If you are considering home care for yourself or a loved one, it can be overwhelming.  You are trusting a stranger to provide quality care and allowing them into your home.  There are terms used in this industry such as companion care, personal care, caregivers, certified nursing assistants (CNAs), private pay, long term care insurance, care plans and certain accreditations.

It can be confusing to know what all of this means.  I held a director of nursing role for a national home care agency for many years, so I’m here to give you the tools you need to make the process easier.  This is your complete guide to home care, based on Maryland regulations, but it should be relevant in any state.

Companion Care vs. Personal Care

Let’s discuss what type of care is needed, companion care or personal care services.  Companion care is just as it sounds, a companion.  This is perfect if you are recovering from a minor procedure, or you don’t have anyone local to help with shopping or picking up medications, but you can still take care of yourself.  A companion helps with light housekeeping, laundry, cooking, running errands, medication reminders and supervision.

Personal care services provide assistance with activities of daily living (ADLs); bathing, dressing, toileting, mobility, and eating.  If you require hands on care and someone to physically support you, personal care services are necessary.  Personal care services also include the tasks mentioned under companion care.

Live-In Caregiver

This is a person who provides care in the home while they also live in the home.  The caregiver should be able to get 8 hours of uninterrupted sleep each night, so it’s not a good choice for someone who needs help during the sleeping hours.  The person receiving care makes accommodations for the caregiver by offering a dedicated bedroom and meals to the caregiver.  This type of care can be less expensive than hiring someone to work 12 hours per day.

Caregiver vs. Certified Nursing Assistant (CNA)

What’s the difference between a caregiver and a CNA?  A caregiver doesn’t have formal training in a school setting, but they do have experience taking care of others.  This could mean they took care of a family member, were a private caregiver for an individual, or they have worked for a home care agency.

A CNA has formal training.  They have attended an approved school, passed an exam, and are certified as a CNA by the board of nursing to provide ADL assistance to others.  CNAs are required to update their certification every two years and work under the supervision of a licensed nurse.

Private Hire vs. Agency Hire

When securing in home care, you will have a choice between hiring someone privately or contracting with a home care agency.  There are pros and cons to both.  If you hire someone privately, you will have the ability to interview each candidate and you are in charge of who you hire.  When going through an agency, you may or may not have you the opportunity to meet the caregiver or CNA before care begins.  Most of the time, the caregiver will meet you when they arrive the first day.  When hiring someone yourself, you will be responsible for taxes and liability insurance.  If you utilize an agency, the agency should take care of these.

Private hires allow you to set the pay rate, and it will cost less to go this route.  An agency must charge a hirer rate because of overhead costs.  If you use an agency, and your regular caregiver is ill, they will attempt to find a replacement.  If you hire independently, you may not have a backup.  If you hire someone yourself, you will communicate directly with them about schedule changes.  If you use an agency, you will most likely go through the agency if there are changes, and then they relay the information to your caregiver or CNA.

Hours and Schedule

There may be a minimum number of hours per day or per week required when working with a home care agency.  This may apply when hiring privately too because if you offer a caregiver 4 hours per day, but they can work for 8 hours per day somewhere else, they may choose longer hours which means more income for them.  Required hours and a set schedule (i.e. Monday, Wednesday, Friday 8 am to 12 pm) is more likely to yield a consistent caregiver; a consistent caregiver is always preferred.

A representative from the home care agency will guide you in the number of hours you or your loved one needs.  Sometimes, this may increase or decrease after care begins.  If you are hiring privately, there may also be a trial-and-error period to get the right schedule.  

Employee Screenings

Most home care agencies will do a thorough interview process before they hire.  Agencies may hire direct employees who receive a @-2, and others will hire contractors.  Employee screenings should include a background check, preferably in 50 states, rather than only the state you live in.  This identifies if the person has any criminal history, fraud against the elderly, and what type of driving record they have.  Drug screenings are also a good idea.  You certainly want to make sure that the person is responsible and trustworthy.  Consider this if you choose to hire privately.

Employee Oversight

There should be a clinical expert, such a Registered Nurse (RN), validating that the caregiver or CNA has the clinical skill set to provide in home care where there is no direct supervision.  This is typically done when the employee is hired, and then periodically.  The RN should competency the employee before they are sent into the home to provide care.  If you hire privately, you will need to trust that they are using correct techniques to provide care and ensure safety.

Who Pays For Home Care?

Medicare and other major medical insurance companies do not cover home care.  They may cover home health care, which is different than home care services.  Home care is private pay unless you have a long-term care insurance policy.  Unfortunately, most do not because the policies are expensive.  If you are one of the few who have this, great!  You will need to review your policy to look at elimination periods and the specifics of your benefits.  Each agency sets their own rates so you can shop around.  

Care Plans

Care plans are generally written by a RN.  They are an outline for the caregiver or CNA to follow.  The care plan lists the tasks that should be completed, the frequency, and what equipment should be used.  For example, “one person assist with shower three times per week using a shower chair”.  RNs have the clinical expertise to know what care is within the scope of practice for a caregiver and CNA, how it should be completed, an appropriate frequency and what assistive devices should be used.  If you hire privately, you can create your own care plan.  I recommend that it’s written so expectations are clear to your caregiver.

The Joint Commission

What is The Joint Commission (TJC)?   The state of Maryland does not require home care agencies to have oversight from a healthcare organization such as The Joint Commission (TJC).  TJC is an outside party who conducts routine, but unannounced surveys on healthcare agencies to make sure that they are adhering to written policies and procedures.  Agencies with this accreditation are likely to offer a high quality of care because their goal is to meet the standards and excel in care.  This doesn’t mean that agencies without it do not provide great care.  You should just be aware that this accreditation exists.  Who We Are | The Joint Commission

Conclusion:

I hope that you find this complete guide to home care beneficial in your search for the perfect home care provider.  The options for home care agencies and private caregivers are countless.  It’s up to you to do your research and select the one that fits your needs the best.  If you aren’t sure exactly what kind of care you need, or how much care, please call for a comprehensive holistic nursing assessment.  I will use 30 years of nursing experience, and home care administration history, to guide you in your search and secure the best outcomes for you or your loved one.  Contact | Wellness Strategies Group