing aides in your home and you are considered the employer making you responsible for things like employee taxes, social security, and workers compensation.
• Are they licensed, insured and bonded? Most states require these.  I would not put anyone in my house if they weren’t.
• Will they provide you references. And if you get them, call them!  Ask for an actual client and another one that is a family member the agency assisted in caring for their loved one.
• What are the office hours? What happens after hours?  When they tell you they are 24/7, clarify what that means.  VOicemail?  On call service?  And I would go as far as testing them.  Okay don’t call them 3 in the morning but I would definitely call them after hours to see the response rate and availability.
• Is there a nurse on staff? What do they do?  Look for things like create the care plan, supervise the aides, monitor the care the aides are providing, assess your family member and do reassessments through out the year to keep the care plan up to date.  The care plan, by the way, should be written, a copy left in the house, and the aide or aides use it to review what is expected of them in caring for your parent.
• Are the aides certified or licensed? How do they get certified?  What is your hiring process when you hire an aide.  What is your training program?  What is your follow up once you place an aide in your parents home.  Do they make unannounced visits?  When can you expect these?
• What are the costs? Is there a charge for the nurse?  Additional costs beyond the hourly rate?  IS there a night or weekend rate?  How about holidays?  Is a deposit required and how does that work? Is there a minimum hourly commitment per shift and per week?  What is the cancellation policy?  When are you billed?  Do they take any insurances?  (Usually not, long term care insurance, Medicaid).  Medicare supplemental in 2019.
• Ask for copy of the written agreement that your parent or you will have to sign. Be sure to read it thoroughly and ask questions before you sign it.  Typically these agreements are more about protecting you than the provider but still very important to understand what you are signing.
• Ask if you can meet the aide in advance? And what is the process if it is not working out with the aide they assigned.  What do they do when an aide cant make it to their shift?

 

Next steps:  Nurse conducts an initial assessment of whom is receiving the care and they create the care plan.  The agency then matches from their qualified staff who would be the best choice.  Ask about this process. 

 

Typically you can find aides to do pretty much any kind of shift you need.  As little as one hour or two per day or week, shifts that match your working hours, overnight staff, weekend help, around the clock 24/7 or someone who lives with your parent.  Important to note that someone who lives with someone they are caring for is NOT considered working around the clock.  Zack reviews these types of shifts.

 

 

Must protect your family. First of all, even though agencies will tell you they are bonded and insured, you still want to eliminate any chances of theft.  I would make sure all valuables are locked up.  I would also make sure any information with social security numbers and confidential information that can lead to identity theft be out eyesight.  Warn your parents of any suspicious behavior and how they must report it immediately.  Never never give an aide money or credit cards unless you know about it and it is for an exact purchase—like groceries.  No check books should be out.  Make unannounced visits all the time with no real schedule.  The aide should never know when you are coming.  The agency should be making unannounced visits as well and report to you anything they observe.

 

Zack reviews what homecare can cost and some ways to pay for it.

 

• You’ll get a few hours paid for by Medicare if a doctor prescribes it and if it is related to a hospital discharge.
• If a parent qualifies for Medicaid, which I recommend everyone always explore as a long term back up plan, then home care can be paid for by them.
• There is long term care insurance which pays for some home care but typically you need to have had that for a while and it is expensive.
• The Veterans Administration has a program called Aid and Attendance which if someone qualifies as a vet during an active war and they fall under thefinancial guidelines, they can receive a pension payment every month towards home care. https://www.benefits.va.gov/pension/aid_attendance_housebound.asp  
• The Alzheimer’s Association may provide some relief as well if the care recipient has dementia. You would need to contact your local chapter to see there are any funds available.  https://www.alz.org/help-support/caregiving/care-options/in-home-care
• Contact the Area Agency On Aging to see if there is any kind of respite care that is paid for.
• The average cost across the nation is $20 an hour according to a survey conducted by Genworth Financial in 2015.    http://www.aging.com/in-home-care-costs-breakdown/.   The average monthly cost is around $4,000 per month. Of course this depends on how much home care you are getting, are there overnight and weekend higher rates, are you higher in a live in?

 

The Survey Showed That The Most Expensive States As Far As Senior In-Home Care Is Concerned Include (Average Costs):
North Dakota – $27
Alaska – $26
Hawaii – $25
Massachusetts – $25
Minnesota – $25
Rhode Island – $25
While The States With The Least Expensive Senior In-Home Care Services Include (Average Costs):
Louisiana and West Virginia – $16
Alabama, Arkansas and Mississippi – $17
Georgia, North Carolina and Tennessee – $18

 

Other issues around cost:  Be sure to ask the agency about all costs involved.  Is there a charge for the nurse when they conduct assessments?  Most agencies include the cost in their rates.  Others do not.  Is there a deposit required?  Is it 100% refundable.  Some agencies ask for two weeks of service in advance.  How is payment received?  Credit card?  Automatic electronic withdrawal from checking accounts which is convenient for long distance caregivers.  WHat is the cancellation policy and are there any costs involved with that? 

 

Hiring a family caregiver has a lot of upside. 

• Usually already trusted and known by the family. Feel more comfortable with them.
• Usually affordable.
• May show more care and compassion and attention to your parents.

The down side? 

• Family conflicts arise from family caregivers. It is important to clarify their role and be specific to what they can and cant do and who they “report” to. 
• If you are paying them, then remember, you are the employer. Taxes and workers compensation may be required to be taken out.  Check with your state laws. 
• And most long term care insurance companies will only reimburse home care costs if the caregiver came from an agency so check with them as well before you start.

 

Hiring a private aide is also affordable but like the family caregivers has some risks:

• Tey are your employee so check with your state laws. You usually as the employer are responsible to report their wages, take out for taxes and social security, and pay for workers compensation. 
• Did you conduct a background check and thoroughly research their references.
• What is their training? Usually they are not certified and they are not being supervised by a nurse. 
• If something happens, like they have an accident or theft occurs, how will you handle it? If they do not show up to work or get sick, how will you replace them? 

Be extra diligent in your evaluation of that option and know that you will need to closely manage the situation to make sure it is a good option. 

 

Here is the last piece of advice if this applies to you:  If it is not urgent or an emergency to hire a caregiver whether it is private or from a home care agency, take your time and do your research.  That way the head will work equally as the heart.  This is an emotional process and a very important decision to make.  Take it seriously.  The good news is that there are many good agencies out there so doing your research will reveal good choices. 

 

So that’s Day 17.  Join us for Day 18 as we talk about another long term care option:  Adult Day Care Centers.

 

Thank you for listening to the Raising ‘Rents podcast. If you have any questions or feedback, please go to our website www.raisingrents.com and click on the “Contact” tab.  Let us know about any topics you want covered.  You can also find the show notes and references to anything we talked about.  Until we talk again, remember that our parents raised us, the least we can do is help raise them. Talk to you later.

Sources used in this series:

Intro/outro music: Arthaiz

Other music:  Philipp_Weigl_-_01_-_Subdivision_of_the_Masses, Blue_Dot_Sessions_-_06_-_Wahre
Daughter Anastasia Demopoulos does the opening voice over
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